Scalp and Face Anatomy PDF

Scalp  Anteriorly: Supraorbital ridge  Posteriorly: External occipital protuberance and superior nuchal lines  Laterally: zygomatic arch  Layers:  S-skin: Hair, sebaceous glands  C-connective tissue: (dense) Highly vascular  A-aponeurotic layer  L-loose conn...

Scalp  Anteriorly: Supraorbital ridge  Posteriorly: External occipital protuberance and superior nuchal lines  Laterally: zygomatic arch  Layers:  S-skin: Hair, sebaceous glands  C-connective tissue: (dense) Highly vascular  A-aponeurotic layer  L-loose connective tissue: infections spread  P-pericranium: removable, except in the area of sutures  Sebaceous cysts are common  scalp has a profuse blood supply  in emergency encircle the head above the ears with a tie. Why?  infection spreads by the emissary veins (valveless) to the skull bones, causing osteomyelitis  Subgaleal hemorrhage: May cause raccoon eye Muscles of the Scalp Occipitofrontalis:  Origin:  Frontal belly: Skin and superficial fascia of eyebrows  Occipital belly: Highest nuchal line of occipital bone  Insertion: Epicranial aponeurosis  NS: Facial nerve  Temporal branches  Posterior auricular branch  Action: Moves scalp on skull and raises eyebrows Sensory Nerve Supply  Anterior to the ears and the vertex: (Trigeminal)  Ophthalmic  Supratrochlear nerve  Supraorbital nerve  Maxillary division:  Zygomaticotemporal nerve  Mandibular division:  Auriculotemporal nerve  Posterior to the ears and the vertex: (cervical plexus)  Lesser occipital nerve: (C2)  Greater occipital nerve: cervical plexus (C2)  Remember foramina from which cranial nerves exit the Skull Trigeminal Nerve  Ophthalmic  Frontal: Superior orbital fissure  Supratrochlear nerve  Supraorbital nerve  Maxillary  Zygomatic: Pteyrgopalatine fossa Inferior orbital fissure  Zygomaticotemporal nerve  Mandibular  Auriculotemporal nerve  Frontal Nerve  Between the periosteum of the orbit and the levator palpebrae superioris  Supratrochlear nerve  Supraorbital nerve  Both supply as far as the vertex of the skull  Auriculotemporal nerve  Deep to the parotid gland,  Anterior to the ear Sensory Nerve Supply of the Scalp  Supratrochlear nerve: (Ophthalmic division) as far as the vertex of the skull  Supraorbital nerve: (Ophthalmic division) as far as the vertex of the skull  Zygomaticotemporal nerve (maxillary division): supplies the scalp over the temple  Auriculotemporal nerve (mandibular division)  Lesser occipital nerve: cervical plexus (C2)  Greater occipital nerve: cervical plexus (C2) Arterial Supply of the Scalp  Branches from external and internal carotid arteries common carotid artery  Right common carotid: from the brachiocephalic artery  Left common carotid artery: from arch of the aorta  Begins: sternoclavicular joint  Ends: upper border of the thyroid cartilage.  Divisions: External and internal carotid arteries The external carotid artery  Medial to the internal carotid artery, then passes backward and lateral to it.  Terminates: in the substance of the parotid gland behind the neck of the mandible. External carotid artery  Superficial temporal artery: lateral aspect of the scalp  Posterior auricular artery: posterior to the ear  Occipital artery: posterior aspect of the scalp Internal Carotid Artery  Passes deep to the parotid gland  Through the carotid canal  No branches in Neck Ophthalmic artery  Supratrochlear artery: (Ophthalmic artery)  Supraorbital artery : (Ophthalmic artery)  Zygomaticotemporal artery : (Ophthalmic artery) Ophthalmic artery branches  Supratrochlear artery  Supraorbital artery  Anterior and superior aspects of the scalp  Supply as far as the vertex Ophthalmic artery branches  Zygomaticotemporal Artery: from lacrimal artery  Through: Zygomaticotemporal foramen: Near the center of the temporal surface of the zygomatic bone  Supplies area over temporal region Ophthalmic artery branches Arterial Supply of the Scalp  Supratrochlear artery: (Ophthalmic artery)  Supraorbital artery : (Ophthalmic artery)  Zygomaticotemporal artery : (Lacrimal from Ophthalmic artery)  Superficial temporal artery (external carotid artery)  Posterior auricular artery: (external carotid artery)  Occipital artery : (external carotid artery) Venous drainage of the Scalp  Supraorbital and Supratrochlear viens  communicate with the ophthalmic veins in the orbit  Form the facial vein (medial angle of eye)  The facial vein  join the anterior division of the retromandibular vein, and drains into the internal jugular vein.  Retromandibular vein: Union of superficial temporal and the maxillary veins  Superficial Temporal Vein - Formed on the side of the scalp - Enters the parotid gland, where it joins the maxillary vein to form the retromandibular vein.  Posterior auricular vein: joins the posterior branch of retromandibular vein vein to form the external jugular vein.  