SCALP

OBJECTIVES:
• Definition
• Extent
• Structure – layers of scalp
• Arterial supply
• Venous drainage
• Lymphatic drainage
• Nerve supply
• Applied anatomy
DEFINITION:
The scalp is soft tissue which
covers the calvaria of the skull.
 EXTENT:

It extends:

Anteriorly – supraorbital margin Zygomatic arch

Posteriorly – external occipital

protuberance and superior
Superior nuchal line
nuchal line.
External occipital
protuberance
On each side – zygomatic arch
LAYERS OF SCALP:
The scalp consists of five
layers namely (mnemonic):

1. S – Skin

2. C – Cutaneous tissue

3. A – Aponeurosis

4. L – Loose areolar tissue

5. P - Pericranium
 1. S - SKIN:

• Thick and hairy

• Sebaceous and sweat glands

2. C - CUTANEOUS TISSUE
• Subcutaneous or superficial fascia.
• Composed of close network of fibro-
fatty tissue.
• It binds the skin to the subjacent
aponeurosis.
• It provides a medium for passage of
vessels and nerves to the skin.
• The walls of the vessels are adherent
to the fibrous network, so that when
the vessels are torn in an open wound
they are unable to retract and produce
profuse bleeding. However bleeding
can be arrested by pressure against the
underlying bone.
2. C - CUTANEOUS TISSUE cont….
Occipitofrontalis muscle:
• Has two bellies – occipital and frontal belly.
• Both are inserted into the epicranial
aponeurosis.
• Occipital bellies – arises lateral 2/3rd of the
superior nuchal line of occipital bone. It is
supplied by posterior auricular branch of
facial nerve.
• Frontal bellies – no bony origin. They arise
from the skin and subcutaneous tissue of the
eye-brow and the root of the nose. It is
supplied by temporal branch of facial nerve.
• Action – frontal bellies raise the eyebrows as
in surprise or horror, and causes transverse
wrinkles of forehead.
3. A - APONEUROSIS
• Galea aponeurotica (epicranial aponeurosis).
• Sheet of fibrous tissue which connects
occipitalis and frontalis muscles.
Extent:
➢ Behind – external occipital protuberance and
highest nuchal line.
➢ Front – blends with subcutaneous tissue of root
of nose.
➢ On each side – zygomatic arch
Temporal extension of the aponeurosis gives
attachment to:
• Auricularis anterior and
• Auricularis superior muscles.
4. L – LOOSE AREOLAR TISSUE
• Loose subaponeurotic tissue.

• Potential space beneath the occipitofrontalis

muscle and its aponeurosis.

• This space contains emissary vein.

• Emissary vein – are devoid of valves and

communicates the veins of scalp with
intracranial venous sinuses.

• An infection in this space may spread to

intracranial sinuses through the emissary
veins and hence the 4th layer of scalp is called
as dangerous area of scalp.
5. P - PERICRANIUM
• Outer periosteum of skull

• Loosely covers the bone

• At the sutures it is
continuous with the
endocranium through the
sutural membrane.
ARTERIAL SUPPLY:
In front of auricle:
1. Supratrochlear artery – ophthalmic
artery – internal carotid artery
2. Supraorbital artery – ophthalmic artery –
internal carotid artery
3. Superficial temporal artery – external
carotid artery.
Behind the auricle:
4. Posterior auricular and
5. Occipital arteries, both are branches of
external carotid artery.
VENOUS DRAINAGE
1. Supratrochlear vein

2. Supraorbital vein

3. Superficial temporal vein

4. Posterior auricular vein

5. Occipital vein
VENOUS DRAINAGE CONT….

Two sets of emissary veins:

1. Parietal emissary vein enters

through parietal foramen
communicates the scalp with the
superior sagittal sinus.

2. Mastoid emissary vein through

mastoid foramen communicates the
scalp veins with sigmoid sinus.
VENOUS DRAINAGE CONT….
Two sets of diploic veins:

1. Frontal diploic vein appears through

supraorbital notch and drains into
supraorbital vein.

