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Scalp
For other uses, see Scalp (disambiguation).
Scalp
Illustration depicting the layers of the scalp and meninges
Details
Latin scalpus
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Structure
Blood supply
Innervation
Lymphatic drainage
Society and culture
Role in aesthetics
Hair transplantation
Redness in scalp after surgery
Clinical significance
Disease
Scalp conditions
See also
References
External links
Artery supratrochlear, supraorbital, superficial temporal, occipital
Vein superficial temporal, posterior auricular, occipital
Nerve supratrochlear, supraorbital, greater occipital, lesser occipital
Lymph occipital, mastoid
Identifiers
Gray's p.378
MeSH Scalp
Anatomical terminology
The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides
and posteriorly.
Contents
Structure
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Diagrammatic section of scalp
Illustration of the scalp and meninges
The scalp is usually described as having five layers, which can conveniently be remembered
as a mnemonic:
[1]
S: The skin on the head from which head hair grows. It contains numerous sebaeceous
glands and hair follicles.
C: Connective tissue. A dense subcutaneous layer of fat and fibrous tissue that lies
beneath the skin, containing the nerves and vessels of the scalp.
A: The aponeurosis called epicranial aponeurosis (or galea aponeurotica) is the next layer.
It is a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the
occipitalis posteriorly.
L: The loose areolar connective tissue layer provides an easy plane of separation between
the upper three layers and the pericranium. In scalping the scalp is torn off through this layer. It
also provides a plane of access in craniofacial surgery and neurosurgery. This layer is
sometimes referred to as the "danger zone" because of the ease by which infectious agents
can spread through it to emissary veins which then drain into the cranium. The loose areolar
tissue in this layer is made up of random collagen I bundles, collagen III. It will also be rich in
glycosaminoglycans (GAGs) and will be constituted of more matrix than fibers. This layer
allows the more superficial layers of the scalp to shift about in relation to the pericranium.
P: The pericranium is the periosteum of the skull bones and provides nutrition to the bone
and the capacity for repair. It may be lifted from the bone to allow removal of bone windows
(craniotomy).
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The clinically important layer is the aponeurosis. Scalp lacerations through this layer mean
that the "anchoring" of the superficial layers is lost and gaping of the wound occurs; this
requires suturing. This can be achieved with simple or vertical mattress sutures using a non-
absorbable material, which are subsequently removed at around days 7-10.
Blood supply
The blood supply of the scalp is via five pairs of arteries, three from the external carotid and
two from the internal carotid:
internal carotid
the supratrochlear artery to the midline forehead. The supratrochlear artery is a branch of
the ophthalmic branch of the internal carotid artery.
the supraorbital artery to the lateral forehead and scalp as far up as the vertex. The
supraorbital artery is a branch of the ophthalmic branch of the internal carotid artery.
external carotid
the superficial temporal artery gives off frontal and parietal branches to supply much of
the scalp
the occipital artery which runs posteriorly to supply much of the posterior aspect of the
scalp
the posterior auricular artery, a branch of the external carotid artery, ascends behind the
auricle to supply the scalp above and behind the auricle.
Note: The walls of the blood vessels are firmly attached to the fibrous tissue of the superficial
fascial layer, hence cut ends of vessels here do not readily retract; Even a small scalp wound
may bleed profusely.
Innervation
Innervation is the connection of nerves to the scalp: the sensory and motor nerves innervating
the scalp. The scalp is innervated by the following:
[2]
Supratrochlear nerve and the supraorbital nerve from the ophthalmic division of the
trigeminal nerve
Greater occipital nerve (C2) posteriorly up to the vertex
Lesser occipital nerve (C2) behind the ear
Zygomaticotemporal nerve from the maxillary division of the trigeminal nerve supplying the
hairless temple
Auriculotemporal nerve from the mandibular division of the trigeminal nerve
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The innervation of scalp can be remembered using the mnemonic, "Z-GLASS" for,
Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve, Auriculotemporal
nerve, Supratrochlear nerve and Supraorbital nerve.
[2]
Lymphatic drainage
Lymphatic channels from the posterior half of the scalp drain to occipital and posterior
auricular nodes. Lymphatic channels from anterior half drain to the parotid nodes.The lymph
eventually reaches the submandibular and deep cervical nodes .
Role in aesthetics
The scalp plays an important role in the aesthetics of the face. Androgenic alopecia, or male
pattern hair loss, is a common cause of concern to men. It may be treated with varying rates
success by medication (e.g. finasteride, minoxidil) or hair transplantation. If the scalp is heavy
and loose, a common change with ageing, the forehead may be low, heavy and deeply lined.
The brow lift procedure aims to address these concerns.
Hair transplantation
All the current hair transplantation techniques utilize the patient's existing hair. The aim of the
surgical procedure is to use such hair as efficiently as possible. The right candidates for this
type of surgery are individuals who still have healthy hair on the sides and the back of the
head in order that hair for the transplant may be harvested from those areas. Different
techniques are utilized in order to obtain the desired cosmetic results; Factors considered
may include hair color, texture, curliness, etc.
The most utilized technique is the one known as micro grafting because it produces
naturalistic results. It is akin to Follicular Unit Extraction although less advanced. A knife with
multiple blades is used to remove tissue from donor areas. The removed tissue is then
fragmented into smaller chunks under direct vision inspection (i.e., without a microscope).
[3]
Redness in scalp after surgery
After the surgery is complete, and during healing, scalp redness may occur. The main reason
is that, during this period, areas of the head where transplantation has taken place are softer
than normal. This is an expected consequence of the medical procedure. The plastic surgeon
Society and culture
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will usually have explained the likelihood of symptoms of apparent irritation, also having
provided a series of indications and follow-up procedures to facilitate proper recovery. Such
recommendations might include the application of ice and abstaining from strenuous physical
activity in the short term.
[4]
Disease
The scalp is a common site for the development of tumours including:
epidermoid cyst
pilar cyst
actinic keratosis and squamous cell carcinoma
basal cell carcinoma
merkel cell carcinoma
Scalp conditions
Dandruff A common problem due to the excessive shedding of dead skin cells from the
scalp
Seborrhoeic dermatitis a skin disorder causing scaly, flaky, itchy, red skin
Cradle Cap a form of this disorder which occurs in newborns
Cutis verticis gyrata A descriptive term for a rare deformity of the scalp.
Head lice
Tycoon's cap, also known as acne necrotica miliaris, characterized by pustules and itching.
This article uses anatomical terminology; for an overview, see anatomical terminology.
Trichology the scientific study of hair and scalp
Trichodynia burning scalp syndrome
Trichotillomania obsessive hair pulling
Dermatillomania obsessive skin picking
Scalping the act of removing the scalp, usually with the hair, as a portable proof or trophy
of prowess in war.
Clinical significance
See also
References
25.10.2014 Scalp - Wikipedia, the free encyclopedia
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1. MedicalMnemonics.com: 258
2. "Scalp: Nerve supply, Medical mnemonic" . LifeHugger. Retrieved 2009-12-15.
3. An overview on hair transplantation Retrieved on 2010-03-09
4. Pistone, Gregory MD. "Scalp Redness Following a Hair Transplant" 2010-03-09.
Histology image: 08601ooa - Histology Learning System at Boston University -
"Integument: scalp, transverse"
Histology image: 08801ooa - Histology Learning System at Boston University -
"Integument: scalp"
lesson1 at The Anatomy Lesson by Wesley Norman (Georgetown University)
http://www.dartmouth.edu/~humananatomy/figures/chapter_47/47-1.HTM
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