Layers of Scalp Question And Answers

Question 1. Enumerate the layers of scalp. Give their blood supply, nerve supply & lymphatic drainage. (or) Describe the layers of scalp. Give its nerve supply, blood supply & lymphatic drainage. Add a note on its surgical anatomy. (or) Describe the layers of scalp. Add a note on its applied anatomy (or) Epicranial aponeurosis.
Answer:

• Scalp is the soft tissue which covers the calvaria of the skull

Scalp Layers:

S-Skin:

• It is outermost layer
• It is thick and hairy
• It is adherent to the epicranial
• It contains large number of hairs, sweat glands, sebaceous gland and is richly supplied by blood vessels

Read And Learn More: BDS Previous Examination Question And Answers

C-Superficial fascia:

• It is second layer
• It is more fibrous and dense in the center than periphery
• It contains large blood vessels & nerves of the scalp
• Thus it provides the proper medium for passage of vessels and nerves to the skin

A-Epicranial Aponeurosis:

• It is freely movable

Scalp Attachments:

• Anteriorly: Insertion of frontalis
• Posteriorly: Insertion of occipitalis
• In between occipital bellies: Extrernal occipital protuberance & highest nuchal lines
• Each side: Attached to superior temporal line

L-Loose areolar tissue:

• It contains emissary veins devoid of valves
• This communicates the veins of scalp with intracranial venous sinuses

Extent:

• Anteriorly: Eyelids
• Posteriorly: Highest & superior nuchal lines
• Each side: Superior temporal lines

P-Pericranium: Fifth layer

• Loosely attached to bony surfaces
• Firmly adherent to bony sutures
• It is the outer periosteum of skull Emissary vein

Blood Supply Arterial Supply:

Venous Drainage:

Lymphatic Drainage:

Nerve Supply:

Applied Anatomy According to layers:

Skin:

• Common site of sebaceous cyst due to abundant sebaceous glands
  • Superficial fascia
• Avulsed portion need not be cut away due to rich blood supply
• In open wound the vessels present in this layer are unable to retract & thus produce profuse bleeding
• Inflammation leads to little swelling but much pain
  • Loose areolar tissue
• Dangerous area of scalp as emissary vein open here
• If blood is collected in this layer, it leads to generalized swelling
  • Epicranial aponeurosis
• Wounds of scalp donot gape unless this layer is divided transversely
  • Pericranium
• Collection of fluid deep to it leads to cephalhaematoma

Question 2. Describe the origin, course, relation & branches of facial artery (or) Facial artery (or) Origin, course, relation & branches of facial artery
Answer:

Facial Artery Origin:

• It is branch of external carotid artery
• Given off in the carotid triangle just above the tip of greater cornua of hyoid bone

Facial Artery Course:

• It runs first in the neck as cervical part
• Then on the face as facial part
• Both parts are very tortuous
• It winds around the base of mandible, pierce the deep cervical fascia at the anteroinferior angle of masseter muscle and enters the face
• Starts: at 25 cm lateral to the angle of the mouth
• Ascends: By side of nose upto medial angle of eye
• Terminates: By supplying lacrimal sac
• Anastomose: With dorsal nasal branch of the ophthalmic artery

Facial Artery Branches:

Question 3. Describe the arterial supply and venous drainage of face.
Answer:

• The face is richly vascular.

Arterial supply:

1. Facial artery
   • It is chief artery of face
     Branch of:
   • External carotid artery given off in carotid triangle

Venous Drainage of Face Branches:

1. Anterior branches

2. Posterior branches

• They are small and unnamed

3. Transverse facial artery

• It is small artery
  Branch of:
  • Superficial temporal artery
• Structures supplied by it
• • Parotid gland and its duct
  • Masseter and the overlying skin
  • Anastomose with neighbouring arteries

4. Arteries that accompany the cutaneous nerves

• These are small branches of ophthalmic, maxillary and superficial temporal artery.

Venous Drainage:

• Veins of the face communicates with the cavernous sinus.

