face and scalp.pptx

SCALP AND FACE BY: D R A H M E D BDS AMOUD UNIVERSITY  OBJECTIVES By the end of this lecture the student should be able to : o Mention the layers of the scalp o Describe the blood, nerve supply & lymphatic drainage of the scalp. o Discuss the skin of the face and its innerva...

SCALP AND FACE BY: D R A H M E D BDS AMOUD UNIVERSITY  OBJECTIVES By the end of this lecture the student should be able to : o Mention the layers of the scalp o Describe the blood, nerve supply & lymphatic drainage of the scalp. o Discuss the skin of the face and its innervations o Mention the muscles of the face and its action and innervations  H E LP T CA S  THE SCALP The scalp is the soft tissues covering the cranial vault. It extends from the supraorbital margins anteriorly to the highiest nuchal lines posteriorly. Laterally it continues inferiorly to the zygomatic arch. Fig1: layers of the scalp LAYERS OF THE SCALP  LAYERS OF THE SCALP 1- Skin - is thick, contains numerous hair follicles and sebaceous glands. It is a common site for sebaceous cysts. 2- Connective tissue - Dense and connects the skin to the epicranial aponeurosis. It is richly vascularized and innervated. 3- Epicranial Aponeurosis - It is a tendinous sheet that connects anteriorly to the frontal bellies and posteriorly to the occipital bellies of the occipitofrontalis muscle.  LAYERS OF THE SCALP 4- Loose Areolar Connective Tissue - A thin connective tissue layer that separates the periosteum of the skull from the epicranial aponeurosis. 5- Periosteum – The outer layer of the skull bones Loosely attached to the bones but firmly adherent to the sutures between bones.  MUSCLE OF THE SCALP Occipitofrontalis muscle It has 2 larger and fused frontal bellies anteriorly , 2 separate occipital bellies posterioly, and an Epicranial aponeurosis connecting the frontal and occipital bellies together. Fig2 : Occipitofrontalis TABLE 1: OCCIPITOFRONTALIS MUSCLE Muscle Origin Insertio Nerve Action n Supply Occipital highest post. border posterior pull the belly nauchal line. of epicranial auricular scalp back Of occipital aponeurosis branch of bone the facial nerve. Frontal ant. border the skin of temporal elevates the belly of epicranial the eye branch of eyebrows aponeurosis brows facial nerve. and produces wrinkles in the skin of the forehead. NERVE SUPPLY OF THE SCALP It is from two major sources, the cranial nerves or the cervical nerves, depending on whether it is anterior or posterior to the ears and the vertex of the head. o Pre auricualar region o Post auricular region NERVE SUPPLY OF THE SCALP NERVE SUPPLY OF THE SCALP NERVE SUPPLY OF THE SCALP Fig3 : nerve supply of the scalp Fig4 : nerve supply of the scalp ARTERIAL SUPPLY The scalp has a rich blood supply drived from branches of either the external carotid artery or the ophthalmic artery which is a branch of internal carotid artery (Front of.auricle) (Behind of the 1.Supratrochlear auricle) 2.Supraorbital 1.Posterior 3.Superfacial temporal auricular artery Artery 2.Occipital Arteries Fig.4 : Arterial supply of the scalp Fig.5 : Arterial supply of the scalp VENOUS DRAINAGE They accompany the corresponding arteries: Both Unite at the 1. Supra-trochlear vein medial Angle of the eye to form the anterior Facial vein 2. Supra-orbital vein VENOUS DRAINAGE 3.Superficial temporal vein unit with the maxillary vein to form the retromandibular vein. 4. Posterior auricular vein unites with the post.division of the retromandibular v. to form the external jugular vein. 5. Occipital vein End either in the suboccipital plexus of vein or in the internal jugular v. It is connected to the sup. sagittal sinus Fig.6 : Venous and arterial supply of the scalp  LYMPHATIC DRAINAGE The anterior part of scalp drains in to the pre auricular or parotid lymph nodes. The posterior part of the scalp drainage in to the posterior auricular or mastoid and occipital lymph nodes. Fig.7 : lymphatic drainage of the scalp  CE FA H E T  THE FACE The face is the part of the front of the head between the ears and from the chin to the hairline The basic shape of the face is determined by the underlying bones. The face plays an important role in communication.  