Scalp and Face

Features that can be identified on the Face.

•Forehead: upper part of face between the hair line of the scalp &
eyebrows.
•Frontal eminence: superolateral prominence of forehead.
 prominent ridge separating the right & left halves of the nose
is called the dorsum
Upper end of the nose is called the root of the nose.
Lower end of the dorsum is in form of a somewhat rounded tip
At the lower end of the nose are two nostrils
Two nostrils are seperated by a soft median partition called the
columella.
 Nasal septum separates two nasal cavities
 Each nostrils is bounded laterally by the ala.
 Palpebral fissure- an elliptical opening between the two eyelids
 Lids are joined to each other at the medial & lateral angles
(canthi) of the eye.
 Free margins of each eyelid has eye lashes arranged along its
outer edge.
 Through the palpebral fissure we can see
a. opaque sclera
b. transparent circular cornea through which colored iris and
dark circular pupil are seen.
 Conjunctiva- moist, transparent membrane which covers the
ant surface of the eyeball (bulbar conjunctiva) and post surface
of eye lids (palpebral conjunctiva)
 The line along which bulbar conjunctiva becomes palpebral
conjunctiva is known as conjunctival formix.
 Oral fissure is the opening between upper and lower lips
 Angle of the mouth usually lies just in front of the 1st premolar
tooth.
 Philtrum is the median vertical groove on the upper lip.

 External ear is made up of 2 parts

a. Auricle or pinna is the superficial projecting part
b. External acoustic meatus is a deep canal.
 The scalp

• Soft tissues covering the

cranial vault form the scalp.
• Consists of 5 layers
1. Skin
2. Connective tissue
3. Aponeurosis
4. Loose areolar tissue
5. Pericranium
Muscles of Scalp

• Occipitofrontalis:

Origin:

Insersion:

Nerve supply:

Action:
Sensory Nerve supply of the scalp

• They lie in the superficial

fascia
• They are:
• Infront of auricle:
1. Supratrochlear N.
2. Supraorbital N.
3. Zygomaticotemporal N.
4. Auriculotemporal N.

• Behind the auricle:

1. Lesser occipital N.
2. Greater occipital N.
 Arterial supply of the scalp
• Has rich blood supply
• Arteries lie in the superficial fascia
• They are:
• Infront of auricle:
1. Supratrochlear and supraorbital arteries
2. Superficial temporal artery

• Behind the auricle:

1. Posterior auricular artery
2. Occipital artery
Venous drainage of the scalp

• Veins of the scalp

accompanies the arteries
• Supratrochlear and
supraorbital v.
• Superficial temporal v.
• Posterior auricular v.
 Lymphatic drainage of scalp
• Lymph vessels in the ant part of the scalp and forehead drain in
submandibular LN.
• Lateral part of scalp above the ear drains into superficial parotid
nodes.
• Lymph vessels from behind the ear drains into the mastoid
nodes.
• Vessels in the back of the scalp drain into occipital nodes.
 Clinical significance
• Skin of scalp possess numerous sebaceous glands, the duct of which are
prone to infection and damage by combs. therefore sebaceous cysts of
scalp are common.
• The scalp has a profuse blood supply to nourish hair follicles. Even a small
laceration of scalp can cause severe blood loss. It is difficult to stop the
bleeding of scalp wound because arterial walls are attached to the fibrous
septa in sub cut tissue and are unable to contract allowing the blood clotting
to take place.
Local pressure applied to the scalp is the only satisfactory method of
stopping bleeding.

• Life threatening scalp hemorrhage: it is useful to remember in emergency,

that all the superficial arteries supplying the scalp ascends from face and
neck. In an emergency situation, encircles the head just above the ears and
eyebrows with a tie or shoe laces and tie it tight. Then insert a pen or pencil
or stick into the loop and rotate it so that tourniquet exerts pressure on the
arteries.
 Face
Boundaries:
• Superiorly- hairline
• Inferiorly- base of mandible
• On each side- auricles
 Forehead is therefore common to both face and the scalp.

Skin:
• Very vascular
• Rich in sebaceous and sweat glands.
• Laxity

Superficial fascia:

Contains:
• Facial muscles
• Vessels and nerves
• Fat
Facial muscles (muscles of facial expression):
• Subcutaneous muscles
• Bring about different facial expressions
Grouped under following heading:
1. Muscles of scalp:
• Occipitofrontalis
2. Muscles of auricle:
• Auricularis ant
• Auricularis sup
• Auricularis post
3. Muscles of eyelids:
• Orbicularis oculi
• Corrugator supercilli
• Levator palpebrae superioris
4. Muscles of nose:
• Procerus
• Compressor naris
• Dilator naris
• Depressor septi
5. Muscles around the mouth:
• Orbicularis oris
• Levator labii superioris alaequae nasi
• Zygomaticus major
• Levator labii superioris
• Levator anguli oris
• Zygomaticus minor
• Depressor angulioris
• Depressor labii inferioris
• Metalis
• Risorius
• buccinator
6. Muscles of neck
• Platysma

• Expressions produced by these muscles:

1. Smiling & laughing- zygomaticus major
2. Sadness- levator labii superioris, levator angulioris
3. Grief- depressor anguli oris
4. Anger- dilator naris / depressor septi
5. Frowning- corrugator supercilli/ procerus
6. Horror/ terror/ fright- platysma
7. Surprise- frontalis
8. Doubt- mentalis
9. Grinning- risorius
10. Contempt- zygomaticus major
11. Closing of mouth- orbicularis oris
12. Whistling- buccinator/ orbicularis oris
• Motor nerve supply of face:
• Facial nerve: through 5 branches
1. Temporal
2. Zygomatic
3. Buccal
4. Mandibular
5. Cervical

• Sensory supply of face:

• Trigeminal nerve: through 3 branches
1. Ophthalmic
• Lacrimal
• Supraorbital
• Supratrochlear
• Infratrochlear
• Ext nasal nerve
2. Maxillary N:
• Infraorbital
• Zygomatico facial
• Zygomatico temporal
3. Mandibular N:
• Mental
• Buccal
• Auriculotemporal
Arterial supply of face:
1. Facial artery:
• Submental A
• Inf. labial A
• Sup. Labial A
• Lat. Nasal A

2. sup. Temporal A:
3. Transverse facial A:
4. supratrochlear/ supraorbital A:
Venous drainage of
face:
Lymphatic drainage of face:
• Divided in 3 territories
1. Upper t- greater part of
forehead/ lat. Halves of
eyelids/ conjunctiva/ lat. Part
of cheek/ parotid area
2. Middle t- median part of
forehead/ ext nose/ upper lip/
lat part of lower lip/ medial
halves of eyelids/ medial part
of cheek/ lower jaw
3. Lower t- central part of lower
lip/ chin
Dangerous area of the face:
• Facial vein communicates with cavernous sinus through
pterigoid plexus & deep facial vein. Infection from the face can
spread in a retrograde direction and cause thrombosis of the
cavernous sinus. This is likely to occur in infection of the upper
lip & lower part of the nose, therefore called dangerous area of
face.
• Bell’s palsy (infranuclear lesions of facial nerve)
 Whole of the face of same side gets paralyzed & becomes
asymmetrical
 Face is drawn towards the normal side
 Affected side is motionless
 Wrinkles disappear from forehead
 Eye of the affected side can not be closed
 Attempt to smile draws the mouth to the normal side
• Supranuclear lesion of facial nerve: (usually a part of
hemiplegia)
• Only the lower part of the opposite side of face is paralyzed
• Upper part with frontalis and orbicularis oculi escapes due to its
bilateral representation in the cerebral cortex.