L13 Scalp & Face Soft Tissue PDF

Scalp & Face Soft Tissue Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt Edited by: Dr. Nora Helal Scalp & Face 1 Learning Outcomes To Identify the extent and structure of the Scalp & Face. To Identify the b...

Scalp & Face Soft Tissue Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt Edited by: Dr. Nora Helal Scalp & Face 1 Learning Outcomes To Identify the extent and structure of the Scalp & Face. To Identify the blood supply of the Scalp & Face. To identify the nerve supply of the Scalp & Face. To identify the lymph drainage of the Scalp & Face. To identify the applied anatomy and clinical important scenarios related to the Scalp & Face. Scalp  Case Scenario http://t3.gstatic.com/images?q=tbn:ANd9GcQ-NcmwyGT9rcw7e2OEblVnh8qcjK2hWl6EVkuiOxC8W0sAvgGETDSaeUM8 Three days after head trauma in a motor car accident, a 33-year-old male patient complained bluish black discoloration of skin around his right eye. What is your explanation?  Scalp Extent: eyebrows ❖ Anteriorly: the eyebrows. ❖ Posteriorly: o External occipital protuberance. o Superior nuchal line. ❖ Laterally: the superior temporal lines. NB: ❖ The area from the superior temporal lines downwards to the zygomatic arch is called Superior temporal line the temple. Temple zygomatic arch  Scalp Layers: ✓ S: Skin. ✓ C: Connective tissue of superficial fascia. ✓ A: Epicranial Aponeurosis. ✓ L: Loose areolar tissue. ✓ P: Pericranium.  Scalp Layers: S: Skin. ✓ The 1st layer ✓ Pierced by the hairs and contains many sebaceous glands.  Scalp Layers: C: Connective tissue of superficial fascia. ✓ The 2nd layer. ✓ Consists of dense connective tissue that binds the skin tightly to the aponeurosis. ✓ Contains the blood vessels and the nerves of the scalp.  Scalp Layers: A: Epicranial Aponeurosis. ✓ The 3rd layer. ✓ Attached to the skin by the connective tissue. ✓ Receives the insertion of the occipitofrontalis muscle.  Scalp Layers: L: Loose areolar tisse (Subaponeurotic space). ✓ The 4th layer. ✓ It allows free movement of the above 3 layers. ✓ It contains emissary veins. ✓ It extends anteriorly beneath the orbicularis oculi into the eye. ✓ Bleeding anywhere in it may appear in the upper eyelids causing black eye. 4th  Scalp Layers: P: Pericranium. ✓ The 5th layer. ✓ Fibrous layer covering the outer surface of the skull. ✓ Carries the blood supply to the diploe of the skull.  Scalp Occipito-frontalis muscle: Origin: ✓ Frontal belly: ▪ skin of the eyebrows and the forehead. ✓ Occipital belly: ▪ Highest nuchal lines. Insertion: in the epicranial aponeurosis. Nerve supply: facial nerve. Action: ✓ Frontal belly: Highest nuchal line ▪ Corrugate the skin of the forehead as in surprise. ✓ Occipital belly: ▪ Draws the scalp backward. N.B. The contraction tone of the occipito-frontalis muscle is the cause of gaping of scalp cut wounds. Face  Case Scenario After exposure to a sudden ice storm. Rana, a 7- year-old student complained difficult closure of her left eye and difficulty in closure of her mouth. On examination, the GP reported loss of the left nasolabial fold. What is your explanation?  Face Definition: ▪ the part between the ears and from the eyebrows to the chin. Extent: forehead ▪ Superiorly: the eyebrows. ▪ Inferiorly: the chin. ▪ Laterally: the external auditory meatus. NB The forehead is common to both scalp and face  Face Layers: ✓ Skin. ✓ Muscles  Face Muscles of the face have these criteria: 1. They take origin from the bones surrounding the openings of the face (eye, ear, nose, and mouth). 2. They are inserted in the skin. 3. Their action appears directly on the face hence named muscles of facial expression. 4. They develop from the 2nd pharyngeal arch. 5. They are supplied by the facial nerve (VII cranial nerve). Prof. Wael M Elsaed  Face Openings of the face: 1. Orbit 2. Nose 3. Mouth 4. Ear  Face Muscles of face: Orbicularis oculi 1. Orbicularis occuli 2. Orbicularis oris 3. Buccinator 4. Platysma Orbicularis oris Buccinator Platysma  Orbicularis occuli: Orbicularis Occuli orbital septum upper tarsal plate Orbicularis Oris Lateral palpebral raphe Medial palpebral ligament the lacrimal sac  Lacrimal Orbital Palpebral Orbicularis occuli: Orbital Palpebral Lacrimal Origin: Medial palpebral ligament Medial Lacrimal bone and palpebral the fascia covering ligament the lacrimal sac Insertion: Form concentric rings, Lateral Upper & lower eye return to same point of palpebral raphe lids origin Action: Wrinkles the skin around Closes the lids Dilate lacrimal sac the orbital margins gently to drain tears Prof. Wael M Elsaed Mouth cavity proper Buccinator Lateral pterygoid Vestibule of mouth Lateral pterygoid Buccinator Buccinator: Upper fibers Origin: from maxilla opposite molar teeth Insertion: upper lip Lower fibers Origin: mandible opposite molar teeth Insertion: lower lip Middle fibers Origin: from pterigomandibular raphe Insertion: decussate at modulus before passing to lips Action: prevent accumulation of food in vestibule of mouth by compressing the cheeks against the lip and gum, to whistle and to blow. Prof. Wael M Elsaed Orbicularis oris: Origin: maxilla & mandible near midline Insertion: skin of lip. Action: closes the mouth.  Face Platysma: Origin: facia over the chest Insertion: base of mandible, skin of lower face and lip Action: 1. Releases pressure of skin on the subjacent veins. 2. Depress mandible. 3. Pulls angle of mouth downwards. Platysma  Questions Q1 What part of orbicularis oculi gently closes the eye? A. Palpebral part. B. Orbital part. C. Lacrimal part. MCQ questions D. Orbital and lacrimal parts acting together. E. Lacrimal and palpebral parts acting together. Answer: A  Questions Q2 Paralysis of which muscle lead to accumulation of food in the vestibule of the mouth? A. Temporalis muscle. B. Buccinator muscle. C. Masseter muscle. MCQ questions D. Orbicularis oris muscle. E. Medial pterygoid muscle. Answer: B  References Grey’s anatomy for students Lippincott’s anatomy and embryology