The document discusses the anatomy of the face and scalp. It describes the layers of the scalp including skin, connective tissue, aponeurosis, loose areolar tissue and pericranium. It details the muscles of the scalp including the occipitofrontalis muscle. The document then covers the anatomy of the face including skin, superficial fascia and facial muscles. It provides an in-depth overview of specific facial muscles and their functions. Finally, it discusses some applied considerations regarding abnormalities of the buccinator muscle and damage to the facial nerve.

2. ANATOMY OF FACE AND SCALP
&
MUSCLES OF HEAD AND NECK
DR. SPANDANA KASHYAP

3. Contents:
 Anatomy of Scalp
 Muscles of Scalp
 Applied Considerations of Scalp
 Anatomy of Face
 Muscles of Face
 Facial Expressions
 Applied Considerations of Facial muscles.
 References.

4. Anatomy of Scalp

5. What is a Scalp?
 It is a soft tissue covering the vault of the
cranium.

6. Extent:-
Anteriorly: Supra orbital margin.

7. Posteriorly: External occipital protuberance and
superior nuchal line.
External occipital protuberance Superior nuchal line

8. Laterally: Superior temporal line.

9. Layers of Scalp
 Skin
 Connective tissue
 Aponeurosis
 Loose areolar
tissue
 Pericranium

10. (1) Skull; (2) periosteum; (3) loose areolar tissue;
(4) galea; and (5) scalp.
Ref: Anatomical Study of Perfusion of a Periosteal Flap with a Lateral Pedicle
Kim, Boktae MD* et al. Plastic and Reconstructive Surgery - Global Open: September 2017 - Volume 5 -
Issue 9 - p e1476

11. 1. Skin
 The skin is thick and hairy.
 It is adherent to the epicranial aponeurosis through
dense superficial fascia(as in palm and soles)
 Contains numerous sebaceous glands.

12. 2. Connective tissue (superficial fascia)
 More fibrous and dense in the centre than at the
periphery of the head.
 Firmly attached to the skin and the aponeurosis.
 Provides a passageway for nerves and blood
vessels.

13. 3. Epicranial Aponeurosis
(Galea Aponeurotica)
 Freely movable on the
pericranium.
Extent:
 Anteriorly: Receives
insertion of frontalis.
 Posteriorly: receives
insertion of occipitalis &
attached to external
occipital protuberance

14.  Laterally: Aponeurosis is attached to the superior
temporal line, passes over the temporal fasica
and is attached to the zygomatic arch.

15. 4. Loose Areolar Tissue.
Attachment:
 Anteriorly: Eyelids.
 Posteriorly: Highest and
superior nuchal line.
 Laterally: Superior
temporal line
Gives passage to the emissary
veins which connect
extracranial veins to intracranial
venous sinuses.

16. 5. Periosteum (Pericranium) :
 Loosely attached to the
surface of the bones.
 But firmly adherent to their
sutures where the sutural
ligaments bind the
pericranium to the
endocranium .

17. Muscles of Scalp

18. Occipitofrontalis muscle:
Two
bellies
Occipital/
occipitalis
Frontal/
frontalis
Both are inserted into the epicranial aponeurosis.

19. Frontal Belly
 Longer, wider and
partly united in the
median plane.
 Origin: Epicranial
Aponeurosis.
 Insertion: Skin of the
eyebrows and
forehead.

20.  Action: Elevates eyebrows, wrinkles the forehead
and moves the scalp.
 Nerve supply: Temporal nerve.
 Arterial supply: Frontal branch of superficial
temporal artery, supraorbital and supratrochlear
artery.