2. Occipital diploic vein drain into occipital

vein by piercing outer table or drains
into transverse sinus by piercing inner
table.
LYMPHATIC DRAINAGE:
• Anterior part of scalp – preauricular
lymph nodes (superficial parotid
nodes).

• Posterior part of scalp –

➢ post auricular lymph nodes or mastoid

group of nodes and

➢ Occipital lymph nodes.

 NERVE SUPPLY OF SCALP:

• Ten nerves supply the scalp

on each side, five in front of
the auricle and five behind
the auricle.

• In each set, four nerves are

sensory and one is motor.
 NERVE SUPPLY OF SCALP CONT….
Nerves in front of auricle:
1. Supratrochlear nerve – branch of frontal
nerve from ophthalmic division of
trigeminal nerve.
2. Supraorbital nerve – branch of frontal nerve
from ophthalmic division of trigeminal
nerve.
3. Zygomatico-temporal nerve – branch of
zygomatic nerve from maxillary division of
trigeminal nerve.
4. Auriculo-temporal nerve – branch of
mandibular division of trigeminal nerve.
5. Temporal branch of facial nerve – supplies
frontal belly of occipitofrontalis.
NERVE SUPPLY OF SCALP CONT….
Nerves behind the auricle:
6. Great auricular nerve (posterior
branch) – C2 and C3 of the cervical
plexus.
7. Lesser occipital nerve – C2 of the
cervical plexus.
8. Greater occipital nerve – dorsal ramus
of C2 nerve.
9. Third occipital nerve – dorsal ramus
of C3 nerve.
10.Posterior auricular branch of facial
nerve – supplies occipital belly of
occipitofrontalis muscle.
NERVE SUPPLY OF SCALP CONT….

Motor nerves:

• In front of auricle – temporal

branch of facial nerve.

• Behind the auricle – posterior

auricular branch of facial
nerve.

Facial nerve
APPLIED ANATOMY:

1. Skin: Common site for the

formation of sebaceous
cysts.
Applied anatomy
2. Cutaneous tissue

Wound in the scalp bleed profusely?

Because:

• The walls of the vessels are

adherent to the fibrous network, so
that when the vessels are torn in an
open wound they are unable to
retract and produce profuse
bleeding. However bleeding can be
arrested by pressure against the
underlying bone.
2. C - CUTANEOUS TISSUE cont….
• Subcutaneous haemorrhage – localised
in extent.

• Inflammation painful

• Good healing.

Avulsion of scalp:

• Avulsion of scalp, connected by narrow

pedicle, when replaced and stitched,
will heal with little loss from sloughing.
APPLIED ANATOMY
3. Aponeurosis
• Wounds of the scalp do not gape unless the
epicranial aponeurosis is divided transversely.

• Operation on the scalp should be preferably

done under general anaesthesia, because S
dermatomes of trigeminal and cervical nerves C
undergo considerable overlap and density of A
L
subcutaneous tissue prevents ready diffusion P
of local anaesthetic in the scalp.

• First three layers of scalp are called surgical

layers of the scalp, these are called as scalp
proper also.
APPLIED ANATOMY
4. LOOSE AREOLAR TISSUE BLACK EYE
• Dangerous area of scalp because the
emissary veins, which course here may
transmit infection from the scalp to the
cranial venous sinuses.

• Collection of blood in this layer due to a

blow on the skull produces generalised
swelling. The blood slowly gravitates into
the eye lids because the frontalis has no
bony attachments results in black eye.
APPLIED ANATOMY CONT…..
4. LOOSE AREOLAR TISSUE
• Safety valve haematoma – because of the
spread of blood, compression of brain is not
seen and so this layer is also called safety layer.

• Caput succedaneum of the new born is a

temporary swollen and oedematous condition
of a portion of scalp and takes place during the
passage through the birth canal due to
interference of venous return.
APPLIED ANATOMY
5. PERICRANIUM
• Collection of fluid beneath the
pericranium produces localised
swelling in the form of
cephalohaematoma or
traumatic cephalohydrocele
which assumes the shape of
related bones.
THANK YOU