Skull & Scalp

Objectives
• At the end of the lecture the students would be able to —
• List the Parts of the Skull & name the bones forming the
parts
• Describe the Bony Elements and Features of Norma
Verticalis, Norma Occipitalis, Norma Frontalis, Norma
Lateralis and Norma Basalis of the Skull

• Describe the Layers of the Scalp

• Describe the Clinical importance of 4th layer of the scalp
• Describe the blood supply and nerve supply with
lymphatic drainage of the scalp
• Describe the importance of emissary veins
• 2 Main parts of Skull
• Calvaria (encloses the brain)
• Facial Skeleton
• 22 bones
• CALVARIA: 8 bones
Paired: Parietal, Temporal
Unpaired: Frontal, Occipital, Sphenoid, Ethmoid
• Facial Skeleton: 14 bones
Paired: Maxilla, Zygomatic. Nasal, Lacrimal,
Palatine, Inferior Nasal Concha
Unpaired: Mandible, Vomer
• Anatomical Position
Reid’s base line: Horizontal line joining Infraorbital
margin with centre of External Acoustic Meatus
Frankfurt Horizontal plane: plane at the level of line:
Infraorbital margin with upper margin External
acoustic meatus
 Norma Verticalis
• Norma Verticalis:
View from above
1. Frontal, 2. paired Parietal, 3. Occipital
Features:
Coronal Suture
Sagittal Suture
Lambdoid Suture
Metopic Suture—in frontal bone median plane about
3-8% people

• Vertex: Highest point on sagittal suture

• Vault: arched roof (dome)
• Bregma: Meeting point of Coronal &
Sagittal suture: Foetal & newborn skull
(below 18 mth-2 years) Membranous gap-
Anterior Fontanelle
• Lambda: Meeting point Lambdoid & Sagittal
Suture: Foetal & newborn Posterior Fontanelle
(closes 3 months)
• Parietal eminence (maximum convexity) Measurement
Bi-Parietal Diameter
• Temporal lines: Over parietal bones, superior & Inferior
• Parietal Foramina: Transmits EMISSARY Veins Foetal skull
 Norma Occipitalis
• Norma Occipitalis
View from behind
1. Parietal bones, 2.Squamous part of
Occipital bone, 3. Mastoid part of
Temporal bone
Features:
• Lambdoid Suture (sutural bones
sometimes)
• Occipito-Mastoid suture
• Parieto-Mastoid suture
• Lambda
• Parietal foramina
• EXTERNAL OCCIPITAL
Protuberance (between Head & Neck
below) INION
• Superior Nuchal Lines
• Highest Nuchal lines
• Mastoid Foramina: Emissary veins
 Norma Frontalis
• Norma Frontalis
View from In Front
Frontal bone, Right & Left Maxilla, Nasal Bones, Zygomatic bones,
Mandible
Features:
i. Frontal Region:
Superciliary arch, (Males, Frontal sinus)
Glabella: Median elevation between the two arch
Nasion: Medan point at root of nose
Frontal prominence: Low elevation above arch
ii. Orbit
Supra-orbital margin (frontal bone, Supraoribital notch)
Infra-orbital margin (Zygomatic, Maxilla)
Lateral orbital margin (Frontal, Zygomatic)
Medial orbital margin (Frontal, Lacrimal crest)
iii. Nose
Above: Nasal bones, Below: Maxilla (articulations)
Nasal bone most commonly fractured
Anterior Nasal spine (over lower wall)
Iv Face
Maxilla—Nasal notch, Anterior Nasal spine, Infraorbital foramen, Incisive fossa,
Canine fossa, 3 processes
Zygomatic bone
Mandible—Alveolar arch (upper border), BASE of Mandible
Mental point (GNATHION), Mental protuberance
Mental Foramen: Below 2 Pre-molar tooth
• Norma Lateralis
Norma Lateralis
View from Lateral side
Frontal, Parietal, Occipital, Temporal,
Sphenoid (Greater wing), Zygomatic, Mandible, Maxilla, Nasal

Features:
Superior Temporal Line: Attachment of TEMPORAL
FASCIA
Inferior Temporal Line: continue as Supramastoid crest
Zygomatic Arch: Temporal process of Zygomatic bone &
Zygomatic process of Temporal bone(Attachement MASSETER
Muscle)
External Acoustic Meatus (Suprameatal Triangle= Mastoid antrum)
Mastoid part of Temporal bone (absent <2 yr)
Styloid Process
STYLO-MASTOID FORAMEN (exit of facial nerve)
TEMPORAL FOSSA: Between Temporal line & Zygomatic arch
(TEMPORALIS MUSCLE Origin)
PTERION: H-shaped suture where 4 bones meet (Frontal,
Parietal, Greater wing of Sphenoid, Temporal)—This
area called PTERION Anterior Division of
Middle Meningeal artery
EXTRA-DURAL HAEMORRHAGE
INFRA-TEMPORAL FOSSA
Roof: Greater Wing of Sphenoid, Temporal bone
Laterally: Communicates with Temporal fossa, Mandible
Floor Open
Medial Wall: Lateral Pterygoid plate
Anterior wall: Maxilla
 Norma Basalis
• Normal Basalis
View from below
Anterior Part
Bony Palate (Hard Palate): Anterior 2/3rd Maxilla,
Posterior 1/3rd by Palatine
Cruciform suture
Incisive fossa, Incisive canal
Greater Palatine Foramen
Lesser Palatine foramen
Palatine crest
Middle part
Posterior border of Hard palate to Foramen
Magnum: Vomer, Bar of bone (junction of Sphenoid,
Occipital-Pharyngeal tubercle)
Posterior Part
Foramen Magnum: Medulla Obongata, Vertebral artery,
accessory nerve
External occipital crest
External Occipital Protuberance
 Scalp
SCALP
Soft tissue covering the vault of the skull

