THE SCALP. 27 



region and usually empties into the angular vein. [The angular vein communicates with the 

 ophthalmic vein and through it with the cavernous sinus ; it thus favors the extension of infection 

 from the face or orbit to the interior, particularly in erysipelas. ED.] 



2. The temporal vein, usually situated behind the artery of the same name. It unites with 

 the internal maxillary to form the temporomaxillary vein. 



3. The posterior auricular -vein, draining the region supplied by the artery of the same 

 name. It assists in the formation of the external jugular vein. 



4. The occipital vein, which empties into the external jugular vein. [It generally receives 

 the mastoid emissary vein, one of its tributaries receives the parietal emissary vein and occasionally 

 an emissary vein from the torcular Herophili opens into it (Cunningham). ED.] 



[The veins of the scalp are also, through the diploic veins, connected with the veins of the 

 dura mater and the venous sinuses. Similar connections are established by small veins which 

 pass from the pericranium directly through the bones, and particularly through the inter- 

 sutural membranes. ED.] 



The important lymphatic vessels, through which inflammations extend to the scalp, are 

 situated : 



1. Anteriorly in the middle line of the forehead passing down alongside of the nose to the 

 lymphatic vessels of the face and to the submaxillary lymphatic glands. 



2. Laterally along the temporal and posterior auricular arteries and passing to the lymphatic 

 glands of the parotid region and to those behind the ear. (This lymphatic vessel is particularly 

 affected by syphilis.) 



3. Posteriorly along the occipital artery and running to the occipital lymphatic glands upon 

 the origin of the trapezius. 



There are no lymphatic glands upon the cranial vault. 



Nerves (Plate 2). Only the sensory nerves of the scalp are of interest to the practi- 

 tioner (the motor filaments to the occipitofrontalis muscle are supplied by the facial nerve). 

 They are furnished partly by the trifacial and partly by the cervical nerves. The following 

 distinct branches should be mentioned : 



1. The supratrochlear (a branch of the frontal from the ophthalmic division of the fifth) is 

 found above the inner canthus of the eye, one centimeter from the median line at the supraorbital 

 margin, where it leaves the orbit to reach the skin of the forehead. 



2. The supraorbi.al nerve (also a branch of the frontal from the ophthalmic) is larger than 

 the preceding and frequently divides into two branches as it runs over the supraorbital margin. 

 It passes upward through the supraorbital foramen or notch, which is palpable 2.5 centimeters 

 from the median line [at junction of inner and middle thirds of upper margin of the orbit. ED.], 

 and which is the landmark for locating the nerve in supraorbital neuralgia. In performing 

 neurectomy upon this nerve the orbit is entered from the supraorbital margin, the orbital contents 

 are pushed downward, and the nerve is sought as far back as possible immediately below the 

 orbital periosteum (the so-called "periorbita") upon the levator palpebrae superioris muscle. 

 In this manner a long piece of the nerve may be excised. 



3. The auriculotemporal nerve (from the inferior maxillary division of the trifacial) accom- 

 panying the temporal artery, frequently being situated between this vessel and the vein, and 

 passing to the skin of the temporal region. 



