1. Scalp, face and lacrimal apparatus
Dr. ASHWINI SHETTY

2. Scalp Soft tissue covering the cranial vault
It is hair bearing area of the skull
Extend from supra orbital margin anteriorly to external occipital protuberance & superior nuchal line posteriorly
On each side to superior temporal line

3. SCALP S-Skin C-connective tissue (superficial fascia)
A-aponeurosis (galea aponeurotica)
L-loose areolar tissue
P-pericranium

4. Skin
Thick and hairy
Firmly attached to the epicranial aponeurosis through dense fascia
Abundance sebaceous glands
Sebaceous cyst are common

5. Connective tissue
Fibrous and dense containing blood vessels and nerves
Binds skin to subjacent aponeurosis
Wounds bleed profusely as blood vessels are prevented from retraction by fibrous tissue. Bleeding is stopped by applying pressure against the bone
Subcutaneous hemorrhage are not extensive since fascia is dense
Inflammation cause little swelling but are much painful

6. Aponeurosis
Anteriorly frontal belly and posteriorly occipital belly of occipitofrontalis muscle
Frontal belly originate from skin of forehead and mingled with orbicularis oculi muscle
Occipital belly originate from lateral 2/3 of superior nuchal line
It gaps if cut transversely and should be stitched

7. Loose areolar tissue
Extends anteriorly into the eyelids because frontalis has no bony attachment
Posteriorly to superior nuchal line
On each side to superior temporal line
Bleeding cause generalized swelling of scalp
Called dangerous layer of scalp-emissary veins open here and carry any infections inside the brain (venous sinus)
Bleeding lead to black eye
Caput succedaneum in new born

8. Pericranium Is the periosteum of skull
Loosely attached to surface of bone but is firmly adherent to the sutures
Injury deep to it take the shape of bone (cephalhaematoma)
Scalping injury- should be replaced and stitched because healing is better

9. Caput succedaneum
cephalhaematoma

11. Blood supply Arteries Veins-follows the artery Supratrochlear
Supraorbital
Superficial temporal
Posterior auricular artery
Occipital artery
Veins-follows the artery

12. Nerve supply In front of auricle Behind auricle Supratrochlear n.
Supraorbital n.
Zygomaticotemporal n.
Auriculotemporal n.
Temporal branch of facial n.
Behind auricle
Greater auricular n
Lesser occipital n.
Greater occipital n.
Third occipital n.
Post. Auricular branch of facial n.

13. Lymphatics Anterior part Posterior part
Preauricular (parotid) gr. of lymph node
Posterior part
Posterior (mastoid) gr. of lymph node &occipital gr. of lymph node

14. Face
Boundaries
Extends superiorly to the hair line, inferiorly to the chin and base of mandible, and on each side to auricle
Forehead is common to both scalp and face

15. Skin Very vascular Due to rich vascularity face blush and blanch
Wounds of face bleed profusely but heal rapidly
Results of plastic surgery are excellent on face
Facial skin is rich in sebaceous gland and sweat gland
Sebaceous gland keep the skin oily but also cause acne in adult
Sweat gland regulate body temperature

16. Facial muscle
Called muscle of facial expression and lie in superficial fascia
Embryologically they develop from mesoderm of 2nd branchial arch, therefore supplied by facial nerve

18. Orbicularis oculi 3 parts- Orbital part
Originate from medial part of medial palpebral ligament and form concentric rings, return to point of origin
Action –closes the lids tightly
Palpebral part
Originate from lateral part of medial palpebral ligament
Insert into lateral palpebral raphe
Action-closes the lids gently
Lacrimal part
Originate from lacrimal fascia& lacrimal bone
Insert into upper &lower tarsi
Action-dilate lacrimal sac

19. Orbicularis auris
Originate from maxilla above incisor teeth and insert into skin of lip.
Action –closes the mouth

20. Buccinator Upper fibers Origin- from maxilla opposite molar teeth
Insertion-upper lip
Lower fibers
Origin-from mandible opposite molar teeth
Insertion-lower lip
Middle fibers
Origin –from pterigomandibular raphe
Insertion-decussate before passing to lips
Action- prevent accumulation of food in vestibule of mouth

21. Platysma Origin– upper part of pectoral and deltoid fascia
Insertion– base of mandible, skin of lower face and lip
Action– releases pressure of skin on the subjacent veins, depress mandible, pulls angle of mouth downwards

22. Nerve supply of face
Motor supply
Facial nerve

23. Sensory supply Ophthalmic division Supratrochlear Supraorbital
Lacrimal
Infratrochlear
External nasal
Maxillary nerve
Infraorbital
Zygomaticofacial and zygomaticotemporal
Mandibular nerve
Auriculotemporal
Buccal nerve
Mental
Skin over the mandibular angle is supplied by ant. Div. Of greater auricular n.

24. Blood supply of face Arterial supply- Facial artery
Superficial temporal artery
Ophthalmic artery
Supraorbital and
Supratrochlear

25. Venous drainage
Vein follow the arteries and drain into common facial vein and retromandibular vein
Deep connections of facial vein-
Communication between supraorbital &superior ophthalmic vein
With pterigoid plexus of vein through deep facial vein.
Superior ophthalmic vein & ptergoid plexus of vein communicate with cavernous sinus

26. Lymphatic drainage 3 territories-
Upper territories- greater part of forehead, lateral ½ of eye lid, conjunctiva, lateral part of cheek and parotid area– preauricular lymph node (parotid)
Middle territories- median part of forehead, external nose, upper lip, lateral part of lower lip, medial ½ of eye lid, medial part of cheek, greater part of lower jaw– submandibular lymph node
Lower territories- central part of lower lip, chin– sub mental lymph node

27. Applied Trigeminal neuralgia
Maxillary and mandibular nerve are involved
Excruciating pain in the region of distribution of these nerve
In infranuclear lesions of facial nerve (eg, bell’s palsy)- whole face is paralyzed
c/f
Affected side is motionless
Loss of wrinkles
Eye cannot be closed
In smiling the mouth is drawn to normal side
During mastication food accumulates in vestibule of mouth
In supranuclear lesions of facial nerve only the lower part of face is paralyzed. The upper part (frontalis &part of orbicularis oculi) escapes due to its bilateral innervation

29. Dangerous area of face- infections from face mainly from upper lip & nose can go to cavernous sinus through ophthalmic vein and deep facial vein

30. Thanks