THE_SCALP_AND_THE_FACE.pptx

Dr. NDAYISABA CORNEILLE
CEO of CHG
MBChB,DCM,BCSIT,CCNA
THE SCALP AND THE FACE
Supported BY

THE SCALP
• Is a multilayered structure with the layers that
can be defined by the word itself.
• Extends from;
– The supraorbital margins anteriorly
– To the highest nuchal line posteriorly
– Down to the ears & zygomatic arches laterally.
• The forehead is common to both the scalp &
face.
7/17/2023 DR NDAYISABA CORNEILLE

Layers of the SCALP
•Skin
•Connective tissue
•Epicranial
aponeurosis
•Loose areolar tissue
•Pericranium

Skin
• Is thick & hairy.
• Contains
numerous
sebaceous gland.
• Firmly attached to
the CT as in palms
& soles.

Connective tissue Layer
• This is a fibrofatty layer that
connects skin to the underlying
aponeurosis of the
occipitofrontalis muscle
• Provides a passageway for
nerves and blood vessels.
• Blood vessels are attached to
this CT.
• If the vessels are cut, this
attachment prevents vasospasm,
which could lead to profuse
bleeding after injury.
• the arteries are branches of the
external and internal carotid
arteries, and a free anastomosis
takes place between them

DR NDAYISABA CORNEILLE
APONEUROSIS
• EPICRANIAL
APONEUROSIS,
galea aponeurotica
• thin, tendinous
sheet
• unites the occipital
and frontal bellies
of the occipito-
frontalis muscle
• The lateral margins
of the epicranial
aponeurosis are
attached to the
temporal fascia

Loose areolar tissue
• This connects the
aponeurosis to the
pericranium.
• Allows the 3 superficial
layers to move over the
pericranium & permits
avulsion(scalping) to
occur.
• Extends down beneath
the orbicuaris oculi into
the eyelid..

• Bleeding anywhere
beneath the
aponeurosis may
appear as black eye
due to blood tracking
down via the space
• Infections tend to
localize & spread via
the space.
• Certain emissary
veins traverse this
layer, & connects the
scalp veins to the
diploic veins &
intracranial venous
sinuses.

Pericranium
• Is the periosteum of
the skull bones.
• Along the suture
lines, it becomes
continuous with the
endosteum.
• It is loosely attached
to the skull & easily
stripped up by a
subperiosteal
hematoma.

Occipitofrontalis muscle
• Consists of 2 occipital
bellies and 2 frontal bellies.
• The occipital bellies arise
from the superior nuchal
lines on the occipital bone.
• The frontal bellies originate
from the skin and
superficial fascia of the
upper eyelids.
• Both of them insert into
the epicranial aponeurosis.
The frontal bellies can raise the eyebrows as in
surprise situation.

Nerve Supply
• Occipital belly -
by the posterior
auricular branch
of the facial
nerve.
• Frontal belly - by
the Temporal
branch of the
facial nerve.

• Supratrochlear nerve - A branch
of the ophthalmic division of
the trigeminal nerve; supplies
the scalp in the medial plane at
the frontal region, up to the
vertex
• Supraorbital nerve - a branch of
the ophthalmic division of the
trigeminal nerve; supplies the
scalp at the front, lateral to the
supratrochlear nerve
distribution, up to the vertex
Innervation

• Zygomaticotemporal
nerve - A branch of the
maxillary division of the
trigeminal nerve; it
supplies the scalp over
the temple region
• Auriculotemporal nerve-
A branch of the
mandibular division of
the trigeminal nerve;
supplies the skin over
the temporal region of
the scalp

• Lesser occipital nerve - A
branch of the cervical plexus
(C2); it supplies the scalp over
the lateral occipital region
• Greater occipital nerve - A
branch of the posterior ramus
of the 2nd cervical nerve; it
supplies the scalp in the
median plane at the occipital
region, up to the vertex
NOTE:
 The motor nerves are;
Temporal branch of facial
nerve and posterior auricular
branch of facial nerve.
 Other nerves are sensory

