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Dr ARJUN SHENOY 
DEPT OF OMFS
CONTENTS 
EXTENT 
LAYERS 
BLOODY SUPPLY 
VENOUS DRAINAGE 
LYMPHATICS 
NERVE SUPPLY 
APPLIED CLINICAL ANATOMY 
SCALP AVULSI...
EXTENT 
The scalp extends from the top of the 
forehead in front to the superior nuchal line 
behind. 
Laterally it projec...
CONSISTS OF FIVE LAYERS 
Skin 
Subcutaneous tissue 
Occipitofrontalis (epicranius) and it’s 
aponuerosis 
Subaponuerotic a...
SKIN 
The skin is thick and hairy. 
It is adherent to the epicranial 
aponuerosis through the dense superficial 
fascia.
SUPERFICIAL FASCIA 
It is more fibrous and dense in the centre 
than at the periphery of the head. 
Provides the proper me...
EPICRANIAL APONUEROSIS 
It is freely movable on the pericranium 
along with the overlying and adherent 
scalp and fascia. ...
LOOSE AEREOLAR TISSUE 
Extends anteriorly into the eyelids. 
Posteriorly to the highest and superior 
nuchal lines and on ...
PERICRANIUM 
Loosely attached to the surface of the 
bones,but is firmly adherent to the 
sutures where the sutural ligame...
BLOOD SUPPY
ARTERIAL SUPPLY 
IN FRONT OF AURICLE-Supratrochlear 
Supraorbital 
Superficial temporal arteries 
BEHIND THE AURICLE 
Post...
VENOUS DRAINAGE 
Emissary veins connect the extracranial 
veins with the intracranial venous sinuses 
to equalise the pres...
The superficial temporal vein joins the 
maxillary vein to form retromandibular 
vein. 
The supratrochlear and the supra o...
LYMPHATIC DRAINAGE 
Lymph vessels from the frontal region above 
the root of the nose drain into the 
submandibular nodes ...
The occipital region of the scalp is drained by 
the occipital nodes,and partly by the vessel 
that runs along the posteri...
NERVE SUPPLY 
Scalp supplied by ten nerves on each 
side. 
Five nerves (4 sensory and one motor) 
enter scalp in front of ...
IN FRONT OF AURICLE BEHIND THE AURICLE 
SUPRATROCHLEAR POSTERIOR DIVISION OF 
GREAT AURICULAR 
SUPRAORBITAL LESSER OCCIPIT...
Supratrochlear nerve- smaller terminal 
branch of frontal nerve 
Supplies the skin of the lower forehead near 
the midline...
Zygomaticotemporal- 
Supplies skin of temple as it pierces the 
deep layer of temporal fascia it sends a 
slender wig betw...
Opthalmic nerve- skin over the 
forehead
CLINICAL ANATOMY 
Since there are numerous sabaceous 
glands, the scalp is the commonest site 
for sabaceous cyst
Scalp lacerations bleed profusely because 
elastic fibres of underlying galea 
aponuerotica prevent initial vessel 
retrac...
It is very easy to raise a flap within the 
plane between the galea and the 
pericranium without compromising the 
blood o...
Scalp flaps can be used in craniofacial 
surgery for correction of congenital 
deformity,for release of craniosynostosis, ...
When suturing scalp lacerations, it is 
essential to control all bleeding points 
before repairing the scalp itself 
Usual...
Failure to control bleeding points as a 
separate step can result in significant 
hematomas,often subgaleal , leading to 
...
LOCATING THE INCISION LINE 
AND PREPARATION
INCISION
ELEVATION OF CORONAL 
FLAP AND EXPOSURE OF 
ZYGOMATIC ARCH
SUBPERIOSTEAL EXPOSURE OF 
THE PERIORBITAL AREAS
HARVESTING CRANIAL 
BONE GRAFTS
SCALP AVULSION INJURIES
Dr. S. Raja Sabapathy, Dr. Ravindra Bharathi, Dr. Hari Venkataramani, Dr. 
