ANATOMY OF THE

SCALP AND FACE

LECTURE NOTE
BY
DR CO AYARA
OUTLINE
• INTRODUCTION
• SCALP
• -Extent
• -Layers
• -Arteries of the scalp
• -Veins of the scalp
• -Nerves of the scalp
• FACE
• -Extent
• - Facial muscles: “Muscles of facial expression”
• -Facial artery
LEARNING OBJECTIVES / OUTCOMES
• At the end of this lecture you should be able to:
• 1. Define the scalp
• 2. Enumerate and discuss the layers of the scalp
• 3. Discuss the vasculature of the scalp and its clinical importance.
• 4. Discuss the motor, sensory & sympathetic innervations of the scalp
and face.
• 5. identify and list the different groups of facial muscles and their
action (see Fig. 7.17 page 848, Clinically Oriented Anatomy by Keith
Moore.
INTRODUCTION
THE SCALP
• The Extent: covers the vault of the skull & extends to the right & left
temporal lines, the eye brows and the superior nuchal lines.
• The Layers: the soft tissues of the skull are arranged in 5 layers
namely:
• S –skin;
• C- connective tissue; (dense)
• A- aponeurosis
• L- loose connective tissue;
• P- pericranium.
• SKIN: is the outermost layer, bears the hair follicles, richly supplied by sebaceous
glands>>> commonest site of sebaceous cysts in the body.

• CONNECTIVE TISSUE: the subcutaneous connective tissue consists of lobules of fat

bound in tough fibrous septa + blood vessels of the scalp lie in this layer. Thus this
area has the richest cutaneous blood supply of the body hence there is profuse
haemorrhage from a scalp laceration or operation site.

• -Vein of the scalp connect with the intracranial venous sinuses via numerous
emissary veins which pierce the skull & link the 2 venous sinuses with the diploic
veins btw the skull vault.>>> superficial infection of the scalp may spread via this
system resulting in an Osteitis of skull, Meningitis & Venous sinus thrombosis
• APONEUROSIS: is a fibromuscular layer of the Occipitofrontalis. It is fibrous over the
dome of the skull but muscular in the occipital & frontal regions. This muscle arises
from the superior nuchal line of the occipital bone & insert into the zygomatic arch &
anteriorly into the subcutaneous tissues of the eyebrows & nose.

• LOOSE CONNECTIVE TISSUE: lies beneath the aponeurosis & accounts for the
mobility of the scalp on the underlying bone. Blood or pus collecting in this loose
tissue track freely under the scalp but cannot pass into either the occipital or
subtemporal regions because of the attachments of the occipitofrontalis.
• -fluid can, however track forward into the orbits and this accounts for the orbital
haematoma that may form a few hours after a severe head injury or cranial operation.
• PERIOSTEUM: (pericranium) adheres to the suture lines of the skull; if
there is collection of blood or pus beneath this layer, it outlines the
affected bone. Example is Cephalhaematoma; seen in birth injuries
involving the skull.
• -Cephalhaematoma does not cross sutural line unlike caput
succedaneum.
ARTERIES OF THE SCALP &
SUPERFICIAL TEMPORAL REGION
• This region is supplied by branches of the External carotid artery, except for
the forehead which is supplied by the supra-orbital & supra-trochlear arteries.

• Branches from External Carotid:

• -superficial temporal artery; (anterior & posterior branches)
• -transverse facial artery
• -middle temporal artery
• -posterior auricular artery
• -occipital artery
• Clinical importance:
• These arteries of the scalp anastomose freely with each other & those
of the opposite side, therefore, wounds of the scalp bleed profusely,
but heal fast.
VEINS OF THE SCALP & SUPERFICIAL
TEMPORAL REGION
• The veins also anastomose freely & their main tributaries accompany the
arteries of the scalp but their proximal part drain by different route.
• The scalp is drained by the following veins:
• -supratrochlear + supra-orbital >>facial vein
• -superficial temporal vein+ middle temporal vein >> retromandibular vein.
• -retromandibular vein>> (anterior & posterior branches): anterior branch +
facial vein>>Internal Jugular Vein.
• -posterior branch + posterior auricular vein >>External Jugular vein
• -occipital vein
• -Emissary veins
• Clinical importance:
• These veins + other emissary veins & communications with veins in
the orbits, form routes along which infection may spread into the skull
from outside the skull.
NERVES OF THE SCALP & SUPERFICIAL
TEMPORAL REGION
• The superficial structures of this region & of the face receive:

