1. Scalp

2. Learning objectives Describe the layers of scalp.
Describe the blood supply & nerve supply of scalp.
Describe the clinical importance of different layers of scalp.

3. Scalp Soft tissue covering the cranial vault. Extent:
Anterior - supra orbital margin.
Posterior- external occipital protuberance & superior nuchal lines.
Sides - superior temporal lines.

4. Scalp Scalp is made up of 5 layers. 1. Skin- S
2. Connective tissue (superficial fascia)- C
3. Deep fascia – A - Epicranial aponeurosis or galea aponeurotica with occipito frontalis muscle.
4. Loose areolar connective tissue- L
5. Pericranium- P

5. Layers of scalp

6. Scalp- skin Thin skin and hairy, rich blood supply.
Adherent to the epicranial aponeurosis.
Hairy part and non-hairy part

7. Scalp- superficial fascia
Fibrous and dense in the centre than periphery, contains blood vessels and nerves of scalp.
Binds the skin to the aponeurosis(first layer to the third layer).
Provides medium for the blood vessels and nerves to pass through.

8. Scalp - Epicranial aponeurosis
Freely mobile over the pericranium along with the the 1st and 2nd layers.
Anteriorly receives insertion of frontalis.
Posteriorly receives insertion of occipitalis.
Sides attached to the superior temporal lines.

9. Scalp: Loose areolar connective tissue
Anteriorly extends to the eyelid.
Posteriorly extends to the superior nuchal lines.
Laterally extends to the superior temporal lines.

10. Scalp: Pericranium Loosely attached to the bones.
But firm in the sutures.

11. Muscle of scalp Occipitofrontalis muscle:
Pairs of frontal and occipital belly connected by broad aponeurosis- the galea aponeurotica
Attachments :
Occipital belly and galea aponeurotica - to occipital bone (posterior) and zygomatic arches (lateral).
Frontal belly - into the skin
Function: moves the scalp, forehead skin (Tranverse wrinkles – Fright) and raise eyebrows ( surprise).

12. Scalp- Arterial supply
In front of the auricle:
1.Supratrochlear
2.Supraorbital
3.Superficial temporal – External carotid artery.
Behind the auricle:
4.Posterior auricular
5.Occipital
Ophthalmic artery -
Internal carotid
artery
External carotid

13. Scalp – Venous drainage
Supratrochlear + Supra orbital → angular vein → facial vein
Superficial temporal + Maxillary vein
→ retromandibular vein → divides into anterior and posterior division.
- Anterior division + facial vein → common facial veins → internal jugular vein.
Posterior division + Posterior auricular vein
→ external jugular vein → subclavian vein.
Occipital vein → sub occipital plexus

14. Scalp – Nerve supply Preauricular region: 5 nerves-
Sensory-
Supraorbital and supratrochlear – frontal – ophthalmic division
Zygomatico temporal – maxillary division
Auriculotemporal – mandibular division
Motor-
- Temporal branch – Facial nerve
Post auricular region: 5 nerves-
Sensory
Great auricular – C 2,3
Lesser occipital – C 2
Greater occipital – C 2
Third occipital C 3
Motor
- Posterior auricular branch – Facial nerve

15. Scalp-Artery & Nerve

16. Scalp – lymphatic drainage
Anterior part – pre auricular nodes or parotid group.
Posterior part - posterior auricular nodes and occipital group.

17. Applied anatomy
Skin – Numerous sebaceous glands make the scalp one of the most common sites for sebaceous cysts.
Connective tissue - Blood vessels in this area are unable to retract when lacerated ( wall are attached to fibrous network) → scalp wounds bleed profusely and scalp wounds heal quickly.
Aponeurotic layer - Wounds of scalp gape if it is divided
Fluid accumulating here can not pass posteriorly or laterally – bony attachments of occipitalis and galea aponeurotica.
the frontalis is inserted anteriorly.
Loose areolar layer
Infections can be transmitted through bony channels by emissary and diploic veins to the cranial cavity. – Dangerous area of scalp. collection of fluids in loose connective tissue can enter the eyelids,to cause black eye
Cephalo hydrocele, caput succedaneum
Pericranium cephalohaematoma 17