21. Occipital Belly
 Small and separate.
 Origin: Lateral two thirds
of the superior nuchal
line of occipital bone.

22.  Insertion: Epicranial aponeurosis.
 Nerve Supply: Posterior auricular nerve.
 Arterial Supply: Posterior auricular artery

23. Applied Considerations

24. Sebaceous cysts
 Because of the abundance of sebaceous glands,
SCALP is a common site for sebaceous cysts.

25. Dangerous area of scalp
 The LOOSE AREOLAR CONNECTIVE TISSUE is a
harbor for a potential infection that can spread to
the meninges.
 Named ‘the danger zone’ of the scalp, the tissue
contains valve-less emissary veins that have direct
access to the cranial cavity.
 Pus and blood can build up in the flexible tissue, and
provide a route for meningitis.

26. Black eye
 Blunt trauma can result in
hemorrhage in Loose
Areolar Connective Tissue.
 Blood can spread forward
into the face, as frontalis
has no bony attachment,
resulting in black eye.

27. Caput Succedaneum
 Localised edema observed on an infant's scalp
shortly after delivery.
 It is a benign condition associated with birth-related
trauma to the scalp during delivery

28. Subgaleal hematoma
 Collection of blood in
between galea
aponeurotica and
periosteum.
 Associated with
delivery or attempted
delivery by vacuum
extraction..
Ref: Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and
management. CMAJ. 2001;164:1452–3.

29. Cephalohematoma
 Is an accumulation of blood/fluid deep to pericranium
.
 During the birth process, small blood vessels on the
head of the fetus are broken as a result of minor
trauma.

30. Anatomy of Face

31. FACE
It extends:
Superiorly: Superciliary
arches
Inferiorly: Lower edge of the
mandible.
Laterally: Each side of
the auricle.

32. Skin:
 Very vascular.
 Rich in sebaceous and sweat glands.
 Laxity of the skin.
 Fixity of the skin to underlying cartilages.
 Very elastic and thick.

33. Superficial fascia:
Facial muscles
Vessels and nerves
Adipose tissue

34.  Deep fascia is absent from the face.
 Except from:
Parotid gland
• Parotid
fascia
Buccinator
• Buccophary-
ngeal fascia.

35. FACIAL MUSCLES

36. Introduction:
 The muscles of facial expression are embedded in
the superficial fascia.
 They arise from the bone of the skull and inserted
into the skin.
 The absence of deep fascia makes facial expression
possible.

37. Embryological development:
 Innervated by branches of facial nerve.
Facial muscles develop from the mesoderm of the second
pharyngeal arch

38. MUSCLES OF FACE
Orbital Nasal Oral
Scalp Auricle Neck
TOPOGRAPHICAL DIVISION

39. Muscles of Auricle:
Auricularis Anterior
Auricularis Superior
Auricularis Posterior
AURICULAR ORIGIN INSERTION ACTION
ANTERIOR GALEA
APONEUROTICA
HELIX DRAWS AURICLE
ANTERIORLY
SUPERIOR GALEA
APONEUROTICA
SUPERIOR PART OF
AURICLE
DRAWS AURICLE
SUPERIORLY
POSTERIOR MASTOID PROCESS POSTERIOR PART OF
AURICLE
DRAWS AURICLE
POSTERIORLY

40. Muscles of Orbital Group
1. Corrugator supercilii:

41. 2. Orbicularis oculi:
ORBICULARIS
OCULI
ORIGIN INSERTION ACTION
ORBITAL PART MEDIAL PART OF
MEDIAL PALPEBRAL
LIGAMENT &
ADJOINING BONE
CONCENTRIC RINGS
RETURNING TO THE
POINT OF ORIGIN
•CLOSES LIDS
FORCEFULLY
•WRINKLES
•PROTECTS EYE FROM
BRIGHT LIGHT
PALPEBRAL PART LATERAL PART OF
MEDIAL PALPEBRAL
LIGAMENT
LATERAL PALPEBRAL
RAPHE
•CLOSES LID GENTLY--
BLINKING & SLEEPING
LACRIMAL PART LACRIMAL FASCIA &
POSTERIOR LACRIMAL
CREST
UPPER AND LOWER
EYELIDS
•DILATES LACRIMAL SAC
•PULLS EYELIDS
•RESHAPES EYEBALL
POSITION