The retromandibular vein  Formed by the union of the superficial temporal and the maxillary veins  On leaving the parotid salivary gland, it divides into  Anterior branch: joins the facial vein,  Posterior branch: joins the posterior auricular vein to form the external jugular vein. Occipital vein  Posterior aspect of the scalp  Plexus of veins in posterior triangle  Internal jugular vein Face  Skin  No deep fascia  Muscles embedded in the superficial fascia  Origin: facial bones  Insertion: Skin  localized around orifices  NS: Facial nerve Orbital group  Orbicularis oculi:  Orbital part: Closes the eyelids forcefully  Palpebral part: Closes the eyelids gently  Corrugator supercilii: Draws the eyebrows medially and downward, Vertical wrinkles of forehead Nasal group  Nasalis:  Transverse part (compressor nasi): compresses mobile nasal cartilages  Alar part (dilator naris):Widens nasal aperture  Procerus: Draws down medial angle of eyebrows producing transverse wrinkles over bridge of nose  Depressor septi nasi: Pulls nose inferiorly Oral group  Modiolus: button- shaped connective tissue at the interface between the muscles of the lips and cheeks  Orbicularis oris:  Origin: Maxilla, mandible, and skin  Insertion: Encircles oral orifice  Action: Closes and protrudes lips Buccinator muscle  Origin: pterygomandibular raphe, from the alveolar part of the mandible and alveolar process of the maxilla  Insertion: modiolus  Action: holds the cheeks against the alveolar arches and keeps food between the teeth when chewing Oral group: (Upper)  Risorius:  Zygomaticus major  Zygomaticus Minor  Levator labii superioris  Levator labii superioris alaeque nasi  Levator anguli oris Oral group: (Upper)  Risorius:  Zygomaticus major  Zygomaticus Minor  Levator labii superioris  Levator labii superioris alaeque nasi  Levator anguli oris Oral group: (Lower)  Depressor anguli oris  Depressor labii inferioris  Mentalis: raises and protrudes Auricular muscles  Anterior auricular  Superior auricular  Posterior auricular Sensory Nerve Supply of face  Trigeminal (V)  Ophthalmic  Maxillary  Mandibular  Exception:  Great auricular: over the angle of the mandible and the parotid gland Ophthalmic Nerve  Supratrochlear nerve  From Frontal N  Supraorbital nerve  From Frontal N  Infratrochlear nerve  Branch from Nasociliary N  Lacrimal nerve  External nasal nerve  From Anterior ethmoidal  From Nasociliary N Ophthalmic Nerve Ophthalmic Nerve Ophthalmic Nerve  Supratrochlear nerve: skin and conjunctiva on the medial part of the upper eyelid  Supraorbital nerve: skin and conjunctiva on the central part of the upper eyelid  Infratrochlear nerve  Skin and conjunctiva on the medial part of the upper eyelid and bridge of the nose  Lacrimal nerve: skin and conjunctiva of the lateral part of the upper eyelid  External nasal nerve: skin on the side of the nose down as far as the tip Maxillary Nerve  Zygomatic nerve: Pteyrgopalatine fossa Inferior orbital fissure  Zygomaticotemporal nerve: skin over the temple  Zygomaticofacial N: skin over the prominence of  the cheek  Infraorbital nerve:  Inferior palpebral: skin of the lower eyelid and cheek  Nasal: the side of the nose (ala)  Superior labial: upper lip Mandibular Nerve  Mental nerve: skin of the lower lip and chin  Buccal nerve: skin over the buccinator and mucous membrane lining its inner surface and gingiva along the mandibular molars  Auriculotemporal nerve: skin of the auricle, the external auditory meatus, the outer surface of the tympanic membrane, and the skin of the scalp above the auricle Motor Nerve Supply of face  Stylomastoid foramen  Substance of the parotid salivary gland  Branches:  Temporal  Zygomatic  Buccal  Manidbular  Cervical Vascular Supply of the Face  External carotid artery  Superficial temporal  Facial  Maxillary  Internal carotid artery  ophthalmic Vascular Supply of the Face  Superficial temporal artery  Transverse facial artery: Vascular Supply of the Face  Facial artery  Superior labial artery  Inferior labial artery  Lateral nasal artery  Angular artery Vascular Supply of the Face  Maxillary artery:  Infraorbital  Buccal  Mental: from inferior alveolar supply the chin Vascular Supply of the Face  Ophthalmic artery  Supratrochlear artery  Supraorbital artery  Zygomaticofacialal artery: from lacrimal artery  Dorsal nasal Ophthalmic artery  Dorsal nasal  External nasal artery: from anterior ethmoid a Venous drainage of the Face Venous drainage of the Face  Communicating veins:  Superior ophthalmic  Inferior ophthalmic  Infraorbital  Deep facial  Deep veins  Pterygoid plexus  Cavernous sinus Infections in the dangerous area of the face can lead to Cavernous Sinus Thrombosis Cavernous sinus syndrome  sepsis from the central portion of the face or paranasal sinuses clinical manifestations:  Ophthalmoplegia with diminished pupillary light reflexes  Venous congestion leading to periorbital edema  Exophthalmos Pain or numbness of the face Lymph drainage of the Face  Submandibular nodes: medial corner of the orbit, most of the external nose, medial part of the cheek, the upper lip and the lateral part of the lower lip  Submental nodes: central part of the lower lip and the skin of the chin are drained  Parotid nodes: part of the external nose, and the lateral part of the cheek lateral parts of the eyelids Lymph drainage of the Scalp  Occipital nodes:  Mastoid nodes: posterior to the vertex  Pre-auricular and parotid nodes: anterior to the vertex  Submandibular nodes: forehead