18. Sebaceous cyst
Black eye

19. S-C-A-L-P
Extent: between superior orbital margin to superior nuchal line.
Divisions: hair-bearing & non–hair-bearing (ie, forehead).
Layers:
S - skin
C - connective tissue or superficial fascia
A - aponeurotic layer - galea aponeurotica /epicranial aponeurosis - dense fibrous sheet connecting frontalis and occipitalis muscle.
L - loose areolar connective tissue.
P -pericranium, periosteum of bone. 19

20. Blood supply Branches of the external carotid : superficial temporal
posterior auricular
occipital
Branches of internal carotid:
via the ophthalmic artery :
Supratrochlear
supraorbital

21. Nerve supply
Sensory:
Branches of the trigeminal nerve: (5th cranial nerve)
Supratrochlear,supraorbital.
Zygomatico temporal
Auriculotemporal
Branches from cervical nerves: (spinal cord)
Great auricular
Greater occipital
Lesser occipital
Third occipital
Motor:
Branches of facial nerve:(7th cranial nerve)
Temporal branch
Posterior auricular branch

22. FACE

23. Learning objectives Describe the muscles of facial expression.
Describe the blood supply, nerve supply (sensory & motor) and lymphatic drainage of face.
Describe the clinical importance of face.

24. Face - Skin
Very vascular – bleeds profusely and wound healing is good. Reason for blush…
Rich sebaceous gland – infection – Acne
Laxity of skin – edema.
Boils on the nose and pinna are painful.

25. Face – Superficial fascia
Has muscles, nerves and blood vessels.
Variable amount of fat.
Deep fascia is absent.

27. Face - Muscles

28. Muscles of facial expression
The muscles of facial expression inserted into to the dermis of the face.
All the muscles of facial expression are supplied by VII nerve.

29. Face - Muscles Muscles of scalp - Occipitofrontalis
Muscles of auricle -
Auricularis anteiror
Auricularis posterior
Auricularis superior
Muscles of the eyelid -
Orbicularis occuli
Corrugator supercilii
Levator palpebrae superioris
Muscles of the nose -
Procerus
Compressor naris
Dilator naris
Depressor septi

30. Face - Muscles

31. Face - Muscles

32. Face - muscles Muscles around mouth - Orbicularis oris
Levator labii superioris alaequae nasi
Levator labii superioris
Levator anguli oris
Zygomaticus minor
Zygomaticus major
Depressor anguli oris
Depressor labii inferioris
Mentalis
Buccinator
Muscle on the neck -
Plastyma

33. Face - Muscles

40. Face – Blood supply
Arterial supply

41. Facial artery Branch from external carotid artery.
Given off at the carotid triangle.
In face is very tortuous.
Course:
Winds around the base of the mandible
Pierces deep fascia at the antero-inferior angle of masseter.
Ascends upwards towards the angle of the mouth.
Ascends upwards by the side of the nose to the angle of the eye to anastomose with dorsal nasal branch of the ophthalmic artery.
Branches:
ANTERIOR Branches
Inferior labial
Superior labial
Lateral nasal
POSTERIOR branches
Unnamed ones
ALL THESE BRANCHES ANASTOMOSE WITH THEIR COUNTERPARTS FROM THE OTHER SIDE OF THE FACE
Facial artery

43. Facial Artery
Facial artery

47. Face – Blood supply
Venous drainage

48. Veins of the face
Supratrochlear + Supra orbital → angular vein → facial vein.
Superficial temporal + Maxillary vein
→ retromandibular vein → divides into anterior and posterior division.
- Anterior division + facial vein → common facial veins → internal jugular vein.
Posterior division + Posterior auricular vein
→ external jugular vein → subclavian vein.

