ADVIENTO, AUDREY A.

TABLE #1 – TEAM B GROSS ANATOMY

1A-MED

ACD 1

SCALP AND SKULL

SPECIFIC OBJECTIVES (SO):

1. Differentiate the layers of the scalp including the clinical significance of each layer.

The human scalp is composed of 5 layers and these layers can be easily remembered
by remembering the word SCALP itself. Additionally, the first three layers of the scalp are
connected and move together as a unit due to the connection provided by the second layer.

S stands for skin. The skin is the most superficial among all other layers of the scalp. It
is a thick layer of cells containing the most number of hair follicles and sebaceous glands
releasing sebum.

Clinical significance: The skin, together with the growing hair, are the first line of defense
of the head against trauma. However, due to the presence of open pores (hair follicles and
sebaceous glands), the skin is also prone to infections such as sebaceous cysts.

C stands for connective tissue. Directly underneath the skin is a fibrofatty layer of
connective tissue, fibrofatty meaning it contains both fibrous connective tissue and some fats.
The C layer contains numerous nerves and blood vessels such as the superficial vein of the
scalp. Additionally, the fibrous septa located in the connective tissue connects the upper layer
of skin to the aponeurosis of the occipitofrontalis muscle.

Clinical significance: The blood vessels located in this layer of connective tissue are
adherent to the fibrous septa. Due to this, laceration of the scalp up to this level results to profuse
bleeding because the blood vessels are unable to constrict or retract in order for the blood to
coagulate. Applying pressure on the wounded area is a good way to stop the bleeding.

A stands for aponeurosis. The epicranial aponeurosis is a thin, tendinous structure that
connects the bellies of the occipitofrontalis muscle: the frontal belly and the occipital belly. This
is connected to the skin via the fibrous septa in the connective tissue layer.

Clinical significance: Wounding of the head up to this layer causes the wound to further
open up due to the tension of the aponeurosis produced by the tone of the occipitofrontalis
muscle. Therefore, even wounds caused by blunt objects could appear like incisions because
the scalp splits against the skull due to the pull of the occipitofrontalis muscle. Closing of the
wound completely would require suturing the aponeurosis first.

L stands for loose connective tissue. The type of connective tissue composing the
fourth layer is loose areolar tissue and it occupies the space directly below the epicranial
aponeurosis. Also, this layer loosely connects the aponeurosis to the pericranium (periosteum
of the skull) but the strength of connection is definitely not as much as the C layer to the S and
A layers. The L layer contains very few small arteries and the very important emissary veins
pass through this layer before reaching the diploe of the skull.

Clinical significance: Infections are the fastest to spread in the loose areolar tissue layer
commonly caused by the infections arriving through the valveless emissary veins. Due to the
looseness of this layer, blood or pus could spread faster and could only be limited by the orbital
margins (anterior), nuchal lines (posterior), and temporal lines (lateral).

P stands for pericranium. The periosteum covering the outer surface of the skull is called
the pericranium. It is a connective fibrous tissue sheath that becomes continues with the
periosteum on the inner surface of the skull through the visible sutures that holds the skull bones

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 together. The pericranium, just like all other periosteum, receives a rich nerve and blood supply
and is very sensitive.

Clinical significance: Because the pericranium is limited by sutural ligaments, infections

that occur subperiosteally are localized only on one bone. Additionally, the cells on the
underside of the periosteum are osteogenic.

2. Illustrate the neurovascular supply and lymphatic venous drainage of the scalp.

Sensory Nerve Supply

SUPRATROCHLEAR NERVE. This is

a branch of the ophthalmic division of the
trigeminal nerve. It supplies the scalp and
passes backwards close to the median
plane where it reached nearly as far as the
vertex of the skull.

SUPRAORBITAL NERVE. This is a

branch of the ophthalmic division of the
trigeminal nerve and is located around the
superior orbital margin. It ascends overhead
and supplies the scalp as far backward as
the vertex.

ZYGOMATICOTEMPORAL NERVE. This is a branch of the maxillary division of the

trigeminal nerve and supplies the scalp over the temple.

AURICULOTEMPORAL NERVE. This is a branch of the mandibular division of the

trigeminal nerve and ascends over the side of the head in front of the auricle. It supplies the
skin over the temporal region.

LESSER OCCIPITAL NERVE. This is a branch of the second cervical plexus (C2) and
supplies the scalp over the lateral part of the occipital region and skin over the medial surface
of the auricle.

