[M-MURSLEEN] September 9, 2022

SCALP
The soft tissues covering the cranial vault form the scalp.
Extent of Scalp
Anteriorly, supraorbital margins; posteriorly, external occipital protuberance
and superior nuchal lines; and on each side, the superior temporal lines .
Structure
Conventionally, the superficial
temporal region is studied with the
scalp, and the following
description, therefore, will cover
both the regions.
The scalp is made up of five layers
(mnemonic SCALP)
a. Skin
b.Superficial fascia (Connective
tissue)
c. Deep fascia in the form of the
epicranial aponeurosis or galea
aponeurotica with the
occipitofrontalis muscle
d. Loose areolar tissue
e. Pericranium
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The skin is hairy. It is adherent to the epicranial aponeurosis through the

dense superficial fascia. It has more number of sweat glands and sebaceous
glands.
The subcutaneous or superficial fascia is more fibrous and dense in the centre
than at the periphery of the head. It contains many blood vessels. It binds the
skin to the subjacent aponeurosis, and provides the proper medium for
passage of vessels and nerves to the skin.
The occipitofrontalis muscle has two bellies, occipital or occipitalis and frontal
or frontalis, both of which are inserted into the epicranial aponeurosis.
The occipital bellies are small and separate. Each arises from the lateral two-
thirds of the superior nuchal line, and is supplied by the posterior auricular
branch of the facial nerve .
The frontal bellies are longer, wider and partly united in the median plane.
Each arises from the skin of the upper eyelid and forehead, mingling with the
orbicularis oculi and the corrugator supercilii. It is supplied by the temporal
branch of the facial nerve .
The muscle raises the eyebrows and causes horizontal wrinkles in the skin of
the forehead.

The epicranial aponeurosis, or galea aponeurotica is freely movable on the

pericranium along with the overlying and adherent skin and fascia. Anteriorly,
it receives the insertion of the frontalis, posteriorly, it receives the insertion
of the occipitalis and is attached to the external occipital protuberance, and to
the highest/superior nuchal lines in between the occipital bellies. On each side,
the aponeurosis is attached to the superior temporal line, but sends down a
thin expansion which passes over the temporal fascia and is attached to the
zygomatic arch.
First three layers of scalp are called surgical layers of the scalp. These are
called scalp proper also.
The fourth layer of the scalp is made up of loose areolar tissue. It extends
anteriorly into the eyelids because the frontalis muscle has no bony
attachment; posteriorly to the highest and superior nuchal lines; and on each
side to the superior temporal lines. It gives passage to the emissary veins
which connect extracranial veins to intracranial venous sinuses.
The fifth layer of the scalp, called the pericranium, is loosely attached to the
surface of the bones, but is firmly adherent to their sutures where the sutural
ligaments bind the pericranium to the endocranium.
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SUPERFICIAL TEMPORAL REGION

It is the area between the superior temporal line and the zygomatic arch. This
area contains the following 6 layers :
1 Skin
2 Superficial fascia
3 Thin extension of epicranial aponeurosis which gives origin to extrinsic
muscles of the auricle.
4 Temporal fascia
5 Temporalis muscle
6 Pericranium.
Tempus means time. Greying of hair first starts here.
Arterial Supply of Scalp and
Superficial Temporal Region
In front of the auricle, the scalp is supplied from before backwards by the:
• Supratrochlear
• Supraorbital
• Superficial temporal arteries .
The first two are branches of the ophthalmic artery which in turn is a branch of
the internal carotid artery. The superficial temporal is a branch of the external
carotid artery. Behind the auricle, the scalp is supplied from before backwards
by the:
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• Posterior auricular
• Occipital (tortuous) arteries, both of which are branches of the external
carotid artery.
Thus, the scalp has a rich blood supply derived from both the internal and the
external carotid arteries, the two systems anastomosing over the temple.

Venous Drainage
The veins of the scalp accompany the arteries and have similar names. The
supratrochlear and supraorbital veins unite at the medial angle of the eye
forming the angular vein which continues down as the facial vein.
The superficial temporal vein descends in front of the tragus, enters the
parotid gland, and joins the maxillary vein to form the retromandibular vein.
This vein divides into two divisions.
The anterior division of the retromandibular vein unites with the facial vein to
form the common facial vein which drains into the internal jugular vein.

The posterior division of the retromandibular vein unites with the posterior
auricular vein to form the external jugular vein which ultimately drains into the
subclavian vein. The occipital veins terminate in the suboccipital venous
plexus.
Emissary veins connect the extracranial veins with the intracranial venous
sinuses to equalise the pressure. These veins are valveless. The parietal
emissary vein passes through the parietal foramen to enter the superior
sagittal sinus. The mastoid emissary vein passes through the mastoid foramen
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to reach the sigmoid sinus. Remaining emissary veins are shown in.Extracranial
infections may spread through these veins to intracranial venous sinuses.

Diploic veins start from the cancellous bone within the two tables of skull.
These carry the newly formed blood cells into the general circulation. These
are four veins on each side.
The frontal diploic vein emerges at the supraorbital notch open into the
supraorbital vein. Anterior temporal diploic vein ends in anterior deep
temporal vein or sphenoparietal sinus. Posterior temporal diploic vein ends
in the transverse sinus. The occipital diploic vein opens either into the occipital
vein, or into the transverse sinus near the median plane .

Lymphatic Drainage
The anterior part of the scalp drains into the preauricular or parotid lymph
nodes, situated on the surface of the parotid gland. The posterior part of the
scalp drains into the posterior auricular or mastoid and occipital lymph nodes.

Nerve Supply
The scalp and temple are supplied by 10 nerves on each side. Out of these, five
nerves (four sensory and one motor) enter the scalp in front of the auricle. The
remaining five nerves (again four sensory and one motor) enter the scalp
behind the auricle.