Face and Scalp

Face and Scalp
Intended learning outcomes

o To describe skin and muscles of the face
o To describe nerve supply of the face
o To describe blood supply of the face
o To describe layers of scalp
o To describe blood and nerve supply of the scalp
o To discuss clinical correlation
Face
Extension
o Extends superiorly to the hair line, inferiorly to the
chin and base of mandible, and on each side to
auricle
o Forehead is common to be part of both scalp and
face
Skeletal framework (facial skeleton)
Skin
o Very thin and highly vascular
o Facial skin is rich in sebaceous gland and sweat
gland
o Sebaceous gland keep the skin oily but also cause
acne in adult
o Sweat gland regulate body temperature
Facial skin
Tension lines
Aging of facial skin
worry lines
Crow’s feet
Loss of elastic fibers in skin cause permanent wrinkles (e.g., “Crow’s

feet” and “worry lines”.
Fascia of the Face
Superficial fascia
is loose –
however, there is
no discrete layer
of deep fascia of
the face
Deep fascia does
exist in the regions
of the parotid
glands and the
masseter muscles.
The other regions of
the face have much
subcutaneous tissue,
but no deep fascia.
Muscles of the face
oCalled muscle of facial expression and lie
in superficial fascia
oEmbryologically they develop from
mesoderm of 2nd branchial arch, therefore
supplied by facial nerve
Muscles of the Orbit
Muscles of the Mouth, Lips, and Cheeks
Muscles of ear
Other muscles of facial expression
Nerve supply of face
oMotor supply - Facial nerve
Sensory supply
o Ophthalmic nerve supply upper part to the tip of the nose
o Maxillary nerve supply middle part including upper lip
o Mandibular nerve supply lower part including lower lip
o Great auricular nerve supply skin covering angle of mandible
Blood supply of face
oArterial supply
oFacial artery
oSuperficial
temporal
artery
oOphthalmic
artery
o Supraorbital
o Supratrochlear
superficial
Blood supply of the face temporal
maxillary
occipital
internal facial
carotid a.
lingual
ext.carotid
sup.thyroid
vertebral inf. thyroid
common
carotid a.
Mohammed A. Ahmed 20
Venous drainage
o Vein follow the arteries and
drain into common facial vein
and retromandibular vein
o Deep connections of facial vein-
o Communication between
supraorbital &superior
ophthalmic vein
o With ptrygoid plexus of vein
through deep facial vein.
o Superior ophthalmic vein &
ptrygoid plexus of vein
communicate with cavernous
sinus
Dangerous triangular area of the face
Dangerous area of face-

infections from face
mainly from upper lip &
nose can spread to
cavernous sinus
through ophthalmic vein
and deep facial vein
Lymphatic drainage
o Greater part of forehead, lateral
½ of eye lid, conjunctiva, lateral
part of cheek and parotid area–
preauricular lymph node
(parotid)
o 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
o Central part of lower lip, chin–
sub mental lymph node
Damage of the Facial Nerve
Bell’s Palsy
Paralysis of Facial Muscles
Injury to the facial nerve (CN VII)
or its branches produces paralysis
of some or all facial muscles on
the affected side (Bell
palsy) ,lower motor neuron lesion.
SCALP
Scalp
The scalp consists of:

