SCALP

Layers of the Scalp and their
Clinical Implications
SKIN
• 1-1.5 mm thick
• Thickest at the occipital area
• Hair follicles
• Sebaceous glands
SKIN

The ducts of the sebaceous glands are prone to infection and damage which is why
sebaceous cysts of the scalp are common.
CONNECTIVE TISSUE
• Also known us Subcutaneous Tissue
• Soft fibrous septa: unites the skin to the
underlying layer – Aponeurosis
• Fibrofatty
• With numerous nerves and blood vessels
embedded in inelastic fibers
CONNECTIVE TISSUE



The layer is made up of blood vessels – superficial veins and branches of external
and internal carotid arteries.

The INELASTIC FIBERS prevent retracting and narrowing of the layer when parted
during injuries.

APONEUROSIS
• Also known as
Epicranium
• “galea aponeurotica” –
(helmet of fibrous
tissue)
• Occipito-frontalis
muscles
– Occipital belly
– Frontal belly

Aponeurosis
APONEUROSIS
*Epicranium tension – can pull an injury into a gaping wound; makes a blunt hit
on the head and an incised wound look similar

Scalp injuries should be closed with sutures.

Exercise of the occipito-frontal muscules improves scalp circulation since it
involves movement of the top three layers: skin, connective tissue and the
aponeurosis. So…
KEEP MAKING FACES!!!
Loose Areolar Connective Tissue
• Separates the first three layers from the
pericranium




The Dangerous Layer of the Scalp:

Emissary Veins are valveless veins that are direct links to the skull.

Osteomyelitis and Subdural Hematoma

PERICRANIUM
• Periosteal covering of the skull bones









Intersutural Fibrous Tissue

Subperiosteal bleeding may be limited to one bone because of the sutures.

Limited or absent osteogenic capabilities


SCALP LAYER REMARKABLE
COMPONENTS
CLINICAL IMPLICATIONS
SKIN Hair Follicles
Sebaceous Glands
Sebaceous Cysts
Common Scalp infections
(ex: Folliculitis)
CONNECTIVE TISSUE Blood vessels embedded
on INELASTIC FIBERS
Prevents narrowing and
retracting of the tissue
*Bleeding
APONEUROSIS Occipito-frontalis muscles Scalp and face muscle
exercise to improve
circulation
Epicranium Tension and
scalp wounds
LOOSE AREOLAR
CONNECTIVE TISSUE
Emissary Veins
“the dangerous layer of the
scalp
Osteomyelitis
Subdural Hemorrhage
PERICRANIUM *Intersutural fibrous tissue
w/o osteogenic capabilities
Limited subperiosteal
bleeding
Skull bones do not fuse
together
Neurovascular Supply and
Venous Drainage
Blood Vessels cross
the connective tissue
layer, which receives
it’s arterial supply
from the internal and
external carotid
arteries.

The blood vessels
anastomose freely in
the scalp.
The Supratrochlear and Supraorbital arteries are 2 branches
of the opthalmic artery, which is a branch of the internal
carotid artery.
The superficial artery supplies the scalp over the temporal
region and travels with the auriculotemporal nerve
The posterior auricular ascends posterior to the
auricle and is a branch of the external carotid artery
The occipital artery is also a branch of the external carotid
artery and accompanies the greater occipital nerve.
The supratrochlear
and supraorbital
veins drain the
anterior region of the
scalp

These 2 veins unite
to form the angular
vein and continues
further down as the
facial vein.
The superficial
temporal vein
descends in front of
the auricle and
enters the parotid
gland
It joins the
maxillary vein to
form the
retromandibular
vein
The anterior division of the retromandibular
vein unites with the facial vein to form the
common facial vein, which then drains into the
internal jugular vein.
The posterior auricular vein joins the
posterior portion of the retromandibular vein
to form the external jugular vein.
Temporalis muscle
Temporalis Muscle
• Origin: temporal
fossa
• Insertion: coronoid
process of the
mandible
• Action:
• Elevate the mandible
(closes the jaw)
• Helps in the retraction
of the mandible
Temporalis Muscle
• Innervation: deep temporal branches of the
mandibular nerve
• Blood supply: The muscle receives its blood supply
from the deep temporal arteries which anastomose
with the middle temporal artery.
THE NEUROCRANIUM AND
VISCEROCRANIUM
Neurocranium
(encloses the eyes, the middle ear, the olfactory bulbs for the nose, and the brain)
• 1 Frontal bone
• 2 Parietal bones
• 1 Occipital Bone
• 2 Temporal Bones
• 1 Sphenoid bone
• 1 Ethmoid bone

Viscerocranium
(facial bones)
• 2 Zygomatic bones
• 2 Maxillae
• 2 Nasal Bones
• 2 Lacrimal bones
• 1 Vomer
• 2 Palatine bones
• 2 Inferior conchae
• 1 Mandible
Background source: http://www.hopkinsmedicine.org/craniofacial/lynmproject/BSC/BSC1.HTM

SGD1 #5
Define the bony landmarks that
demarcate the three cranial fossae
and its contents.
The Three Cranial Fossae
• Anterior cranial fossa
LESSER WING OF THE SPHENOID
• Middle cranial fossa
PETROUS PART OF TEMPORAL BONE
• Posterior cranial fossa
Base of the Skull (internal surface)
Foramen
cecum
Crista galli
Lesser wing of
the sphenoid
Foramen
rotundum
Foramen ovale
Foramen
spinosum
Foramen
lacerum
Foramen
magnum
Internal
occipital
protuberance
Petrous part of the
Temporal bone
QUESTION :6
Identify the neurovascular
structures transmitted by the
different foraminae
Neurovascular System
of the Scalp
• Arteries are generally accompanied by
corresponding similarly named veins and
nerves except one
Overview of Neurovascular System of
the Scalp
ANTERIOR (FOREHEAD)
• Supraorbital and supratrochlear vessels and
sensory nerves
– Terminal branches of : Opthalmic Arteries and
Nerves
– Emerge from orbital cavities


Opthalmic supraorbital
Artery supratrochlear

supraorbital
Opthalmic - communicating vein will join
Vein sup. Opthalmic vein into
cavernous sinus

supratrochlear

*supraorbital + supratrochlear = Angular Vein [facial vein]
LATERAL (TEMPORAL)
• Superficial temporal vessels
- ST Artery: principal artery that supplies blood to
greater part of the scalp
+
Auriculo-temporal nerve
- sensory branch of the mandibular nerve
LATERAL (TEMPORAL)
• ECA superficial temporal artery

commencement: in front of ext. auditory
meatus – pulsations!!!

• STA branches spread out over the lateral part of
the scalp


*ECA- external carotid artery
Lateral (Temporal)
POSTERIOR (OCCIPITAL)
• ECA occipital branch
sensory branches frm C2,3 [lesser
occipital, greater occipital] and
greater auricular nerves

Occipital suboccipital plexus of veins
Vein region w/ vertebral veins
POSTERIOR (OCCIPITAL)
Superficial Temporal Vein + Maxillary Vein
= Retromandicular Vein [descends in the parotid]

*Level- Zygomatic Arch
Overview of Arterial and Venous
System
SCALP: NERVE SUPPLY
G : Greater occipital/auricular
L : Lesser occipital/auricular
A : Auriculotemporal
S : Supratrochlear
S : Suppraorbital
Base of the skull
Anterior Cranial Fossa
Middle Cranial Fossa
Posterior Cranial Fossa
Anterior Skull
Base of the skull
References
• R Snell, R.S. Clinical Anatomy by Regions, 8
th

edition, 2008, Lippincott Williams and Wilkins