Deepak . K.L., Dr. Divakar Raju. K. 
(Departmen...
HANDLING THE AVULSED SCALP
The inner smooth surface of the avulsed scalp is 
first placed on a spherical vessel or container. 
This is done before cl...
All patients had acceptable recovery of 
sensation of forehead and scalp by 6– 
9 months after replantation. In two of our...
REFERENCES 
Journal of Plastic, Reconstructive & 
Aesthetic Surgery 
Volume 59, Issue 1, January 2006, Pages 
2–10 
GREYS ...
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
Anatomy of scalp
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Anatomy of scalp

anatomy of the layers of scalp with surgical aspect

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Anatomy of scalp

  1. 1. Dr ARJUN SHENOY DEPT OF OMFS
  2. 2. CONTENTS EXTENT LAYERS BLOODY SUPPLY VENOUS DRAINAGE LYMPHATICS NERVE SUPPLY APPLIED CLINICAL ANATOMY SCALP AVULSION INJURIES
  3. 3. EXTENT The scalp extends from the top of the forehead in front to the superior nuchal line behind. Laterally it projects down to the zygomatic arch and external acoustic meatus
  4. 4. CONSISTS OF FIVE LAYERS Skin Subcutaneous tissue Occipitofrontalis (epicranius) and it’s aponuerosis Subaponuerotic aereolar tissue pericranium
  5. 5. SKIN The skin is thick and hairy. It is adherent to the epicranial aponuerosis through the dense superficial fascia.
  6. 6. SUPERFICIAL FASCIA It is more fibrous and dense in the centre than at the periphery of the head. Provides the proper medium for passage of vessels and nerves of the skin
  7. 7. EPICRANIAL APONUEROSIS It is freely movable on the pericranium along with the overlying and adherent scalp and fascia. On each side it is attached to the superior temporal lines. Anteriorly ,it receives the insertion of the frontalis. Posteriorly ,receives insertion of the occipital bellies.
  8. 8. LOOSE AEREOLAR TISSUE Extends anteriorly into the eyelids. Posteriorly to the highest and superior nuchal lines and on each side to the superior temporal lines.
  9. 9. PERICRANIUM Loosely attached to the surface of the bones,but is firmly adherent to the sutures where the sutural ligaments bind the pericranium to the endocranium.
  10. 10. BLOOD SUPPY
  11. 11. ARTERIAL SUPPLY IN FRONT OF AURICLE-Supratrochlear Supraorbital Superficial temporal arteries BEHIND THE AURICLE Posterior auricular Occipital arteries
  12. 12. VENOUS DRAINAGE Emissary veins connect the extracranial veins with the intracranial venous sinuses to equalise the pressure.
  13. 13. The superficial temporal vein joins the maxillary vein to form retromandibular vein. The supratrochlear and the supra orbital vein unite at the medial angle of eye to form angular vein The posterior division of retromandibular vein unites with the posterior auricular vein to form external jugular vein Frontal diploic- sphenoparietal sinus occipital diploic- transverse sinus
  14. 14. LYMPHATIC DRAINAGE Lymph vessels from the frontal region above the root of the nose drain into the submandibular nodes Vessels from rest of the forehead,temporal region,upper half of the lateral auricular aspect and anterior wall of the external acoustic meatus drain into superficial parotid nodes,just anterior to the tragus ,on or deep to the parotid fascia.
  15. 15. The occipital region of the scalp is drained by the occipital nodes,and partly by the vessel that runs along the posterior borderof the sternocleidomastoid to the lower deep cervical nodes A strip of the scalp above the auricle drains to the upper deep cervical and retro auricular nodes. The retro auricular in turn drain to deep cervical.
  16. 16. NERVE SUPPLY Scalp supplied by ten nerves on each side. Five nerves (4 sensory and one motor) enter scalp in front of the auricle. Remaining five(4 sensory one motor) enter behind the auricle.