Question 4. Buccinator Muscle.
Answer:

Buccinator Muscle Origin:

• Upper fibres from maxilla opposite molar teeth
• Lower fibres from mandible opposite molar teeth
• Middle fibres from pterygomandibular raphe

Buccinator Muscle Insertion:

• Upper fibres straight to the upper lip
• Lower fibres straight to the lower lip
• Middle fibres decussate before passing to the lips

Buccinator Muscle Action:

• Flattens cheek against gums & teeth
• Prevents accumulation of food in the vestibule
• It is a whistling muscle

Buccinator Muscle Examination:

• Puffing the mouth and then blowing forcibly as in whistling

Buccinator Muscle Nerve Supply:

• Buccal branch of facial nerve

Buccinator Muscle Applied Anatomy:

• In infranuclear lesions of the facial nerve, (Bell’s palsy) buccinators muscle is effected
• It leads to inability to blow the cheek & food accumulation between teeth & cheek.

Question 5. Cutaneous innervations of face. (or) Mention the sensory nerve supply to the face.
Answer:

Question 6. Give a short account of parts, relation & nerve supply of lacrimal gland (or) Nasolacrimal apparatus (or) Name the structures forming lacrimal apparatus
Answer:

Lacrimal Gland Parts:

1. Lacrimal gland and its duct:

1. Lacrimal gland:
   • Lacrimal gland is serous ‘J’ shaped gland
     Site:
   • In the lacrintal fossa on the anterolateral part of the roof of the bony orbit & partly on the upper eyelid
     Parts:
   • Orbital part: larger & deeper
   • Palpebral part: smaller & superficial
2. Lacrimal duct:
   • It pierces the conjunctiva of the upper eyelid, open into the conjunctival sac at the superior fornix
   • Most of the ducts of orbital part pass through the palpebral part

2. Conjunctival Sac:

1. Palpebral conjunctiva:
   • Lines the deep surface of eyelids
   • It is thick, opaque, highly vascular & adherent to tarsal plate
2. Bulbar conjunctiva:
   • Lines the front of eyeball
   • It is thin, transparent & loosely attached to eyeball
   • Conjunctival Ssac is the potential space between bulbar & palpebral part
3. Conjunctival fornices:
   • The lines along which the palpebral conjunctiva of the upper & lower eyelids is reflected on eyeball

3. Lacrimal puncta & canaliculi:

• Lacrimal canaliculi is 10 mm long structure beginning at lacrimal punctum
• It has
  • 2 mm long vertical part
  • 8 mm long horizontal part
• It has dilated ampulla at the bend
  • Opening
• In the lateral wall of the lacrimal sac behind medial palpebral ligament

4. Lacrimal Sac:

• Site: lacrimal groove behind medial palpebral ligament
• Size: 12 mm long & 5 mm wide
  Parts:
• Upper end is blind
• Lower end continuous with nasolacrimal duct
  Relations:
• Anteriorlymedial palpebral ligament, orbicularis oculi
• Mediallylacrimal groove
• Laterallylacrimal fascia & lacrimal part of orbicularis oculi

5. Nasolacrimal Duct:

• It is 18 mm long membranous passage
  Course:
• Begins at lower end of lacrimal sac
• Runs downwards, backwards & laterally
• Opens into inferior meatus of nose

Valve of Hasner:

• It is a fold of mucous membrane forming imperfect valve at lower end of duct

Nerve Supply:

Question 7. Platysma
Answer:

• It is one of the muscle of neck

Platysma Origin:

• Upper part of pectoral & deltoid fascia
• Fibres run upwards and medially

Platysma Insertion:

• Anterior fibres, to the base of the mandible
• Posterior fibres to the skin of the lower face and lip & may be continuous with the risorius

Platysma Action:

• Releases pressure of skin on the subjacent veins
• Depresses mandible
• Pulls the angle of the mouth downwards as in horror or surprise

Platysma Nerve Supply:

• Cervical branch of facial nerve

Platysma Examination:

• Forcible pulling of the angles of the mouth downwards & backward forming prominent vertical folds of skin on the side of neck

Facial expression associated with It:

• Horror, terror, fright

Question 8. Zygomatic major
Answer:

Zygomatic major Origin:

• From the surface of the zygomatic bone lateral to zygomatic minor muscle

Facial expression associated with it: Smiling & laughing

Nerve Supply: Buccal branch of facial nerve

Question 9. Orbicularis oris.
Answer:

Orbicularis oris Parts:

1. Intrinsic part

• It is very thin sheet
  Origin:
• Superior incisivus from maxilla
• Inferior incisivus from mandible
  Insertion:
• Angle of mouth

2. Extrinsic part.

• It has two strata formed by converging muscles
  Origin:
• Thickest middle stratum from buccinators
• Thick superficial stratum from elevator & depressor of lip & their angles
  Insertion:
• Lips & the angle of the mouth
  Action:
• Closes & purses the mouth
  Nerve Supply:
• Temporal branch of facial nerve
  Examination:
• Whistling & pursing the mouth

Question 10. Orbicularis oculi
Answer:

Orbicularis oculi Parts:

Orbicularis oculi Actions:

1. Orbital part

• It closes the eye tightly, wrinkling
• Protects eye from bright light

2. Palpebral part

• Closes the eye gently in sleep or in blinking

3. Lacrimal part

• Draws the lacrimal papillae medially
• Dilates lacrimal sac
• Supports lower lid

Orbicularis oculi Examination:

• Tight closure of the eyes

Orbicularis oculi Applied Anatomy:

• Paralysis of this muscle leads to
  1. Drooping of lower eyelid
  2. Spilling of tears

Question 12. Sensory and motor nerve supply of scalp
Answer:

1. Sensory nerve supply

• In front of auricle: branches are
  1. Supratrochlear nerve
     • It is branch of frontal nerve which in turn is branch of ophthalmic division of trigeminal nerve
  2. Supraorbital Nerve
     • Branch of frontal nerve which in turn is branch of ophthalmic division of trigeminal nerve
  3. Zygomaticotemporal nerve
     • Branch of zygomatic nerve which is branch of maxillary division of trigeminal nerve
  4. Auriculotemporal nerve
     • It is branch of mandibular division of trigeminal nerve
• Behind the auricle
  1. Posterior division of great auricular nerve
     • Branch from cervical plexus C2, C3
  2. Lesser occipital nerve
     • Branch from cervical plexus C2
  3. Greater occipital nerve
     • Branch from C2, dorsal ramus
  4. Third occipital nerve
     • Branch from C3, dorsal ramus

2. Motor nerves

1. In front of auricle
   1. Temporal nerve
      • Branch of facial nerve
2. Behind the auricle
   1. Posterior auricular
      • Branch of facial nerve

Thus Scalp has got its sensory nerve supply from branches of trigeminal nerve and cervical plexus while motor nerve supply is from facial nerve

Question 13. Loose areolar tissue of scalp and its applied anatomy
Answer:

4th layer of scalp is loose areolar tissue

• It contains emissary veins devoid of valves
• This communicates the veins of scalp with intracranial venous sinuses

Loose Areolar Tissue  Extent:

• Anteriorly eyelids
• Posteriorly Highest and superior nuchal lines
• Each side superior temporal lines

Applied Anatomy:

• It is referred as dangerous area of scalp
• This is because of opening of emissary veins here
• If blood is collected in this layer, it may lead to generalised swelling

Question 14. Levator Palpebrae Superioris
Answer:

• It is dilator of palpebral fissure
• It has radial arrangement
• They are better develop around the eyes

Levator Palpebrae Superioris Origin:

• Inferior surface of lesser wing of sphenoid
• Orbital surface of the body of sphenoid anterior to the optic foramen

Levator Palpebrae Superioris Insertion:

• Orbital septum and palpebral ligaments
• Superior tarsal plate
• Skin of upper eyelid

Levator Palpebrae Superioris Nerve supply:

• Upper division of oculomotor nerve
• Sympathetic chain from T₁ segment of the spinal cord

Levator Palpebrae Superioris Applied anatomy:

• Paralysis of this muscle causes drooping of upper eyelid called ptosis

Question 15. Layers of scalp with its applied aspects
Answer:

Layers of scalp:

Question 16. Facial nerve in face
Answer:

• The facial nerve leave the skull by passing through stylomastoid foramen
• Next it crosses the lateral side of the base of the styloid process
• Enters the posteromedial surface of the parotid gland
• Crosses the retromandibular vein and external carotid artery
• Behind the neck it divides into five terminal branches which emerges along the anterior border of the parotid gland

Facial nerve in face Branches:

• Within the facial canal
  • Greater petrosal nerve
  • Nerve to the stapedius
  • Chorda tympani nerve
• At its exit from stylomastoid foramen
  • Posterior auricular
  • Digastric
  • Stylohyoid
• Terminal branches
  • Temporal
  • Zygomatic
  • Buccal
  • Marginal mandibular
  • Cervical
• Communicating branches with adjacent cranial and spinal nerves

Question 17. Retromandibular vein
Answer:

Retromandibular vein Formation:

• Retromandibular vein is formed by the union of the superfical temporal and maxillary vein

Retromandibular vein Course:

• Descends in substance of parotid gland superficial to external carotid artery
• Runs between ramus of mandible and sternocleidomastoid muscle

Retromandibular vein Branches:

1. Anterior branch
   • Joins anterior facial vein to form common facial vein
   • Drains into internal jugular vein
2. Osterior branch
   • Joins posterior auricular vein to form external jugular vein

Retromandibular vein Applied Anatomy:

• Parrot’s sign
  • It is sensation of pain when pressure is applied to the retromandibualr vein

Question 18. Venous drainage of face
Answer:

Venous Drainage:

Veins of the face communicates with the cavernous sinus.

Question 19. Occipitofrontalis muscle
Answer:

Occipitofrontalis muscles have two bellies

1. Occipital or occipitalis
2. Frontal or frontalis

Actions:

• Raises the eyebrows
• Causes horizontal wrinkles in the skin of the forehead.

Question 20. Bell’s palsy
Answer:

Idiopathic paralysis of the facial nerve of sudden onset

Etiology 5 HYPOTHESIS:

• Rheumatic
• Cold
• Ischaemia
• Immunological
• Viral

Bell’s palsy Clinical Features:

• Pain in post auricular region
• Sudden onset
• Unilateral loss of function
• Loss of facial expression
• Absence of wrinkles on forehead
• Loss of wrinkles
• Crocodile tears
• Inability to close the eyean effort to do so causes roung or eyeball upwards
• Watering of eye
• Inability to blow the cheek
• Nasolabial fold disappears
• Tip of nose is deviated

• Loss of taste sensation
• Hyperacusis
• Slurring of speech

Question 21. Deep facial vein
Answer:

• Deep connection of facial vein include a communication between supraorbital & pterygoid plexus through deep facial vein, which passes backward over buccinators
• The facial vein communicates with cavernous sinus through these connections

Deep facial vein Applied Anatomy:

• Infections from the face specially from upper lip & in the lower part of face can spread in retrograde direction & cause thrombosis of cavernous sinus
• This area is, therefore, called dangerous area of the face

Question 22. Secretomotor supply to lacrimal gland.
Answer:

Question 23. Palpebral ligament
Answer:

• The palpebral fascia of the two lids forms the orbital septum
• Its thickening from tarsal plates of tarsi in the lids & palpebral ligaments at the angles

Question 24. Dangerous area of scalp.
Answer:

Loose areolar tissue

• It is fourth layer of scalp
• It is known as “Dangerous area of scalp” as emissary vein open here
• If blood is collected in this layer, it leads to generalized swelling

Question 25. Palatine aponeurosis
Answer:

The posterior border of the hard palate provides attachment to the palatine aponeurosis

Question 13. Levator palpebrae superioris.
Answer:

• It is dilator of palpebral fissure
• It has radial arrangement
• They are better develop around the eyes

Levator palpebrae superioris Origin:

• Inferior surface of the lesser wing of sphenoid
• Orbital surface of the body of the sphenoid anterior to the optic foramen

Levator palpebrae superioris Insertion:

• Orbital septum & palpebral ligaments
• Superior tarsal plate
• Skin of the upper eyelid