THE FACE The Skin of the face is elastic and very vascular. It has numerous sweat and sebaceous glands. It varies in thickness, as it is very thin on the eyelids. Superficial fascia: contain numerous muscles nerves , vessels and fat. Deep fascia is absent, except over parotid gland and over buccinator muscle. Muscles of the Face (Muscles of Fasial Expression ) Fig.8 :Muscles of the Face  Muscles of the Face (Muscles of Fasial Expression ) o General characteristics: 1. They lie in the superficial fascia. 2. They have a bony origin. 3. They are inserted into the skin without tendons. 4. They arrange themselves around the opening of the face as 2 groups : A) Sphincter group B) Dilator group.  Muscles of the Face (Muscles of Fasial Expression ) o General characteristics: 5. They intermingle with each other. 6. They are developed from the mesoderm of the second pharyngeal arch. 7. They are supply by facial nerve.  Muscles of the Face (Muscles of Fasial Expression ) o The facial muscles can broadly be split into three groups:  Orbital group  Nasal group  Oral group MUSCLES OF THE EYELIDS ( ORBITAL GROUP ) Fig.9 :Muscles of the eyelid MUSCLES OF THE EYELIDS (ORBITAL GROUP ) These muscles control the movements of the eyelids. Important in protecting the cornea from damage. Two muscles : 1. Orbicularis oculi 2. Corrugator Supercilii They are both innervated by the facial nerve. MUSCLES OF THE EYELIDS (ORBITAL GROUP ) 1. ORBICULARIS OCULI The orbicularis oculi muscle surrounds the eye socket and extends into the eyelid. It has 3 distinct parts:  Orbital part – outer  Palpebral part - inner  Lacrimal part – small It is the sphincter of the eye. Fig.10 : Orbicularis Oculi Muscles ORBICULARIS OCULI THE ORBITAL PART - OUTER It is the outer thickest part of the muscle which surrounds the orbital margin. Origin: From the nasal part of the frontal bone. The anterior lacrimal crest. And the frontal process of the maxilla. Insertion : Into the lower border of the medial palpebral ligament. Action Tightly closes the eyelids to avoid the danger. Fig.11 : orbital part of Orbicularis Oculi Muscles Fig.12 :action of orbital part of Orbicularis Oculi Muscles ORBICULARIS OCULI PALPEBRAL PART – INNER Origin From the medial palpebral ligament, anterior to the tarsal plates. Interdigitate laterally to form the lateral palpebral raphe. Insertion Into the lower border of the medial palpebral ligament. Action Gently closes the eyelids as in blinking or during sleep Fig.13 : Orbicularis Oculi Muscles Fig.14 :action of palpebral part of Orbicularis Oculi Muscles ORBICULARIS OCULI LACRIMAL PART Origin From the posterior lacrimal crest and lacrimal sac. laterally they join the upper and lower palpebral fibers. Insertion Into the margins of the eye lids. Action Dilate the lacrimal sac helping the drainage of tears.  MUSCLES OF THE EYELIDS (ORBITAL GROUP ) 2. CORRUGATOR SUPERCILII Origin From the superciliary arch Insertion Into the skin of the eyebrow. Actions Acts to draw the eyebrows together, creating vertical wrinkles on the bridge of the nose. Innervation By Facial nerve. Fig.15: Corrugator Supercilii Fig.15: Action of Corrugator Supercilii Muscles MUSCLES OF THE NOSTRILS (NASAL GROUP ) Fig.16: Nasal group of face  MUSCLES OF THE NOSTRILS (NASAL GROUP ) Three muscles are associated with the nasal group :  Nasalis ( transverse and Alar )  Procerus  Depressor septi nasi.  