GREATER OCCIPITAL NERVE. This is a branch of the posterior ramus of the 2nd cervical
nerve and ascends over the back of the scalp. It supplies the skin as far forward as the vertex
of the skull.

Arterial Supply of the Scalp

SUPRATROCHLEAR and SUPRAORBITAL ARTERIES. These are branches of the

ophthalmic artery and ascends over the forehead.

SUPERFICIAL TEMPORAL ARTERY. This is a small terminal branch of the external

carotid artery and ascends in front of the auricle. It is divided into anterior and posterior branches
and supplies the skin over the frontal and temporal regions.

POSTERIOR AURICULAR ARTERY. This is a branch of the external carotid artery and
ascends behind the auricle. It supplies the scalp above and behind the auricle.

OCCIPITAL ARTERY. This is a branch of the external carotid artery and ascends from
the apex of the posterior triangle. This supplies the skin over the back of the scalp and reaches
as high as the vertex of the skull.

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 Venous Drainage of the Scalp

SUPRATROCHLEAR and SUPRAORBITAL

VEINS. These veins unite at the medial margin of the
orbit to form the facial vein.

SUPERFICIAL TEMPORAL VEIN. This vein

unites with the maxillary vein in the substance of the
parotid gland to form retromandibular vein.

POSTERIOR AURICULAR VEIN. This vein

unites with the posterior division of the
retromandibular vein to form the external jugular vein.

OCCIPITAL VEIN. This vein drains into the

suboccipital plexus.

EMISSARY VEINS. These are valveless veins that connect the superficial veins of the
scalp to the diploic veins of the skull bones and intercranial venous sinuses.

Lymph Drainage of the Scalp

SUBMANDIBULAR LYMPH NODES. This

drains the lymph vessels in the anterior part of the
scalp and forehead.

SUPERFICIAL PAROTID NODES

(PREAURICULAR NODES). This drains the lateral
part of the scalp above the ear.

MASTOID NODES. This drains the part of the

scalp above and behind the ear.

OCCIPITAL NODES. This drains the back of the

scalp.

3. Discuss the temporalis muscle as to its origin, insertion, action, and neurovascular
structures.

The temporalis muscle originates from the floor of the temporal fossa and inserts in the
coronoid process of the mandible. This muscle’s anterior and superior fibers elevate the
mandible while the posterior fibers retract the mandible. It is being supplied nerve-wise by the
mandibular division of the trigeminal nerve and vascular-wise by the superficial temporal vein
and artery.

4. Enumerate the component bones of the neurocranium and viscerocranium.

Bones of the Neurocranium (Cranium) Bones of the Viscerocranium (Facial)

Frontal (1) Zygomatic (2)
Parietal (2) Maxillae (2)
Occipital (1) Nasal (2)
Temporal (2) Lacrimal (2)
Sphenoid (1) Vomer (1)
Ethmoid (1) Palatine (2)
Inferior Conchae (2)
Mandible (1)

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5. Distinguish the bony landmarks that demarcate the three cranial fossae and its
contents.

The three cranial fossae are the Anterior, Middle, and Posterior fossae. The greater wing
of the sphenoid bone separates the anterior cranial fossa from the middle fossa. While the
petrous part of the temporal bone serves as the demarcation between the posterior and middle
fossae.

The major structures contained in the anterior cranial fossa include the frontal lobes of the
two cerebral hemispheres and falx cerebri. The middle fossa lodges the temporal lobes of the
cerebral hemispheres. Lastly, the posterior cranial fossa houses the parts of the hindbrain,
namely, the cerebellum, pons, and medulla oblongata.

6. Enumerate the neurovascular structures transmitted by the different foraminae.

Anterior Fossa Middle Fossa Posterior Fossa

Olfactory nerves Optic nerve
Ophthalmic artery
Lacrimal, frontal, trochlear,
oculomotor, nasociliary, and
abducens nerves
Superior ophthalmic vein
Maxillary division of the V
nerve
Mandibular division of the V
nerve, lesser petrosal nerve
Middle meningeal artery
Internal carotid artery
Medulla oblongata
Spinal part of accessory
nerve, right and left
vertebral arteries
Hypoglossal nerve
Glossopharyngeal, vagus,
and accessory nerves
Sigmoid sinus becomes
internal jugular vein
Vestibulocochlear and
facial nerves

Reference:

Snell, R. S. (2012). Clinical anatomy by regions. Baltimore, MD: Lippincott Williams & Wilkins.