2. Topic – the scalp, Face and Lacrimal
apparatus
Short notes
3. Scalp, arteries supplying scalp, nerve supply
of scalp and applied aspect of scalp. Explain
how the scalp injury can result in “Black eye”
4. Scalp
• The scalp is the part of the
head that extends from the
superciliary arches anteriorly
to the external occipital
protuberance and superior
nuchal lines posteriorly.
• Laterally it continues
inferiorly to the zygomatic
arch or superior temporal
line.
5. The term scalp is applied to the soft tissues
covering the vault of skull.
LAYERS
• Skin.
• Connective tissue (superficial fascia).
• Aponeurosis (occipito-frontalis muscle and
its aponeurosis) or epicranial aponeurosis
or Galea (helmet) aponeurotica.
• Loose areolar tissue.
• Pericranium.
6. Scalp
• The first three layers are
tightly held
together, forming a
single unit.
• This unit is sometimes
referred to as the scalp
proper and is the tissue torn
away during serious
'scalping' injuries.
7. Loose areolar tissue traversed by – Emissary veins
connecting veins in the second layer of scalp with intra-
cranial dural venous sinuses
8. Occipeto-frontalis muscle
(Origin and insertion)
• The frontal bellies arise from skin and
subcutaneous tissue over the eyebrows and root of
the nose run backwards to be inserted into
epicranial aponeurosis in front of coronal suture.
They have no bony attachment of their own. The
deeper fibres of frontal belly merge with procerus,
corrugator supercili, and orbicularis oculi muscles.
The front bellies are longer, wider, and partly
united with each other along their medial borders.
• The occipital bellies arise from lateral two-third of
the superior nuchal lines and extend forwards to be
inserted into the epicranial aponeurosis. The two
occipital bellies are small and separated from each
other by a considerable gap. This gap is filled by
epicranial aponeurosis.
9. Sensory nerve supply of scalp
Mnemonic -- GLASS
ST & SO are branches of ophthalmic A, br of ICA.
STA, PAA & OA branch of ECA
10. Motor nerve supply of scalp
• The scalp on each side of the midline is
supplied by two motor nerves: one in front
of the ear and one behind the ear; both
these nerves are derived from the facial
nerve.
• In front of the ear -- temporal branch of
the facial nerve supplies frontal belly of
occipito-frontalis muscle.
• Behind the ear -- posterior auricular
branch of the facial nerve supplies
occipital belly of occipito-frontalis muscle.
Note --The arteries of one side
freely anastomose with one
another. There is also cross
anastomosis between the arteries of
two sides. Thus the scalp is also the
site of potential collateral circulation
between the external and internal
carotid arteries.
13. • Black eye: The blood and fluid collecting in
the layer of loose areolar tissue following a
blow on head tracks freely under the scalp
producing generalized swelling over the dome
of the skull, but cannot pass into either
occipital or temple regions because of the bony
attachments of the occipito-frontalis. The
blood and fluid can, however, track forward
into the eyelids because occipito-frontalis has
no bony attachment anteriorly. This leads to
formation of hematoma few hours after a head
injury or cranial operation causing black
discoloration of skin around the eyes, a
condition called black eye.
• It is important to note that the commonest
cause of black eye is local violence, such as
fist fight causing subcutaneous extravasation
of blood into the eyelids.
14. • Dangerous area of the scalp: The layer of loose areolar tissue is
called dangerous layer of scalp because blood and pus freely tend
to collect in this layer. If pus collects in this layer, the infection
may travel readily along emissary veins into the intracranial dural
venous sinuses leading to their thrombosis, which may be fatal.
15. Temple
• The area on the side of the skull
between the superior temporal line
and zygomatic arch is popularly
known as temple.
• The name temple is supposedly
derived from the fact that with age
(i.e., time) greying of hair occur first
in this area (tempus = time).