MUSCLES OF THE NOSTRILS (NASAL GROUP ) 1.Nasalis (compressor naris) Is the largest of the nasal muscles. has two parts; transverse and alar. Origin both parts from the maxilla. Insertion Transverse: attaches to an aponeurosis across the dorsum of the nose. Alar : attaches to the alar Fig.17 : Nasalis cartilage of the nasal mucles skeleton  MUSCLES OF THE NOSTRILS (NASAL GROUP ) 1. NASALIS (COMPRESSOR NARIS) Actions: Transverse : compresses the nares Alar : draws cartilage downward and laterally opening the nares. Fig.17 : Nasalis mucles Innervation: MUSCLES OF THE NOSTRILS (NASAL GROUP ) 2. PROCERUS MUSCLE Is a small pyramidal slip. Origin : nasal bone and upper part of lateral nasal cartilage. Insertion : skin of the lower forehead between the eyebrows Action : Draws down medial angle of the eyebrows producing transverse wrinkles over bridge of the nose. It can also contribute to an expression of anger Innervation : Facial nerve MUSCLES OF THE NOSTRILS (NASAL GROUP ) 3. DEPRESSOR SEPTI Arises from the maxilla above the central incisor and is attached to the nasal septum. Action : Depressor septi & Levator labii superioris alaeque nasi contribute to widening the nostril. Innervation : Buccal branches of the facial nerve. Fig.18 : Depressor septi mucles MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) 1.Buccinator muscle Occupying the gap between mandible and maxilla forming the most important part of cheek. Origin Buccinat Alveolar margin of or maxilla and mandible opposite the 3 molars. Fig.19 : Buccinator mucles  MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) 1.Buccinator muscle Insertion The maxillary and mandibular fibres pass medially without decussation into the upper and lower lips. Buccinat or Middle fibers Fig.19 : Buccinator mucles decussate at the MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) 1.Buccinator muscle Posterior part is overlapped by masseter muscle. The muscle is pierced by the parotid duct opposite the second upper molar tooth. Buccinat or The duct also passes through the buccal fat Fig.19 : Buccinator mucles MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) 1.Buccinator muscle Action It is an accessory muscle of mastication Prevents the accumulation of foot in the vestibule of mouth by keeping the cheeks applied to the gum.Used also in whistling and suckling. Nerve supply By the buccal branches of the facial nerve. Fig.20 : Action of Buccinator mucles  MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) 2.ORBICULARIS ORIS It is a sphincter muscle formed of the fibers which surround the oral orifice. Consists of : 1) Extrinsic fibers most of these come from the buccinator muscle which is inserted into the lips Fig.21 : Oral group 2) Intrinsic fibers of face mucles include mental slips  MUSCLES OF THE LIPS AND CHEEKS (ORAL 2.ORBICULARIS GROUP ) ORIS Action whistling expression Closes the mouth by bringing the lips close together. Compresses the lips against the teeth. Important for Fig.21 : Oral group speech the letters of face mucles (P.B.M). MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) DILATOR MUSCLES OF THE LIPS 1) Levator labii superioris alaeque nasi: Arises from the frontal process of the maxilla. Inserted into the ala of the nose and the upper lip. It elevates both. Fig.22 : Levator labii superioris alaeque nasi mucles and its action  MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) DILATOR MUSCLES OF THE LIPS 2) Levator labii superioris: Arises from the inferior orbital margin. inserted into the remainder of the upper lip. 3) Levator anguli oris: From the canine fossa below the infraorbital foramen. The infraorbital nerve lies sandwiched between it and the overlying levator labii superioris. 