42. Procerus:
Muscles around Nasal Opening:

43. Compressor Naris

44. Nasalis

45. Dilator Naris

46. Muscles of Oral Region
1. Orbicularis Oris
2. Levator Labii superior
Alaque Nasi
3. Zygomaticus Major
4. Levator Labii Superioris
5. Levator Anguli Oris
6. Zygomaticus Minor
7. Depressor Anguli Oris
8. Depressor Labii Inferioris
9. Mentalis
10.Risorius
11.Buccinator

47. Orbicularis Oris
ORBICULARIS ORIS ORIGIN INSERTION ACTION
INTRINSIC PART
EXTRINSIC PART
SUPERIOR INCISIVUS, DERVIED
FROM MAXILLA
INFERIOR INSCISIVUS, FROM
MANDIBLE.
THICKEST MIDDLE STRATUM-
DERIVED FROM BUCCINATOR.
THICK SUPERFICIAL STRATUM-
ELEVATORS AND DEPRESSORS
OF LIPS AND THEIR ANGLES.
ANGLE OF MOUTH
LIP AND ANGLE OF
MOUTH
•CLOSES AND
PROTRUDES THE MOUTH
•NUMEROUS EXTRINSIC
MUSCLES MAKE IT
VERSATILE FOR VARIOUS
GRIMACES

48. Mentalis
ORIGIN INSERTION ACTION
MANDIBLE INFERIOR TO
INCISOR TEETH
SKIN OF CHIN •ELEVATES & PROTRUDES
LOWER LIP AS IT WRINKLES
THE SKIN ON CHIN
•RETRACTS ANGLE OF
MOUTH
• LIP TIGHTNER

49. Orbicularis oris and mentalis muscle- Lip tightening

50. Levator Labii Superior Alaque Nasi
ORIGIN INSERTION ACTION
FRONTAL PROCESS OF
MAXILLA
ALAR CARTILAGE OF NOSE &
UPPER LIP
•DILATES THE NOSTRIL
•ELEVATES THE LATERAL
UPPER LIP AND WING OF THE
NOSE

51. ELEVATES THE LATERAL UPPER LIP AND WING OF THE NOSE

52. Orbicularis oris and Levator Labii Superior Alaque Nasi-
Lip funnel and wrinkles nose.

53. Zygomaticus Major
ORIGIN INSERTION ACTION
POSTERIOR ASPECT OF
LATERAL SURFACE OF
ZYGOMATIC BONE
SKIN AT THE ANGLE OF THE
MOUTH
PULLS THE ANGLE UPWARDS
& LATERALLY AS IN SMILING

54. WIDENS & SLIGHTLY ELONGATES OPENING OF MOUTH, WIDE SMILE

55. ORIGIN INSERTION ACTION
ANTERIOR ASPECT OF
LATERAL SURFACE OF
ZYGOMATIC BONE
UPPER LIP MEDIAL TO ITS
ANGLE
ELEVATES THE UPPER LIP
Zygomaticus Minor

56. ELEVATES UPPER LIP AND NASOLABIAL DEEPENER

57. Levator Labii Superioris
ORIGIN INSERTION ACTION
INFRA ORBITAL MARGIN OF
MAXILLA
SKIN OF UPPER LATERAL
HALF OF THE UPPER LIP
ELEVATES THE UPPER LIP,
FORMS NASOLABIAL
GROOVE

58. Levator Labii Superioris- Upper lip raiser.

59. Levator Anguli Oris
ORIGIN INSERTION ACTION
MAXILLA , BELOW THE INFRA
ORBITAL FORAMEN
SKIN OF ANGLE OF THE
MOUTH
ELEVATES THE ANGLE OF THE MOUTH
AND FORMS THE NASOLABIAL
GROOVE

