Scalp And Face

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.

    a. b.

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

The scalp • • 1. 2. 3. 4. 5.

Soft tissues covering the cranial vault form the scalp. Consists of 5 layers Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium

Muscles of Scalp • Occipitofrontalis: Origin: Insersion: Nerve supply: Action:

Sensory Nerve supply of the scalp

• • • 1. 2. 3. 4. • 1. 2.

They lie in the superficial fascia They are: Infront of auricle: Supratrochlear N. Supraorbital N. Zygomaticotemporal N. Auriculotemporal N. Behind the auricle: Lesser occipital N. Greater occipital N.

Arterial supply of the scalp • • • • 1. 2. • 1. 2.

Has rich blood supply Arteries lie in the superficial fascia They are: Infront of auricle: Supratrochlear and supraorbital arteries Superficial temporal artery Behind the auricle: Posterior auricular artery 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 • 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Expressions produced by these muscles: Smiling & laughing- zygomaticus major Sadness- levator labii superioris, levator angulioris Grief- depressor anguli oris Anger- dilator naris / depressor septi Frowning- corrugator supercilli/ procerus Horror/ terror/ fright- platysma Surprise- frontalis Doubt- mentalis Grinning- risorius Contempt- zygomaticus major Closing of mouth- orbicularis oris Whistling- buccinator/ orbicularis oris

• • 1. 2. 3. 4. 5.

Motor nerve supply of face: Facial nerve: through 5 branches Temporal Zygomatic Buccal Mandibular Cervical

• • 1. • • • • •

Sensory supply of face: Trigeminal nerve: through 3 branches 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.