SCALP REGION

SUBMITTED BY SUBMITTED TO
Anupriya Rulaniya Dr. Manish Arora Sir
Batch :- 2023-24 Dr.Varsha Sharma Ma’am
SCALP

• The soft tissue covering the cranial vault

form the scalp
• The scalp extends from the supraorbital
margins anteriorly to the superior nuchal
lines at the back of the skull and down to
the ears and zygomatic arches at the sides.
• Superior nuchal lines extend laterally from
the external occipital protuberance and
represent the boundary and represent the
boundary between the scalp and the neck
EXTENTS OF SCALP

ANTERIORLY • SUPRAORBITAL
MARGINS

POSTERIORLY • EXTERNAL OCCIPITAL

PROTUBERANCE
• SUPERIOR NUCHAL
LINES
ON EACH SIDE • SUPERIOR TEMPORAL
LINES
COMPOSITION OF SCALP

• The scalp is made up of five layers

1. Skin
2. Superficial fascia (Connective
tissue)
3. Epicranial aponeurosis
4. Loose areolar tissue
5. Pericranium
Scalp

• First three layers of

scalp are called
surgical layer of the
scalp.
• These are also
called scalp proper.
Skin
• The skin is thick and hairy.
• It is adherent to the
epicranial aponeurosis
through the dense
superficial fascia.
• It has more number of
sweat gland $ sebaceous
gland and most common
site for sebaceous cysts.
• Many of the fibers of the
scalp are inserted into it.
Connective Tissue

• The subcutaneous or superfisial fascia is more

fibrous $ dense in the center then at the periphery
at the head.
• It contains many blood vessels.
• It bind to the skin to the subjacent aponeurosis,
and provide the proper medium for passage of
vessels $ nerve to the skin.
APONEUROSIS

• The epicranial aponeurosis or galea aponeurotica is freely

movalable on the pericranium along with the overlyning $ adherent
skin and fascia.
• Anteriorly it reccive the insertion of frontalis.
• Posteriorly it reccive the insertion of occipitalis $ is attach to the
external occipital protuberance and to the hightest nuchal lines in
between the occipital bellies.
• On each side the aponeurosis is attach to superior temporal line but
sends down a thin expension which passes over the temporal fascia
$ is attached to the zygomatic arch.
OCCIPITOFRONTALIS

• Consists of four muscular quadrilateral parts, two

occipital and two frontal .
• Connected by the epicranial aponeurosis (galea
aponeurotica).
• The gap between the two occipital parts is occupied
by an extension of epicranial aponeurosis which
extends upto the external occipital protuberance and
the medial part of highest nuchal line.
• Each frontal part (frontalis ) is adherent to the
superficial fascia ,particularly of the eyebrows,it has
no attachment to the skull.
OCCIPITOFRONTALIS
Loose Areolar tissue

• The forth layer of scalp is made up of loose areolar tissue.

• It extent anteriorly into the eyelids because the frontalis
muscle has no bony attachment.
• Posteriorly to the higher $ superior nuchal line.
• On each side to the superior temporal lines.
• It gives passage to emissary veins which connect
extracranial veins to intracranial venous sinuses .
Dngerous Area of Scalp

• The loose connective tissue layer is

considered the “danger area” of the
scalp
• This is because is contains the
emissary veins – these are valveless
veins which connect the extracranial
veins of the scalp to the intracranial
dural venous sinuses.
• The emissary veins are a potential
pathway for the spread of infection
from the scalp to the intracranial space
Pericranium

• Pericranium is loosly attached

to the surface of bone but is
firmly adherent to their sutures
where the sutural ligament
bine the pericranium to the
endocranium.
Arterial Supply

Front of auricle Behind of auricle

Supratrochlear Posterior auricular

Supraorbital Occipital artery

Superficial temporal
artery
Venous Drainage

• The supraorbital and supratrochlear veins unite at the median angle

of the eye forming the angular vein which continues down as facial
vein .

Supratrochlear Supraorbital

Angular vein

Facial vein
Venous Drainage

• The Superficial temporal veins descends in front of the

tragus ,enters the parotid gland and joins the maxillary 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 facialvein 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.
Venous Drainage

Superficial temporal vein Maxillary vein

Retromandibular vein

Anterior division Posterior division

Venous Drainage

• 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 to reach the sigmoid
sinus. 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 transverse sinus
near the median plane .
Lymphatic Drainage

Anterior Posterior

Preauricular Posterior auricular

Parotid lymph node Mastoid

Occipital lymphnodes
Nerve Supply

In front of auricle Behind auricle

Sensory nerves Sensory nerves

• Supratrochlear, branch of the frontal • Posterior division of great auricular nerve
nerve (ophthalmic division of trigeminal (C2, C3) from cervical plexus
nerve)
• Supraorbital, branch of frontal nerve • Lesser occipital nerve (C2), from cervical
(ophthalmic division of trigeminal nerve) plexus

• Zygomaticotemporal, branch of • Greater occipital nerve (C2, dorsal ramus)

zygomatic nerve (maxillary division of
trigeminal nerve)
• Auriculotemporal branch of mandibular • Third occipital nerve (C3, dorsal ramus)
division of trigeminal nerve