Levator palpebrae superioris Nerve Supply:

• Upper division of the oculomotor nerve
• Sympathetic chain from T₁ segment of the spinal cord

Levator palpebrae superioris Applied Anatomy:

• Paralysis of this muscle causes drooping of the upper eyelid called ptosis

Question 26. Name the cervical branches of facial artery
Answer:

• Ascending palatine nerve
• Tonsillar nerve
• Glandular nerve Submental nerve

Question 27. Give the formation & termination of anterior facial vein
Answer:

• Supratrochlear & supraorbital veins unite at medial angle of eye
• It forms angular vein
• This continues and forms facial vein
• Then, facial vein alongwith anterior division of retromandibular vein forms common facial vein
• This drains & terminates as internal jugular vein

Question 28. Facial vein
Answer:

• It is largest vein of the face with no valves

Facial vein Origin:

• At medial angle of eye as angular vein

Facial vein Course:

• Angular vein is formed by union of supraorbital & suprattrochlear vein
• It runs downward & backward behind facial artery
• It crosses anteroinferior angle of masseter, pierces deep fascia, crosses submandibular gland
• It joins anterior division of retromandibular vein below the angle of mandible to form common facial vein

Facial vein Terminates:

• It drains into internal jugular vein.

Question 29. Branches of facial artery in face
Answer:

1. Anterior branches

2. Posterior branches

• They are small and unnamed

Question 30. Branches of facial artery in neck
Answer:

Question 31. Retromandibular vein
Answer:

Retromandibular vein  Formation:

• Retromandibular vein is formed by the union of the superfieal temporal and maxillary vein

Retromandibular vein  Course:

• Descends substance of parotid gland superficial to external carotid artery
• Runs between ramus of mandible and sternocleidomastoid muscle

Retromandibular vein  Branches:

1. Anterior branch
   • Joins anterior facial vein to form common facial vein
   • Drains into internal jugular vein
2. Posterior branch
   • Joins posterior auricular vein to form external jugular vein

Question 32. Nasolacrimal duct
Answer:

• It is 18 mm long membranous passage
• Valve of Hasner, a fold of mucous membrane forming imperfect valve is present at the lower end of nasolacrimal duct

Nasolacrimal duct Course:

• Begins at lower end of lacrimal sac
• Runs downwards, backwards and laterally
• Opens into inferior meatus of nose

Applied anatomy:

Epiphora a condition where there is excessive secretion of lacrimal fluid overflowing on the cheeks may occur due to the obstruction in the lacrimal fluid pathway at the level of nasolacrimal duct

Question 33. Galea aponeurotica
Answer:

• It is third layer of scalp
• It is freely movable

Galea aponeurotica Attachments:

• Anteriorlyinsertion of frontalis
• Posteriorlyinsertion of occipitalis
• In between occipital belliesexternal occipital protuberance and highest nuchal lines
• Each sideattached to superior temporal line

Applied anatomy:

• Wounds of the scalp donot gape unless this layer is divided transversely

Question 34. Name the structures constituting lacrimal apparatus
Answer:

1. Lacrimal gland and its dud
2. Conjunctival sac
3. Lacrimal puncta and canaliculi
4. Lacrimal snc
5. Nasolacrimal duct

Question 35. Dangerous area of face
Answer:

• The facial vein communicates with the cavernous sinus through its deep connections
• The facial vein is devoid of valves and rests directly on the facial muscles
• The movements of facial muscles facilitates the spread of emboli from the infected area of upper lip and lower part of the nose in retrograde direction and causes thrombosis of cavernous sinus
• Hence the area between the upper lip and lower part of nose is consider as dangerous area of face

Question 36. Nerve supply of scalp
Answer:

Question 37. Name any six muscles of facial expressions.
Answer:

Question 38. Give the cutaneous innervation of anterior quadrant of scalp.
Answer:

Question 39. Lacrimal gland
Answer:

• It is serous J shaped structure

Site:

• In the lacrimal fossa on the anterolateral part of the roof of the bony orbit and partly on the upper eyelid.

Parts:

• Orbital part larger and deeper
• Palpebral part smaller and superficial