  17. 17. IN FRONT OF AURICLE BEHIND THE AURICLE SUPRATROCHLEAR POSTERIOR DIVISION OF GREAT AURICULAR SUPRAORBITAL LESSER OCCIPITAL ZYGOMATICOTEMPORAL GREATER OCCIPITAL AURICOTEMPORAL THIRD OCCIPITAL MOTOR MOTOR TEMPORAL BRANCH OF FACIAL POSTERIOR AURICULAR BRANCH OF FACIAL
  18. 18. Supratrochlear nerve- smaller terminal branch of frontal nerve Supplies the skin of the lower forehead near the midline supraorbital- Divides into medial and lateral branches which supply the skin of the scalp nearly as far back as the lambdoid suture The medial perforates the muscle to reach the skin Lateral pierces the epicranial aponuerosis
  19. 19. Zygomaticotemporal- Supplies skin of temple as it pierces the deep layer of temporal fascia it sends a slender wig between the two layers towards the lateral angle of the eye. Lesser occipital-supplies the scalp above and behind the ear . Branch of cervical plexus Greater auricular-derived from anterior rami of second and third cervical spinal nerves.
  20. 20. Opthalmic nerve- skin over the forehead
  21. 21. CLINICAL ANATOMY Since there are numerous sabaceous glands, the scalp is the commonest site for sabaceous cyst
  22. 22. Scalp lacerations bleed profusely because elastic fibres of underlying galea aponuerotica prevent initial vessel retraction, the wounds may be associated with significant blood loss which can result in clinical shock.
  23. 23. It is very easy to raise a flap within the plane between the galea and the pericranium without compromising the blood or nerve supply of the scalp. Similar flaps are seen in traumatic scalp avulsion,when hair is trapped in moving machinery
  24. 24. Scalp flaps can be used in craniofacial surgery for correction of congenital deformity,for release of craniosynostosis, treatment of craniofacial fractures and for repair of scalp defects after excision of skin tumors
  25. 25. When suturing scalp lacerations, it is essential to control all bleeding points before repairing the scalp itself Usually it is necessary to tie off larger arterioles and veins and use bipolar diathermy to control smaller arterioles and veins. Repair of scalp require full thickness tension sutures because galea aponuerotica will otherwise gape as the occipital and frontal bellies contract.
  26. 26. Failure to control bleeding points as a separate step can result in significant hematomas,often subgaleal , leading to breakdown of the orginal wound and sometimes necessitating surgical drainage
  27. 27. LOCATING THE INCISION LINE AND PREPARATION
  28. 28. INCISION
  29. 29. ELEVATION OF CORONAL FLAP AND EXPOSURE OF ZYGOMATIC ARCH
  30. 30. SUBPERIOSTEAL EXPOSURE OF THE PERIORBITAL AREAS
  31. 31. HARVESTING CRANIAL BONE GRAFTS
  32. 32. SCALP AVULSION INJURIES
  33. 33. Dr. S. Raja Sabapathy, Dr. Ravindra Bharathi, Dr. Hari Venkataramani, Dr. Deepak . K.L., Dr. Divakar Raju. K. (Department of Plastic and Reconstructive Micro Surgery)BMMSRC
  34. 34. HANDLING THE AVULSED SCALP
  35. 35. The inner smooth surface of the avulsed scalp is first placed on a spherical vessel or container. This is done before clipping any hair. The long hair is then clipped and shaving commences from front to back and side to side, taking care not to shave the eyebrows. After the shaving is complete, the scalp is washed thoroughly in running tap water and only after all hair has been removed completely, the scalp is taken off the container. In this way, the scalp is well prepared and no hair is found on the inner side. This step hardly takes 10 min.
  36. 36. All patients had acceptable recovery of sensation of forehead and scalp by 6– 9 months after replantation. In two of our cases, the line of avulsion was along the level of medial canthus.Hair growth in all patients has been satisfactory and the cosmetic result excellent.
  37. 37. REFERENCES Journal of Plastic, Reconstructive & Aesthetic Surgery Volume 59, Issue 1, January 2006, Pages 2–10 GREYS ANATOMY

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