Motar nerve Motar nerve

• Temporal branch of facial nerve • Posterior auricular branch of facial nerve

Clinical Anatomy
• Wounds of the scalp gape when the epicranial aponeurosis is
divided transversely.
• Because of the abundance of sebaceous glands, the scalp is a
common site for sebaceous cysts .
• Wounds of the scalp bleed profusely because the vessels are
prevented from retracting by the fibrous fascia. Bleeding can be
arrested by applying pressure at the site of injury by a tight cotton
bandage against the bone.
• Because of the density of fascia, subcutaneous haemorr hages are
never extensive, and the inflammations in this layer cause little
swelling but much pain.
• Because the pericranium is adherent to sufures, collections of
fluid deep to the pericranium known as cephalhaematoma take the
shape of the bone concerned when there is fracture of particular
bone.
Clinical Anatomy

• The layer of loose areolar tissue is known as the dangerous area of the scalp
because the emissary veins which course here, may transmit infection from the
scalp to the cranial venous sinuses.
• Collection of blood in the layer of loose connective tissue causes generalised
swelling of the scalp. The blood may extend anteriorly into the root of the nose
and into the eyelids (as frontalis muscle has no bony origin) resulting in black
eye. The posterior limit of such haemorrhage is not seen . If bleeding is due to
local injury, the posterior limit of haemorrhage is seen.
• Because of the spread of blood, compression of brain is not seen and so this
layer is also called safety layer.
• Since the blood supply of scalp and superficial temporal region is very rich;
avulsed portions need not be cut away. They can be replaced in position and
stitched: They usually take up and heal well.
Quiz

1. The scalp extends posteriorly to which anatomical landmark?

a) External occipital protuberance
b) Superior nuchal line
c) Mastoid process
d) Occipital condyle
1. Answer :- b) Superior nuchal line
2. The lymphatic drainage from the posterior part of the scalp goes to which
nodes?
a) Occipital nodes
b) Preauricular nodes
c) Parotid nodes
d) Submandibular nodes
• 2. Answer: a) Occipital nodes
3. The pericranium is tightly adhered to:
a) Loose areolar tissue
b) Connective tissue
c) Skull bones
d) Aponeurosis
3.Answer: c) Skull bones
4. The sensory nerve supply to the scalp behind the auricle is provided by the:
a) Auriculotemporal nerve
b) Supraorbital nerve
c) Lesser occipital nerve
d) Zygomaticotemporal nerve
• 4. Answer: c) Lesser occipital nerve
5. Which of the following layers of the scalp is highly vascularized and provides
the blood supply to the scalp?
a) Skin
b) Connective tissue
c) Aponeurosis
d) Loose areolar tissue
• 5. Answer: b) Connective tissue
6. Which of the following is the outermost layer of the scalp?
a) Loose areolar tissue
b) Connective tissue
c) Skin
d) Periosteum
• 6. Answer: c) Skin
7. The second layer of the scalp, dense connective tissue, contains:
a) Fat and sweat glands
b) Nerves and blood vessels
c) Bone and bone marrow
d) Aponeurosis
• 7. Answer ( b ) :- nerves and blood vessels
8. Which of the following layers of the scalp is considered the danger area?
a) Skin
b) Connective tissue
c) Loose areolar tissue
d) Periosteum
• 8. Answer ( c ) :- loose areolar tissue
9. The galea aponeurotica is part of which layer of the scalp?
a) Skin
b) Connective tissue
c) Aponeurosis
d) Periosteum
• 9 Answer (c) :- aponeurosis
10. The superficial temporal vein drains into which larger vein?
a) Facial vein
b) Jugular vein
c) Retromandibular vein
d) Subclavian vein
• 10. ANSWER(c):- retromandibular vein
11. Which cranial nerve provides sensory innervation to the scalp anterior to the
auricle?
a) Trigeminal nerve
b) Facial nerve
c) Vagus nerve
d) Hypoglossal nerve
• 11Answer (a) trigeminal nerve
12. The occipital artery is a branch of which major artery?
a) Subclavian artery
b) Carotid artery
c) External carotid artery
d) Vertebral artery
• 12. Answer(c):- external carotid artery
• 13. The loose areolar tissue of the scalp is significant because it:
• a) Contains sebaceous glands
• b) Allows free movement of the scalp
• c) Houses the periosteum
• d) Provides direct blood supply
• 13 Answer ( b) :- allows free movement of the scalp
14. The emissary veins in the scalp connect to :
a) Lymphatic vessels
b) Venous sinuses
c) Deep arteries
d) Cerebrospinal fluid channels
• 14 . Answer:- (b) venous sinuses
15. Infection in the danger area of the scalp can spread to the brain through:
a) Lymphatic vessels
b) Emissary veins
c) Aponeurosis
d) Epidermis
• 15. Answer ( B ) :- Emissiary Vein
16. Which part of the scalp is innervated by the greater occipital nerve?
a) Anterior scalp
b) Temporal region
c) Posterior scalp
d) Auricular region
• 16. Answer:- (c) posterior scalp
17. The superficial temporal artery is a terminal branch of the:
a) Internal carotid artery
b) Vertebral artery
c) Subclavian artery
d) External carotid artery
• 17. Answer:- (d) External carotid artery
18. Which layer of the scalp contains hair follicles, sweat glands, and sebaceous
glands?
a) Skin
b) Loose areolar tissue
c) Connective tissue
d) Aponeurosis
• 18. Answer:- (a ) skin
19. The lymph from the anterior part of the scalp drains into which lymph nodes?
a) Occipital nodes
b) Preauricular nodes
c) Submental nodes
d) Submandibular nodes
• 19. Answer :- (b) preauricular nodes
20. Which artery primarily supplies the posterior part of the scalp?
a) Ophthalmic artery
b) Occipital artery
c) Maxillary artery
d) Facial artery
• 20. Answer :- (B) occipital artery