Arterial Supply
• The scalp has a rich vascular supply.
• The blood vessels traverse the CT layer, which
receives vascular contribution from the int & ext
carotid arteries.
• The blood vessels anastomose freely in the scalp.
They are
Supratrochlear artery
Supraorbital artery
Superficial temporal artery
Posterior auricular artery
Occipital artery

Venous Drainage
• The veins freely anastomose with one another &
are connected to the diploic veins of the skull
bones & the intracranial dural sinuses through
several emissary veins.
NOTE: The emissary veins connect the extracranial
veins with the intracranial veins to equalize the
pressure
• The emissary veins are valve less.
• The scalp veins accompany the arteries & have
similar names

EMISSARY VEINS
• Emissary veins:
are valveless
veins
• They connect
the superficial
veins of the
scalp with the
diploic veins of
the skull bones
and, through
them, with the
intracranial
venous sinuses

Supratrochlear and supraorbital veins
• Drain the anterior region of the scalp; these 2
veins unite to form the angular vein at the
medial angle region of the eye and continue
further as the facial vein
Suparficial temporal vein
• Descends in front of the auricle & enters the
parotid gland.
• It joins the maxillary vein to form the
retromandibular vein.

• The anterior division of
retromandibular vein unites
with the facial vein to form
the common facial vein,
which then drains into the
IJV
Posterior auricular vein -
Joins the posterior division
of the retromandibular vein
to form the EJV which then
drains into the subclavian
vein
Occipital vein - Terminates
in the suboccipital venous
plexus, which lies beneath
the floor of the upper part
of the posterior triangle

Lymphatic drainage
• The part of the scalp
that is anterior to the
auricles is drained to the
parotid, submandibular,
& deep cervical lymph
nodes.
• The posterior part of the
scalp is drained to the
posterior auricular
(mastoid) & occipital
lymph nodes.

Applied Anatomy
• Wounds in the scalp
bleed profusely – blc
the fibrous fascia
prevents
vasoconstriction.
• wounds superficial to
the aponeurosis gap
much less than deep
wounds that cut
through it blc
aponeurosis holds the
skin tight.

• Infection can be transmitted from the scalp to
the cranial cavity blc emissary veins do not
have valves & open in the loose areolar tissue.
The layer of loose areolar tissue is known as
the dangerous area of the scalp.
• Metastatic spread of malignant lesions via
lymph channels

Development of
The FACE

Development of the face
 The face develops from 5
mesenchymal prominences
(swellings or processes) that
appear in the 4th week.
 One Frontonasal prominence
(formed by proliferation of
mesenchyme and ectoderm
ventral to the forebrain).
 Two maxillary swellings (from 1st
pharyngeal arch).
 Two mandibular swellings (from
1st pharyngeal arch).

Development of the face
 These 5 prominences surround the stomodeum
(primitive mouth) , cranially , laterally and caudally.

Mouth:
Primitive oral cavity: develops from:
a)An ectodermal depression form by the
stomodeum. Its floor is closed by the buccopharyngeal
membrane.
b)An endormal part: is the cranial end of the pharynx.
The buccal membrane degenerates during the 4th week,
i.e. the 2 parts continue together.

Lips & gingivae:
Develops as a linear ectodermal thickenings
around the stomodeum  labiogingival laminae.
They grow into mesenchyme, then degenerate
forming labiogingival grooves separating lips
from gingivae.
A small area of laminae persists in median plane
forming frenulum of the lip.

Fate of the frontonasal process
• The lateral nasal folds form
the alae of the nose.
• The nasal pits get deeper and
they form the primitive nasal
cavities.
• The medain nasal fold forms:
1. Forehaed
2. Middle of the nose and nasal
septum
3. Filtrum of the upper lip
4. Premaxilla

Fate of maxillary processes
1. Cheeks
2. Upper lip except the filtrum
3. Palate except the premaxilla
Frnotnasal
process

III. The mandibular processes
• Develop from the mesenchyme of the 1st
pharyngeal arch.
• Fate :
1. Lower jaw
2. Lower lip
3. Floor of the mouth