• MOTOR innervation = Facial nerve &

• SENSORY innervation= Trigeminal nerve + 2nd & 3rd cervical spinal

nerves. +

• SYMPATHETIC innervation to: blood vessels, sweat glands &

arrectores pilorum
NERVES OF THE SCALP & SUPERFICIAL
TEMPORAL REGION…
• SENSORY INNERVATION OF THE SCALP
• Is from 2 major sources: cranial nerves or cervical nerves, depending on
whether it is Anterior or Posterior to the ear & Vertex of the Head.

• Anterior to the Ear & Vertex:

• Supplied by branches of Trigeminal nerve (V) namely:
• -supratrochlear;
• -supra-orbital;
• -zygomatico-temporal;
• -auriculo-temporal nerves.
NERVES OF THE SCALP & SUPERFICIAL
TEMPORAL REGION…
• Posterior to the Ear & Vertex:
• -the sensory innervation is by the cervical nerves especially branches
from spinal cord levels C2 & C3 namely:
• -great auricular
• -lesser auricular;
• -greater occipital &
• -the 3rd occipital nerves
Sensory Innervation of the scalp
Vasculature of the scalp
ANATOMY OF THE FACE
• OUTLINE
• -Definition/Location
• -Clinical importance
• -Muscles of the face
• -Embryology
• -Location
• -Functions
• -Functional grouping of muscles of the face
• -Innervation
• -Vessels
ANATOMY OF THE FACE…
• Definition: the face is that area of the anterior skull which lies between
the supercilliary arches superiorly, the lower edge of the mandible
inferiorly, and as far back as the ears on either side.

• Clinical importance of the face:

• 1. is an important initial contact between individuals for identification
(face-to-face meeting);
• 2. used for facial expression to convey emotions;
• 3. provides important information about an individual’s/ patient’s general
health to the physician.
ANATOMY OF THE FACE…
• MUSCLES OF THE FACE
• Embryology: develop from the 2nd pharyngeal arch and are innervated by the
branches of the Facial nerve (CN VII).

• Location: muscle of the face are in the superficial fascia, with origins from
either bone or fascia and insertion into the skin.
• Functions:

• -also called muscles of expression because they control expression of the face;
• -they act as sphincter & dilators of orifices of the face i.e. orbits, nose & mouth.
ANATOMY OF THE FACE…
• FUNCTIONAL GROUPING OF THE MUSCLES OF THE FACE
• ORBITAL GROUP
• NASAL GROUP
• ORAL GROUP
• OTHER MUSCLES OR GROUPS
Functional grouping of muscles of the face
Functional grouping of muscles of the face…
Muscles of the face: Lateral view
Orbital group of Facial muscles
Nasal group of Facial muscles
Oral group of Facial muscles
Buccinator muscle
Auricular muscles
ANATOMY OF THE FACE…
• FACIAL NERVE (CN VII) MOTOR
• Supplies muscles of the face, scalp, & auricle.
• Its branches communicate freely with each other & with the
branches of the Trigeminal nerve
CLINICAL FEATURES/ CORRELATES
• SCALP LACERATION
• The scalp has an extremely rich blood supply from the external
carotid arteries, so lacerations of the scalp tend bleed profusely.
• Scalp bleeding is predominantly arterial because of 2 reasons:
• First, in the erect position the venous pressure is extremely low.
• Second, the vessels do not retract & close when lacerated because
the connective tissue in which they are found hold them open
CONCLUSION
THANK YOU FOR YOUR
ATTENTION