o Skin (normally hair-bearing) and
o Subcutaneous tissue
o it covers the calvaria
Extension
o Posteriorly, from the superior nuchal lines of the
occipital bone
o Anteriorly, from the supraorbital margin of the
frontal bone
o Laterally, over the temporal fascia, to the zygomatic
arches
26
Structure of the scalp
The SCALP consists of five layers:
oSkin
oConnective tissue
oAponeurosis
oLoose areolar tissue
oPericranium
27
Skin
Connective T
Aponeurosis
Loose CT
Pericranium
Coronal section
o Skin of the scalp is the thickest skin in the body
o Contains hair follicles, numerous sebaceous glands and
sweat glands
o Connective tissue is fibro-fatty
oFibrous septa connect the skin to the
underlying aponeurosis of the Occipito-
frontalis muscle.
oContains arteries, veins, nerves and
lymphatics
oArteries are branches of the external and
internal carotid arteries, and a free
anastomosis takes place between them 29
CONNECTIVE TISSUE
Aponeurosis
o Thin, tendinous
sheet
o Connects
occipital and
frontal bellies
of the
Occipito-
frontalis
muscle
prof. Makarem
o The lateral
margins of the
aponeurosis are
attached to the
temporal fascia
o the skin,
connective tissue
and aponeurosis
(layers 1, 2, 3) are
adherent to each
other and move as
a one unit
Subaponeurotic space
o Potential space
beneath the
aponeurosis
o limited in front
and behind by the
origins of the
Occipito-frontalis
muscle
o extends laterally as
far as the
attachment of the
aponeurosis to the
temporal fascia
o occupied by loose
areolar tissue
Loose areolar tissue
o loosely connects
the aponeurosis
to the periosteum
of the skull
(Pericranium)
o contains a few
small arteries
o contains some
important
emissary veins
Emissary veins
o Emissary veins
are valve less
veins
o connect the
superficial veins
of the scalp with
the diploic veins
of the skull
bones and,
through them,
with the
intracranial
venous sinuses
Pericranium
o It is the periosteum covering the outer surface of the skull bones

o at the sutures between individual skull bones, the periosteum on the
outer surface of the bones is continuous with the periosteum on the
inner surface of the skull bones
Muscles of the scalp
Occipito-frontalis
o consists of four bellies, two
occipital and two frontal,
connected by an
aponeurosis.
o occipital bellies are smaller
and arise from the highest
nuchal line
o The frontal bellies are
larger arise from the skin
and superficial fascia of the
eyebrow
Nerve supply:
o Occipital belly is supplied by the posterior auricular branch of the
facial nerve;
o Frontal belly is supplied by the temporal branch of the facial nerve.
Action
o The first three layers of the scalp can be moved
forward or backward, the loose areolar tissue of the
fourth layer of the scalp allowing the aponeurosis to
move on the Pericranium.
o Frontal bellies of the Occipito-frontalis can raise the
eyebrows in expressions of surprise.
Sensory nerve supply of the scalp
The main trunks of

the sensory nerves
lie in the
superficial fascia
supra-trochlear nerve a branch of the ophthalmic
division of the trigeminal nerve
o Supra-orbital nerve, a branch of the ophthalmic
o It supplies the scalp as far backward as the vertex
o Auriculo-temporal nerve, a branch of the mandibular
o Its terminal branches supply the skin over the temporal
region.
zygoma-ticotemporal nerve, a branch of the maxillary
division of the trigeminal nerve, supplies the scalp over the
temple.
lesser occipital nerve, a branch of the cervical plexus (C2),
supplies the scalp over the lateral part of the occipital
region and the skin over the medial surface of the auricle.
Greater occipital nerve, a branch of the posterior ramus
of the second cervical nerve
Supplies the skin as far forward as the vertex of the skull.
Blood supply of the scalp
o Supratrochlear and supraorbital arteries are branches

of the ophthalmic artery
Superficial temporal artery, the smaller terminal branch of
the external carotid artery
Posterior auricular artery, a branch of the external carotid
artery
Occipital artery, a branch of the external carotid artery
Lymph drainage of the scalp
anterior part of the

scalp and forehead
drain into the
submandibular
lymph nodes
o lateral part of the scalp above the ear is into the
superficial parotid (preauricular) nodes
o part of the scalp above and behind the ear drain into the
mastoid nodes.
o back of the scalp drain
into the occipital
nodes.
o All these groups of
lymph nodes are
drained into the deep
cervical group of
lymph nodes.

Face and Scalp

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Face and Scalp

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Face and Scalp

Intended learning outcomes

Loss of elastic fibers in skin cause permanent wrinkles (e.g., “Crow’s

Dangerous area of face-

The scalp consists of:

o It is the periosteum covering the outer surface of the skull bones

The main trunks of

o Supratrochlear and supraorbital arteries are branches

anterior part of the

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