EXTENT
Anterior: Supraorbital margin
Posterior: External Occipital Protuberance &
superior nuchal line
Lateral: Superior Temporal line on each side
LAYERS of the SCALP

1. Skin S
2. Subcutaneous tissue C
3. Epicranial Aponeurosis A
4. Loose areolar tissue L
5. Pericranium P

The first 3 layers are bound together as a

single unit.
This single unit can move along the loose
areolar tissue over the pericranium
which is adherent to the calvaria
• The skin of the scalp is thick and hair
bearing. Many sebaceous glands;

Scalp is a common site for sebaceous

cysts
• Superficial fascia is a fibro fatty layer
that connects skin to the underlying
aponeurosis of the “occipitofrontalis”
muscle----blood vessels are attached to
fibrous tissue—hence if vessels are cut,
this attachment prevents vasospasm---
profuse bleeding 
• Epicranial aponeurosis is aponeurosis
of “occipitofrontalis” muscle; Occipital
part of the muscle arises from lateral
part of superior nuchal line, Frontal part
attaches to skin of eyebrows; centrally
thick fibrous aponeurosis is formed
• Loose areolar tissue—allows mobility,
‘Dangerous Layer’ as it contains
‘Emissary veins’ which connects veins
of scalp with intracranial venous sinuses
& carry infection
• Pericranium— (periosteum of skull
bones) firmly adherent to sutures
Muscles of scalp
Epicranius (occipitofrontalis)
bipartite muscle consisting of the:
Frontalis
Occipitalis
Galea aponeurotica – epicranial
aponeurosis connecting above muscles
These two muscles have alternate
actions of pulling the scalp forward and
backward

Nerve supply: Facial nerve (VIIth cranial

nerve)
 Nerves & Blood Vessels of scalp

IN FRONT OF THE EAR

Branches of Trigeminal nerve:
–Supratrochlear and Supraorbital nerves (anterior scalp)
–Zygomaticotemporal and Auriculotemporal nerves (lateral
scalp)
BEHIND EAR
•Cervical spinal nerves:
–Lesser Occipital nerves (from ventral ramus of C2)
–Greater Occipital nerves (from dorsal ramus of C2)
innervate lateral and posterior scalp

Outer surface receives branches from arteries to scalp

Inner surface receives branches from meningeal arteries
Blood Vessels In Front of The Ear
Branches of Ophthalmic artery (Branch of Internal Carotid) :
Supratrochlear and Supraorbital arteries (anterior
scalp)
Branches of External Carotid
superficial Temporal artery (to lateral scalp)
Behind The Ear
Posterior auricular artery (scalp above and posterior
to external ear)
Occipital artery (posterior scalp)
Extensive anastomoses between arteries and scalp injury
Supratrochlear +
Supraorbital Facial Vein

Superficial Temporal
+Maxillary (Within
Paroid)
Retromandibular Vein

Anterior Branch of this

Vein + Facial Vein
Common Facial Internal
Jugular Vein
Posterior Barnch of this
vein+ Posterior Auricular
Vein External Jugular
Vein
Venous Drainage
By veins with same names as arteries;
also drain via emissary veins (passing
into diploe) into interior of skull
Calvaria or Skull Cap Consists of hard
inner and outer tables of cortical bone
surrounding layer of spongy bone
(diploe)
Diploic veins – course within diploe,
connects cranial cavity and surface of
skull

Emissary Veins
connect intracranial venous system
with extracranial (face & scalp) veins
blood flow can be in either direction as
there are no valves
therefore potential for infection to
spread from face or scalp to brain
 Lymphatic drainage
• Pre-auricular (Parotid) lymph nodes---
drain anterior part
• Post-auricular (Mastoid) lymph nodes—
drain posterior part
• Occipital lymph nodes—drain posterior
most part
BLACK EYE
Bleeding from head injury
can gravitate down in front
up to upper eye lid & root of
nose in the 4th layer loose
arolar tissue beneath
aponeurosis
But laterally & posteriorly
can not spread due to
attachmemt of aponeurosis
to zygomatic arches and
superior nuchal line