60. Levator Anguli Oris – Sharp lip puller

61. Depressor Anguli Oris
ORIGIN INSERTION ACTION
OBLIQUE LINE OF MANDIBLE
BELOW THE FIRST MOLAR,
PREMOLAR & CANINE TEETH
SKIN AT THE ANGLE OF
MOUTH AND FUSES WITH
ORBICULARIS ORIS
DRAWS ANGLE OF THE
MOUTH DOWNWARD &
LATERALLY

62. Depressor Anguli Oris – Lip corner depressor and chin raiser
along with platysma and mentalis.

63. Depressor Labii Inferioris:
ORIGIN INSERTION ACTION
ANTERIOR PART OF OBLIQUE
LINE OF MANDIBLE
LOWER LIP AT MIDLINE, FUSES
WITH MUSCLES ON THE
OPPOSITE SIDE
DRAWS LOWER LIP
DOWNWARDS

64. Depressor Labii Inferioris: Lower lip depressor

65. Risorius:
ORIGIN INSERTION ACTION
FASCIA ON THE MASSSETER
MUSCLE
SKIN AT THE ANGLE OF THE
MOUTH
RETRACTS ANGLE OF MOUTH

66. Risorius and playtsma- lip stretcher.

67. Buccinator
ORIGIN INSERTION ACTION
UPPER FIBRES – FROM MAXILLA
OPPOSITE MOLAR TEETH
LOWER FIBRES – FROM MANDIBLE
OPPOSITE MOLAR TEETH
STRAIGHT TO UPPER LIP
(ORBICULARIS ORIS)
STRAIGHT – LOWER LIP
•FLATTENS CHEEKS AGAINST GUMS
AND TEETH
•PREVENTS ACCUMULATION OF
FOOD IN THE VESTIBULE
•WHISTLING MUSCLE
MIDDLE FIBRES -
PTERYGOMANDIBULAR RAPHE
MIDDLE FIBRES DECUSSATE
BEFORE PASSING TO THE LIPS

68. Buccinator – Causes dimples

69. Buccinator – Cheek blow

70. Muscles of Neck
 Platysma
ORIGIN INSERTION ACTION
UPPER PART OF PECTORAL
AND DELTOID FASCIA
FIBRES RUN UPWARD AND
MEDIALLY
ANTERIOR FIBRES – BASE OF
THE MANDIBLE
POSTERIOR FIBRES – SKIN OF
LOWER LIP AND FACE
PULLS ANGLE OF MOUTH
DOWNWARDS AS IN FEAR AND
FRIGHT

71. Platysma- Lip stretching

72. Facial Expressions
FACIAL
EXPRESSIONS

73. SMILE
•ZYGOMATICUS MAJOR
•ORBICULARIS OCULI
•DEPRESSOR LABII INFERIORIS
•ORBICULARIS ORIS

74. SADNESS
SADNESS
 FRONTALIS
 CORRUGATOR SUPERCILLI
 DEPRESSOR SUPERCILII
 DEPRESSOR ANGULI ORIS

75. FEAR
 FRONTALIS
 CORRUGATOR SUPERCILII
 ZYGOMATIC MINOR
 DEPRESSOR LABII INFERIORIS
 RISORIUS
 PLATYSMA

76. ANGER
 CORRUGATOR SUPERCILII
 PROCERUS
 DEPRESSOR SUPERCILII
 LEVATOR PALPEBRAE
 DILATOR NARIS
 DEPRESSOR SEPTI MUSCLES

77. SURPRISE
 FRONTALIS
 DEPRESSOR LABII
INFERIORIS

78. Applied Considerations

79. Abnormalities of Buccinator Muscle:
1. Crestal attachment of the buccinator muscle
 Rare phenomenon.
Etiology:
 Can be due to iatrogenic injury
during or postoperative
traumatic extractions.
 Loss of soft tissue
 Atrophic alveolar ridge
 Due to hyperactivity of
buccinator.
Yadav N, Kumar A, Manohar B, Shah M, Shetty N. Buccinator muscle repositioning: A rare case
report, short discussion, and literature review. Natl J Maxillofac Surg 2020;11:140-5

81. 2. Hyperactivity of the buccinator muscle:
 Cause excessive pressure on the underlying hard
tissues resulting in narrow arches and malocclusion.