51. Face – Nerve supply
Sensory supply

52. Face – Nerve supply Sensory supply: Branches from trigeminal nerve.
- Ophthalmic
- Maxillary
- Mandibular

58. Face – Nerve supply Motor:
All the muscles of the face supplied by the facial nerve except levator palpbrae superioris by the 3rd cranial nerve – oculomotor.

60. Facial Nerve

61. Facial Nerve

62. Facial Nerve

63. Face – lymphatic drainage
Pre auricular nodes.
Submandibular nodes.
Submental nodes.

64. Face- applied anatomy Head ache. Facial nerve paralysis.
Trigeminal neuralgia.

65. Bell’s palsy
Paralysis of the facial nerve resulting in inability to control facial muscles on the affected side.
Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common cause of acute facial nerve paralysis.

66. Bell’s palsy

67. Summary

70. Lacrimal apparatus

71. Lacrimal apparatus

72. Lacrimal apparatus
The lacrimal apparatus is the physiologic system containing the orbital structures for tear production and drainage.
Consists of:
(a) the lacrimal gland, which secretes the tears, and its excretory ducts, which convey the fluid to the surface of the eye;
(b) the lacrimal canaliculi, the lacrimal sac, and the nasolacrimal duct, by which the fluid is conveyed into the cavity of the nose

73. Lacrimal gland
Each lacrimal gland is divided into orbital and palpebral portions by the aponeurosis of the Levator palpebrae superioris muscle, the portions are continuous with each other.
The orbital portion is the largest of the portions, and its convex superior surface is lodged in the lacrimal fossa of the orbit.
For the smaller palpebral portion, its inferior surface lies close to the eye; if the upper eyelid is everted, the palpebral portion can be seen.
The orbital portion contains fine interlobular ducts that unite to form main excretory ducts, joining ducts in the palpebral portion before the secreted fluid may enter on the surface of the eye.

74. Structure
The lacrimal gland is a tubuloacinar gland, it is made up of many lobules separated by connective tissue, each lobule contains many acini.
Each acinus consists of a grape-like mass of cells with their apices pointed to a central lumen.
The central lumen of many of the units united to form intralobular ducts, and then unite to from interlobular ducts.

75. Innervation
The sensory innervation to the lacrimal gland is from the lacrimal nerve.
The parasympathetic nerve supply originates from the lacrimal nucleus of the facial nerve in the pons. Just before reaching the geniculate ganglion, the facial nerve gives off the greater petrosal nerve. This nerve carries the parasympathetic secretomotor fibers through the pterygoid canal to the pterygopalatine ganglion. Here the fibers synapse and postganglionic fibers join the inferior orbital nerve, which travels through the inferior orbital fissure. Once it has traversed this opening, the parasympathetic secretomotor fibers join a branch of this inferior orbital nerve, namely the zygomatic nerve, part of which innervates the lacrimal gland.
The sympathetic postganglionic fibres originates from the superior cervical ganglion. They travel as a periarteriolar plexus with the middle meningeal artery, before they merge and form the deep petrosal nerve, which joins the greater petrosal nerve in the pterygoid canal. Together, greater petrosal and deep petrosal nerves form the nerve of the pterygoid canal (vidian nerve) and reach the pterygopalatine ganglion in the pterygopalatine fossa.In contrast to their parasympathetic counterparts, sympathetic fibers do not synapse. However they join the parasympathetic fibers, hence from this point on the routes of the parasympathetic and sympathetic fibers for the lacrimal gland are the same (inferior orbital nerve -> inferior orbital fissure -> zygomatic nerve -> lacrimal gland).

76. Blood supply
The lacrimal artery, derived from the ophthalmic artery supplies the lacrimal gland.
Venous blood returns via the superior ophthalmic vein.

77. Lacrimal apparatus

78. LACRIMAL CANALICULI Begins in lacrimal punctum Ampulla
Superior and inferior canaliculus

79. LACRIMAL SAC Upper blind end Lower continue with naso lacrimal duct
12mm length 5mm width

80. NASO LACRIMAL DUCT 18mm length Bony canal Valve of hasner
Inferior meatus