Congenital anomalies
1. Anomalies of the mouth :
• Microstomia : small mouth opening
• Macrostomia : large mouth opening
• Agnathia : absence lower jaw
• Micrognathia : small lower jaw
• Anodontia : absence of the teeth
2. Anomalies of the nose :
• Stenosis of nostrils
• Deviation of the nasal septum
Macrostomia
Microstomia and single nostril

Microstomia
Macrostomia
Agnathia

3. Anomalies of the
face and palate :
1. Oblique facial cleft:
Due to failure of fusion
between maxillary &
frontonasal processes
(at nasolacrimal groove).
May include cleft upper
lip.

3. Cleft upper lip (harelip): Unilateral or
bilateral. The former is most common anomaly
of head & neck (1:1000). Due to failure of
fusion of maxillary process with medial nasal
fold.
4. Cleft lower lip: Usually central
Median cleft of the lower lip

Cleft lip

Unilateral cleft lip
and palate

Bilateral cleft lip
and palate

Unilateral cleft lip
and palate
Bilateral cleft lip
and palate

The Face
• Part of the head blw the ears & from the chin
to the hairline( or where it ought to be).

Skin of the face
• Has numerous sweat & sebaceous
glands.
• Varies in thickness & very thin on
the eyelids.
• Muscles underlying the skin are
attached to the dermis
• Senile facial wrinkles lie at right
angle to the line of pull of the
underlying muscles
• Brow - horizontal wrinkles
• Lat canthus – crow’s foot wrinkles
• Lips – vertical
• Incisions on the wrinkles heal with
minimal scarring.
 No deep fascia on the face

Muscles of the face
• Muscles of facial expression
• Develop from 2nd pharyngeal arch
• Supplied by facial nerve
• Found in the superficial fascia
• Originate from either bone or fascia & insert into
skin
• Act as sphincter & dilators of the orifices.
• Organized into groups
• Purpose of the muscles are to control the orifices.

Muscles of Facial Expression

Orbital group
Orbicularis oculi
• Large & surrounds each orbital orifice
• Extend into each eyelid
• Has 2 parts:
Outer orbital part
Palpebral part

• Orbicularis Oculi
• –Orbital part
– Closes eyes tightly -
wrinkling
• Palpebral part
– Closes the eyelid gently -
blinking
• –Innervation
– Temporal and Zygomatic
branch of Facial nerve

Corrugator supercillis
• Small & deep to the
eyebrows and the
orbicularis oculi.
• O – medial end of
superciliary arch
• I – skin of the medial half of
the eyebrow
• A – draws the eyebrows
towards the midline,
causing vertical wrinkle
above the nose
• Active when frowning.

Levator palpebral
superioris
• Component of
upper palpebral
fibre of
orbicularis oculi

Nasal group
• Nasalis
• Procerus
• Depressor septi
nasi

Nasalis
Has 2 parts
Originates from the maxila
 Transverse
part(compressor naris)
Inserts into the aponeurosis
across the dorsum
• Action –compresses the
nare
 Dilator naris
• Draws the alar cartilage
downwards & laterally
• Action- Opens the nare
• Inserted into the –alar
cartilage of the nose
• Shows anger

Procerus
• Small & superficial to
nasal bone
• O – nasal bone &
upper part of nasal
cartilage
• I – skin of lower
forehead blw the
eyebrows
• A – draws the medial
border of eyebrows
downwards to
produce transverse
winkle over the bridge
of the nose
• Active when frowning

Depressor septi
nasi
• Origin – maxilla, above
the central incisor
tooth
• Insertion – lower part
of nasal septum
• A – pulls the nose
downwards & help in
opening the nare
• Shows anger

Oral group
Orbicularis oris
• Encircles the mouth
• Origin – maxillary &
mandibular area
• Insertion – form ellipse
around the mouth
• Pursing of the mouth as in
kissing
Orbicularis Oris
(kissing muscle)
–Innervation
Mandibular branch of facial
nerve