4) Zygomaticus minor from the zygomaticomaxillary suture and zygomaticus major further out on the surface of the zygomatic bone. Nerve supply: supplied by buccal branches of the facial Fig.22 : Oral group of face mucles CHANGE Fig. Fig.23 : Oral group of face mucles CHANGE Fig.24 : Oral group of face mucles  MUSCLES OF THE LIPS AND CHEEKS (ORAL GROUP ) DILATOR MUSCLES OF THE LIPS 1) Levator labii superioris: Arises from the inferior orbital margin. inserted into the remainder of the upper lip. 2) Levator anguli oris: From the canine fossa below the infraorbital foramen. The infraorbital nerve lies sandwiched between it and the overlying levator labii superioris. 3) Zygomaticus minor from the zygomaticomaxillary suture and zygomaticus major further out on the surface of the zygomatic bone. Nerve supply: supplied by buccal branches of the facial  MUSCLES ELEVATOR OF THE SKIN OF THE CHIN 1) Depressor anguli oris arises from the mandible below the mental foramen. fibres pass through the modiolus to the deeper stratum. 2) Depressor labii inferioris arises from the mandible in front of the mental foramen fibres are inserted into the lower lip. MUSCLES ELEVATOR OF THE SKIN OF THE CHIN 3) Mentalis arises near the midline of the mandible. Its fibers pass downwards to reach the skin. These muscles are supplied by the marginal mandibular branch of the facial nerve. Fig.25 : Lateral view muscles elevate the chin Fig.26 : Ant. View Muscles that elevate the chin Fig.27 : actions of face Muscles Table2 : summry of Muscles of the face Table2 : summry of Muscles of the face NERVE SUPPLY OF THE FACE 1) Motor Supply By the branches of facial nerve (VII) 2) Sensory Supply Trigeminal nerve (V) Great auricular nerve (C2 and C3 ) COURSE OF THE EXTRA-CRANIAL PART OF FACIAL NERVE  Facial nerve It is the 7th CN and gives 7 motor branches to the muscles of the face and scalp. COURSE OF THE EXTRA-CRANIAL PART OF FACIAL NERVE i. It leaves the skull through the stylomastoid foramen. ii. It curves forwards around the lateral side of the styloid process. iii. Then it pierces the posteromedial surface of parotid gland. iv. It ends inside the gland by dividing into the 5 terminal branches. BRANCHES OF THE FACIAL NERVE Within the parotid gland the facial nerve have 5 terminal branches: 1. Temporal branch emerge from the upper border of the gland, cross the zygomatic arch and supply : a) auricularis anterior and superior. b) frontal belly of occipito-frontalis. c) upper part of the orbicularis occuli. Fig.28 : Branches of the facial nerve BRANCHES OF THE FACIAL NERVE Within the parotid gland the facial nerve have 5 terminal branches: 2. Zygomatic branch supply orbicularis oculi muscle. They may be damaged in fractures or operations in this region. Paralysis of this muscle prevents blinking and the precorneal film of tears is no longer spread The dry cornea easily ulcerates BRANCHES OF THE FACIAL NERVE Within the parotid gland the facial nerve have 5 terminal branches: 3) Buccal branch run forwards close to the parotid duct towards the angle of the mouth. supply buccinator and orbicularis oris m. BRANCHES OF THE FACIAL NERVE Within the parotid gland the facial nerve have 5 terminal branches: 4) Marginal mandibular branch runs forwards along the mandible. Innervates the mentalis muscle. damage to the nerve causes paralysis of the depressors of the lower lip and mouth angle. BRANCHES OF THE FACIAL NERVE Within the parotid gland the facial nerve have 5 terminal branches: 5) Cervical branch passes downward from the lower border of the parotid gland and supplies platysma. Fig.30 : Branches of the facial nerve SENSORY SUPPLY OF THE FACE The skin of the face is supplied by the branches of the three divisions of the trigeminal nerve. The great auricular nerve supplies the skin over the parotid gland.  