82. 3.
• Damage to the facial nerve can lead
to paralysis of the buccinator muscles
• Difficulty in mastication as the non-
functioning of this muscle.
• Repeated laceration of the cheek
mucosa.

83.  Buccinator along with orbicularis oris and pharyngeal
constrictor forms a functional unit (buccinator
mechanism) which is essential for orofacial functions
(swallowing, sucking, whistling, chewing, vowel
pronunciation).
 In the oral cavity, inward forces by the orbicularis oris and
the buccinator muscle get balanced by the outward forces
of the tongue.
 If the buccinator is weakened or paralyzed, food tends to
accumulate in the vestibule during chewing
 Plays a role in stabilizing the denture by gripping the
polished surface of the denture.

84. Hemifacial Spasm
 Movement disorder of the muscles
innervated by the facial nerve.
 Characterized by progressive,
involuntary, irregular, clonic or tonic
movements of the muscles.
 Causes-
Sensory (visual or auditory
disturbances, pain),
Motor (facial weakness, trismus, bruxism)
Autonomic (lacrimation, salivation).
Ref: Hemifacial Spasm: Conservative and Surgical Treatment Options,
Christian Rosenstengel, Marc Matthes, Jörg Baldauf, Steffen Fleck, Henry Schroeder
Dtsch Arztebl Int. 2012 Oct; 109(41): 667–673.

85. Myasthenia Gravis
 Myasthenia gravis (MG) is an autoimmune antibody-mediated
disorder of neuromuscular synaptic transmission.
 Clinical hallmark of MG consists of fluctuating fatigability and
weakness affecting ocular, bulbar and (proximal) limb skeletal
muscle groups.
 Most common symptoms- Unilateral ptosis, diplopia difficulty in
mastication & deglutition. Causes slow & slurred speech
Ref: Clinical features, pathogenesis, and treatment of myasthenia gravis: a supplement to the Guidelines of the German
Neurological Society J Neurol. 2016; 263: 1473–1494.

86. Bells palsy
 An idiopathic facial paralysis, is defined as an acute-
onset, isolated, unilateral, lower motor neuron facial
weakness.
 There may be absence
of forehead wrinkling,
droopy eyelid, dry eye,
or excessive tearing,
facial weakness, drooping
corner of mouth, dry mouth
and impaired taste.
Ref: Somasundara D., Sullivan F. Management of Bell's palsy. Aust
Prescr. 2017;40:94–97.

87. REFERENCES:
 BD CHAURASIA’S HEAD AND NECK ANATOMY 6TH EDITION.
 ULDIS ZARINS – ANATOMY OF FACIAL EXPRESIONS.
 GRAYS ANATOMY FOR STUDENTS, 3RD EDITION.
 Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and
management. CMAJ. 2001;164:1452–3.
 Clinical features, pathogenesis, and treatment of myasthenia gravis:
a supplement to the Guidelines of the German Neurological Society
J Neurol. 2016; 263: 1473–1494.
 Yadav N, Kumar A, Manohar B, Shah M, Shetty N. Buccinator muscle
repositioning: A rare case report, short discussion, and literature
review. Natl J Maxillofac Surg 2020;11:140-5
 Hemifacial Spasm: Conservative and Surgical Treatment Options-
Christian Rosenstengel, Marc Matthes, Jörg Baldauf, Steffen Fleck,
Henry Schroeder, Dtsch Arztebl Int. 2012 Oct; 109(41): 667–673.
 Somasundara D., Sullivan F. Management of Bell's palsy. Aust
Prescr. 2017;40:94–97.