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Face and scalp
Face






Anterior aspect of head, forehead to chin and ear to ear
Shape due to underlying bones – anatomical variations in shape and
prominence of bony features, deposition of fat, placement of hair, and
ageing
Large buccal fat pads in children to prevent collapse during suckling
Development continues into childhood

Scalp





Comprises skin (hairy) and subcutaneous tissue covering the
neurocranium from superior nuchal lines (occipital) to supraorbital
margins (frontal)
Extends laterally to zygomatic arches
FIVE layers that spell SCALP, handily enough
o Skin: sweat and sebaceous glands, hair follicles
o Connective tissue: thick, vascularised subcutaneous layer
o Aponeurosis: broad, strong tendinous sheet connecting
occipitofrontalis, also tempoparietalis and superior auricular
o Loose areolar tissue: spongy layer, allows movement of scalp
proper (first three layers)
o Pericranium: connective tissue forming the external periosteum

Muscles of face and scalp



Muscles of facial expression located in the subcutaneous tissue of the
face, scalp and neck
Most attach to bone or fascia and pull skin to create effect

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Section
Scalp,
forehead,
eyebrows

Muscle
Occipitofrontalis Frontal

Origin
Aponeurosis

Occipital
Corrugator supercilli

Superior nuchal line
Superciliary arch

Eyebrows
and nose

Procerus + transverse nasalis

Nose

Alar nasalis + levator labii
superioris alequae
Orbicularis oculi

Nasal aponeurosis,
lateral nasal
cartilage
Frontal process of
maxilla
Orbital margin,
medial palpebral
ligament, lacrimal
bone
Medial maxilla and
mandible, perioral
skin, angle of
mouth
Maxilla
Zygomatic bone

Orbital
opening

Mouth, lips,
cheeks

Obicularis oris

Levator labi superioris
Zygomaticus minor
Buccinator

Mandible, alveolar
process of maxilla
and mandible

Insertion
Skin and
subcutaneous
tissue of forehead
and eyebrows
Aponeurosis
Supraorbital
margin and
supercilliary arch
skin
Forehead skin
between brows

Action
Elevate eyebrow
Wrinkle forehead
Protracts scalp

Major alar
cartilage
Margin of orbit
skin, tarsal plates

Depresses alar laterally,
flaring nostril
Closes eyelids (palpebral
part gentle, orbital part
tightly)

Lips

Close mouth, protrude lips

Skin upper lip

Dilate mouth, elevate/evert
lip, deepens nasolabial
sulcus
Presses teeth against molars,
works with tongue to keep
food in oral vestibule, resists
distension

Angle of mouth,
orbicularis oris

Retracts scalp
Draws eyebrows medially
and inferiorly

Depresses medial brow,
wrinkles skin over dorsal nose

Zygomaticus major

Zygomatic bone

Angle of mouth

Levator angulae oris
Risorius
Depressor angulae oris
Depressor labii inferioris

Maxilla
Parotid fascia and
buccal skin
Mandible
Platysma, mandible

Dilate mouth, elevate labial
commissure
Dilates mouth, widens
Dilates mouth, depresses
lower lip

Lower lip skin

Mentalis

Mandible

Chin skin

Platysma

Infraclavicular and
supraclavicular
regions

Mandible, skin of
chin and lower lip,
angle of mouth,
orbicularis oris

Dilate mouth, retracts/everts
lower lip
Elevate and protrude lower
lip, elevate chin skin
Depresses mandible, tenses
skin of lower face and neck

Nerves of face and scalp



Sensory innervation of face and anterosuperior scalp is via trigeminal
nerve (CN V)
Motor innervation to facial muscles via the facial nerve (CN VII)

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Superficial vasculature of face and scalp



Highly vascularised
Terminal branches of arteries and veins anastomose freely

Superficial arteries
Face




Mostly branches of the external carotid artery
Facial artery is the major source
Facial artery sends branches to upper and lower lips via superior and
inferior labial arteries






Also forms lateral nasal artery and terminates at the angular artery
Superficial temporal artery runs anterior to the ear, with transverse
facial arising from it within the parotid gland
Others arise from the internal carotid – supraorbital and supratrochlear
(branches of ophthalmic)
Mental artery (derived from maxillary) supplies the chin

Scalp






Rich supply, coursing through layer two (subcutaneous skin and
aponeurosis)
Anastomose freely
Artery walls firmly attached to connective tissue, so can’t freely
constrict when cut; scalp lacerations bleed profusely
Supply from external carotids – occipital, parietal, posterior auricular,
superficial temporals
Also from internal carotids – supratrochlear and supraorbital

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Veins
Face






Drained by veins accompanying the arteries
Venous return from face is generally superficial, but anastomose with
deep veins and dural sinus, plus venous plexus
Abundant anastomoses to compensate for temporary compressions
Facial veins are valveless; tributaries include the deep facial vein
(drains pterygoid venous plexus of the infratemporal fossa)
Facial vein drains into IVC




Facial vein communicates with superior ophthalmic vein, that drains
into the cavernous sinus
Retromandibular vein is a deep vessel of the face (union of superficial
temporal and maxillary vein); empties to subclavian

Scalp





Superficial drainage via accompanying arteries
o Supraorbital and supratrochlear veins
Superficial temporal and posterior auricular veins drain the scalp
anterior and posterior to the ears
Occipital veins drain the occipital region
Drainage of deep parts via deep temporal veins (to the pterygoid
venous plexus)

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Lymphatics





No lymph nodes in the scalp; only in buccal/parotid region of face
Thus drain to superficial ring of lymph nodes in the neck
o Submental, submandibular, parotid, mastoid, occipital
Superficial vessels accompany veins, deep ones accompany arteries
Drain into deep cervical lymph nodes, then jugular trunk, then to
thoracic duct on the left side or the IJV/brachiocephalic on the left

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Neck

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Bones of the neck




Formed by cervical vertebrae, hyoid bone, manubrium of the
sternum, clavicles
Axial skeleton and appendicular (clavicles)
Hyoid bone lies at C3 level in angle between the mandible and
thyroid cartilage
o Not articulation with any other bone; held in place by
muscles, styloid processes, thyroid cartilage, manubrium,
scapulae

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Fascia of neck


Structures surrounded by superficial fascia and compartmentalised by
deep fascia; determine direction an infection may spread

Cervical subcutaneous tissue and platysma




Cervical subcutaneous tissue is a layer of fatty connective tissue inbetween the skin and investing deep layer of fascia
o Contains neurovasculature, lymph vessels, fat
o Anteriorly contains the platysma muscle
Platysma is a broad, thin sheet of muscle; varied in continuity
o Arises in deep fascia of pec major and deltoid
o Extends to mandible to blend with facial muscles
o Diverge inferiorly, leaving gap anterior to larynx and trachea
o Muscle of fascial expression

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Reference
1
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Clinically Oriented Anatomy

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