SENSORY SUPPLY OF THE FACE TRIGEMINAL NERVE. Fig.31 : Branches of the trigeminal nerve. SENSORY SUPPLY OF THE FACE TRIGEMINAL NERVE. OPHTHALMIC DIVISION (V1 ) – BRANCHES : 1. Supraorbital nerve supply the skin over the middle part of the eyelied and overlying skin of the forehead. 2. Supratrochlear nerve supply the middle of the forehead up to the hairline. 3. Lacrimal nerve supplies a small area of skin over the lateral part of the upper eyelid. 4. Infratrochlear nerve supply skin over the bridge of the nose. Fig.32 : Ophthalmic division of the trigeminal nerve. SENSORY SUPPLY OF THE FACE TRIGEMINAL NERVE. MAXILLARY NERVE (V2) – BRANCHES : 1. Infraorbital nerve supply the lower eyelid , cheek, nose, upper lip and labial gum. 2. Zygomatico-facial nerve supply the skin over the zygomatic bone. 3. Zygomatico-temporal nerve supplies a small area of temporal skin. Fig.32 : Maxillary division of the trigeminal nerve. SENSORY SUPPLY OF THE FACE TRIGEMINAL NERVE MANDIBULAR NERVE (V3) – BRANCHES : 1. Auriculo-temporal nerve : two parts : a) the auricular part of the nerve supplies the external acoustic meatus, surface of the tympanic membrane and skin of the auricle above this level. b) the temporal part supplies the hairy skin over the temple 2.Buccal nerve supply a small area over the cheek just below the zygomatic bone. 3.Mental nerve supply the skin of the chin Fig.33 : mandibular division of the trigeminal Fig.34 : branches of the trigeminal nerve. ARTERIAL SUPPLY OF THE FACE Facial artery : The facial artery is a branch of the external carotid artery. It ends at the medial angle of the eye by becoming the angular artery. Fig.35 : arterial supply of the face ARTERIAL SUPPLY OF THE FACE Facial artery branches in the face to give : Inferior labial artery. Superior labial artery. Lateral nasal branch to nasalis muscle. ARTERIAL SUPPLY OF THE FACE Also : supraorbital and supratrochlear branches of the ophthalmic artery supply the forehead. The transverse facial artery a branch of the superficial temporal artery. ARTERIAL SUPPLY OF THE FACE Also : Infraorbital artery is continuation of maxillary artery it reaches the face through the infraorbital foramen to supply the cheek. Mental a. it is branch of inf. alveolar artery , it reaches the face through mental foramen to supply the chin. Fig.36 : arterial supply of the face VENOUS DRAINAGE OF THE FACE Drained by the following veins: 1. Facial vein 2. Retromandibular vein Fig.36 : venous drainage of the face VENOUS DRAINAGE OF THE FACE FACIAL VEIN Provide the superficial drainage of the face. Tributaries of the facial vein include : I. deep facial vein II. Supraorbital III. supratrochlear veins It is joined by the anterior (communicating) branch of the retromandibular vein Drains directly or indirectly into the IJV. VENOUS DRAINAGE OF THE FACE RETRO-MANDIBULAR VEIN It is a deep vein of the face. Formed by the union of the superficial temporal and maxillary veins. The retromandibular vein divides into : i. Anterior branch that unites with the facial vein to form the common facial v. which end in the I.J.V. ii. Posterior branch that joins the posterior auricular vein inferior to the parotid gland to form the external J.V. which end in the subclavian v. Fig.36 : venous drainage of the face LYMPHATIC DRAINAGE OF THE FACE Lymph from the lateral part of the face including the eyelids drains to the superficial parotid lymph nodes. Lymph from the deep parotid nodes drains to the deep cervical lymph nodes. LYMPHATIC DRAINAGE OF THE FACE Lymph from the upper lip and lateral parts of the lower lip drains to the submandibular lymph nodes. Lymph from the chin and central part of the lower lip drains to the submental lymph nodes Fig.38 : lymphatic drainage of anterior face Fig.37 : lymphatic drainage of the face THANK S