Buccinator
• Origin – posterior part of
maxilla, mandible &
pterigomandibular raphe
• Insertion – blend with
orbicularis oris into the
lips
• Pierced by parotid duct
opposite 3rd upper molar
tooth
• For mastication,
whistling (trumpeter)
Buccinator
–Compression of the cheeks
(against the teeth)
-Trumpeter
–Innervation
Buccal branch of the facial nerve

Upper group of oral mzs
Risorius
• Converges on the
modiolus from
parotid fascia
• Retracts corner of
the mouth
• For grinning

Upper group of oral muscles………….
Levator labii superioris
• Origin – inferior orbital
margin
• Insertion - Upper lip
• Action – raises the
upper lip & form
nasolabial furrow
• Shows sadness

Levator labii superioris alaeque nasi
• Origin – frontal part of maxilla
• Insertion – ala of the nose &
upper lip
• Action – elevates both
 Levator anguli oris
• Origin – maxilla, below infra-
orbital foramen
• Insertion – skin at the corner of
the mouth
• Action – raises corner of the
mouth & help to form nasolabial
furrow and shows sadness
• NS – buccal branch of facial n

Zygomaticus major & minor
Major - superficial & arise
deep to orbicularis oris
• Insertion – skin at the
corner of the mouth
Minor –
• Origin – zygomatic bone,
anterior to the margin of
zygomaticus major
• Insertion – upper lip,
medial to the corner of
the mouth
Zygomaticus Muscles
–Elevates corners of mouth;
(smiling muscle)
–Innervation
Buccal branches of Facial nerve

Depressor labii inferioris
• Origin – mandible, in
front of the mental
foramen
• Insertion – lower lip
Depressor Labii Inferioris
–Depresses lower lip
–Innervation Buccal branches of
Facial nerve

Depressor anguli oris
• Origin – side of mandible,
below mental foramen,
premolar & 1st molar teeth
• Insertion – skin & upper part
of orbicularis oris near the
corner of the mouth
• Action – depresses the
corner of the mouth
• Active during frowning
• NS – marginal mandibular
branch of facial n
• Shows grief

Mentalis
• Origin – near the
middle of the mandible
• Insertion – skin
• Action – elevates the
chin, raises & protrude
the lower lip, wrinkles
the skin of the chin
• Nerve supply –
marginal mandibular
branch of facial n

Others
Platysma – large & thin
• Origin – The clavicle
• Insertion - mandible
• –Draws mouth
downward (pouting)
and shows fright
• –Innervation
• Cervical branch of Facial
nerve

Auricular muscles
• Auricularis
Superior
• Auricularis
Anterior
• Auricularis
Posterior
• Not usually
under voluntary
control

Motor innervation

Sensory innervation
Branches of trigeminal nerve:
• Ophthalmic
• Maxillary
• Mandibular
Arterial supply
• Facial artery

Arteries of the face

Venous
• Is superfical
• From forehead – supraorbital & supratrochlear veins.
• The 2 unite with angular v & becomes facial v.
• From temple into superficial temporal v, joined by
maxillary v to form retromandibular v

Veins of the face

Lymphatics
Into:
• Submental
• Submandibular
• preauricular

Clinical correlates
• Trigeminal neuralgia-Sudden attacks of excruciating pain
• Buccal nerve blocks-anesthetic injection can be made
into the mucosa covering the retromolar fossa, a
triangular depression posterior to the 3rd mandibular
molar tooth between the anterior border of the ramus
and the temporal crest

Facial nerve /bells palsy
• Loss of taste on the
anterior two thirds of
the tongue or altered
secretion of the lacrimal
and salivary glands
• Paralysis of the facial
muscles

FACIAL INFECTION
• DANGEROUS AREA OF FACE
• Infection of this area may lead to:
1. Thrombosis of facial vein
2. Infection may be transmitted to cavernous
sinus leading to cavernous sinus thrombosis

END
THANKS FOR LISTENING
By
MBChB,DCM,BCSIT,CCNA
Contact us:
amentalhealths@gmail.com/
ndayicoll@gmail.com
whatsaps :+256772497591
/+250788958241
7/17/2023

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