Questions and Answers
What is the most posterior boundary of the scalp extension?
The highest nuchal line
Which layer of the scalp contains the nerves, vessels, and lymphatics?
The connective tissue layer
Why is bleeding from the scalp profuse and needs compression to stop?
Because the connective tissue layer contains many blood vessels
What is the function of the epicranial aponeurosis layer of the scalp?
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Which muscle is found within the epicranial aponeurosis layer of the scalp?
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What is the function of the aponeurosis in relation to the eyebrows?
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Which nerve supplies the aponeurosis?
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What is the clinical significance of cutting the aponeurosis in a deep scalp wound?
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What is the clinical significance of a subperiosteal hemorrhage (cephalic hematoma)?
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Which layer of the scalp is most dangerous for hematoma formation, resulting in a "black eye"?
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Study Notes
Scalp Extension and Layers
- Scalp extension: from the eyebrows (supra orbital margin) to the highest nuchal line posteriorly and laterally to the superior temporal line
- Five layers of the scalp: skin, connective tissue, aponeurosis, loose areolar connective tissue, and periosteum
Skin
- Hairy and full of sebaceous glands
- Most common site of sebaceous cysts
Connective Tissue
- Formed of compact, dense CT fibers
- Contains many septa that connect this layer with the layers above and below
- Contains nerve, vessels, and lymphatics of the scalp (neurovascular plane)
- Bleeding from the scalp is profuse and needs compression to stop due to CT septa attached to the wall of blood vessels and rich vascularity
Aponeurosis
- Epicranial Aponeurosis
- Only layer with bony attachment to limit scalp movement
- Contains the muscle "Occipito-Frontalis" with four bellies:
- 2 Occipital Bellies (origin: highest nuchal line, insertion: the aponeurosis)
- 2 Frontal Bellies (extension: from the forehead, near the parotid gland, called muscles of expression)
- Clinical Anatomy: cutting the aponeurosis in any deep wound of the scalp will lead to wound gapping, which requires sutures due to traction of the aponeurosis
Loose Areolar Connective Tissue
- Contains loose CT elements continuous anteriorly with connective tissue of the upper eyelids
- Most dangerous: hematoma in this layer will cause "Black Eye"
Periosteum
- Pericranium, confined to each bone
- Clinical Anatomy: subperiosteal hemorrhage (Cephale hematoma) takes the shape of the underlying bone
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