SCALP

MAJ RISHI POKHRELDEPT OF ANATOMY

NAIHS

Scalp• Soft tissue covering skull vault

• Extension– Eyebrows to occipital protuberance

– Zygomatic arch to temporal lines

Layers

S : Skin

C : dense Connective tissue

A : Aponeurosis of occipito-frontalis

L : Loose connective tissue

P : Pericranium

First 3 layers forms a single functional layer

Layers

Skin

– Thickest , 3-7 mm

– Abundance of hair,

sebaceous, sweat glands

Dense Connective tissue

– Corresponds to superficial

fascia

– Dense fibro fatty tissue

– Numerous blood vessels and

nerves

– Connects layer of skin with

aponeurosis

• Aponeurosis of occipeto-frontalis muscle

Attachments of muscle

• Frontal belly

– Ant: Skin of eyebrows, skin of root of nose &

orbicularis oculi

– Post: aponeurosis

• Occipital belly

– Behind : to lat ½ half of superior nuchal line

– Front : aponeurosis

• Functions

– Occipital belly : pulls scalp back, anchors aponeurosis

– Frontal belly : elevate eyebrow, transverse wrinkles

• Nerve supply: facial nerve

Occipitalis is attached to bone, frontalis is not

Aponeurosis (galea aponeurotica)

Loose connective tissue

• Loose areolar tissue

• Contain emissary veins

• Potential space over which

layer 1 to 3 move

Pericranium

• Periosteum of bone of skull

• Intimately adherent to

endocranium

• Firmly attached to suture

lines, loose elsewhere

Nerve supply of head & neck

Nerve supply of scalp

Nerve supply of scalp

Arterial supply & venous drainage of scalp

SCALP – NERVE & BLOOD SUPPLY

1

2

3

4

5

6

8

7

9

10

1. Supratrochlear (V1)

2. Supraorbital (V1)

3. Z-T (V2)

4. Temp br CN VII (supply frontalis)

5. Auriculotemp N (V3)

6. Great auricular ( C1,C2)

7. Post auricular (CN VII N- supply occipital belly))

8. Lesser occipital (C2, C3)

9. Greater occipital (C2)

10. Third occipital (C3)

Supratrochlear – br of opth art

Supraorbital – br of opth art

superficial temporal art-

terminal br of ECA

post auricular art – br of ECA

occipital art – br of ECA

SCALP

Nerve supplyBlood supply

Venous Drainage

– Veins accompany the

artery

– Emissary vein from scalp to

intracranial venous sinus

– Diploic vein

• Drain frontal and occipital

diploe and enter main vein

of scalp

Lymphatic Drainage

– In front of ear : pre-

auricular group

– Behind ear : post auricular

EMISSARY VEINSEmissary veins along with layers of skull

Clinical anatomy

Applied Anatomy• Black eye

– Spread thro subaponeurotic space

• Scalp lacerations

• Sebaceous cysts

• Gaping wounds

– Due to incisional wound of galea in coronal plane

• Cephalhaematoma

• Bone flaps

• Dangerous area of scalp

– Loose areolar tissue – infection spread to intracranial venous sinus thro

emissary vein

• Caput succedaneum

• Safety valve mechanism

• Scalp avulsion

BLACK EYE

Blood tracks down below frontalis to eye lid

Hematoma in Scalp

• Caput succadeum : haematoma bt skin and aponeurosis

• Sub galeal haematoma :b/w aponeurosis and periosteum

• Cephalhaematoma :b/w skull bone and its periosteum (limited by suture lines)

Scalp Avulsionpreoperative

postperative

Hair removed

After some time……

Sebaceous cyst

Gaping wound of scalp

?