Blood supply of head and neck with clinical significance

2. By
A. Vamsi krishna
II M. D. S

3. Functional morphology
Embryology
Common carotid artery
External carotid artery
Internal carotid artery
Venous drainage of face
Venous sinuses
Applied anatomy
Conclusion
References

6. Tight junctions- in brain. Permits smaller molecules
Gap junctions- in skeletal, cardiac & smooth muscle capillaries.
Permits molecules up to 10 nm
Fenestrations- in kidneys, endocrinal glands, intenstinal villi.
Permits molecules up to 20-100 nm.

10. FEATURES
Tunica Intima-Endothelium
Internal elastic membrane
Tunica media
External elastic membrane
Tunica externa
Artery
Usually rippled due vessel
constriction
Present
Thick, dominated by smooth
muscle cells and elastic
fibers
Present
Collagen and elastic fibers
Vein
Often smooth
Absent
Thin, Dominated by smooth
muscle cells and collagen
fibers
Absent
Collagen, elastic fibers and
smooth muscle cells

11. Aortic arches
Aortic arches are short vessels connecting ventral and dorsal aortae on each side they run
within branchial (pharyngeal) arches are based gradually in the 4th and 5th week, in 6 pairs
in total.
The first, second and fifth pairs soon disappear

12. The 1st aortic arch – disappears (a small portion persists and forms a piece of the maxillary
artery)
The 2nd aortic arch – disappears (small portion of this arch contributes to the hyoid and
stapedial arteries)
The 3rd aortic arch - has the same development on the right and left side it gives rise to the
initial portion of the internal carotid artery
The external carotid is derived from
the cranial portion of the ventral aorta
The common carotid corresponds to a
portion of the ventral aorta between
exits of the third and fourth arches

13. The 4th aortic arch - has ultimate fate different on the right and left side
On the left - it forms a part of the arch of the aorta between left common carotid and left
subclavian artery
On the right - it forms the proximal segment of the right subclavian artery
The 5th aortic arch - is transient and soon obliterates

14. The 6th aortic arch - pulmonary arch - gives off a branch on each side that grows
toward the developing lung bud
On the right side, the proximal part transforms into the right branch of the
pulmonary artery and the distal part disappears
On the left side, the distal part persists as the ductus arteriosus during intrauterine
life and the proximal part gives rise to the left branch of the pulmonary artery

16.  ECA is one of the terminal branches of the
CCA.
 Chief artery of supply to structures in
front of the neck and in the face.
 Generally arises medial and anterior to
the ICA
 In 15% ECA originates lateral to the ICA,
this variation occurs more frequently on
the right (3:1)

17.  Anterior
 Superior thyroid
 Lingual
 Facial
 Posterior
 Posterior auricular
 Occipital
 Terminal
 Superficial temporal
 Maxillary
 Medial
Ascending pharyngeal

18.  First branch
 Arises just below the
level of the greater
cornu of the hyoid bone
 Ends in the thyroid
gland.

19.  Hyoid
 Superior Laryngeal
 Sternocleidomastoid
 Cricothyroid
Branches

20. Origin :
 Lingual Artery arises from the ECA
opposite the tip of greater cornu of the
hyoid bone
Course
 First part of artery lies in the carotid
triangle
 Second part of artery lies deep to
the hyoglossus muscle which separates
it from the hypoglossal nerve
 Third Part or deep part : runs
upwards along the anterior margin of
the hyoglossus

21.  Suprahyoid Br
 Dorsal Lingual Br
 Deep Lingual Artery
 Sublingual Artery

22. Facial artery is the chief artery of the face
Origin :
 Arises from the ECA just above the greater
cornu of the hyoid bone
 It has two parts, first cervical part in the neck
and facial part.
 It enters the face by winding around the base
of the mandible
 At the anteroinferior angle of the masseter
muscle, it can be palpated here and is called as
an “anaesthetist’s artery”

23. 1. Ascending palatine artery- it supplies to root of tongue &
tonsil.
2. Tonsillar.
3. Submental artery- it is a large artery which accompanies the
mylohyoid nerve, and supplies the submental triangle and sub
lingual salivary gland.
4. Glandular branches that supplies submandibular salivary gland
and submental lymph nodes.

24. 1. Superior labial- supplies to
upper lip & antero-inferior
part of nasal septum.
2. Inferior labial- supplies to
lower lip.
3. Lateral nasal- to the ala &
dorsum of nose.
4. Angular – supplies the
lacrimal sac and orbicularis
oculi.

25.  A small branch arises from
medial side of ECA
 Long, slender vessel, deeply
seated in the neck
 It runs vertically upwards
between the side wall of the
pharynx, the tonsil, the medial
wall of the middle ear and ,
the auditory tube.

26.  Small and arises above the
posterior belly of digastric
 It runs upwards and backwards
deep to the parotid gland,
crosses the base of the
mastoid process and ascends
behind the auricle.
 Stylomastoid branch

27.  Arises from the posterior
part of the external carotid,
opposite the facial
 Ends in the posterior part of
the scalp
 May arise from Internal
carotid artery.
Occipital Artery

28.  Mastoid
 Meningeal
 Muscular

29.  Larger of the two terminal
branches
 Arises behind the neck of the
mandible, and is imbedded in
the substance of the parotid
gland
 It supplies the deep
structures of the face
Maxillary Artery

31. 1st part (mandibular) :
Lies medial to mandible, it runs along the lower border of
lateral pterygoid muscle
 Deep auricular artery
 Ant.tympanic artery
 Middle meningeal artery
 Accessory meningeal artery
 Inferior alveolar artery

32. Branches
1.Deep auricular
2.Anterior tympanic
3.Middle meningeal
4.Accessory meningeal
5.Inferior alveolar
Foramen transmitting
Foramen in the floor of
external acoustic meatus
Petrotympanic fissure
Foramen spinosum
Foramen ovale
Mandibular foramen
Distribution
External acoustic
meatus,outer surface of
tympanic membrane
Inner surface of tympanic
membrane
5th and 7th nerve, middle
ear, tensor tympani
Meninges, Structures in
the infra temporal fossa
Lower teeth and mylohyoid
muscle

33.  Largest artery that supplies
the dura
 It ascends to the foramen
spinosum through which it
enters the cranium
 Divides into two branches,
anterior and posterior.
 It supplies the dura mater
(the outermost meninges)
and the calvaria.
Middle Meningeal Artery

34.  Runs downword & forward
medial to ramus of mandible
to reach mandibular
foramina
 Before entering mandibular
foramina gives off lingual
and mylohyoid arteries
 In canal gives branches to
mandibular teeth
 After coming out of canal
supply chin via mental artery.

35. 2nd part (pterygoid part) :
 Artery runs forward &upward superficial to the lower head
of the lateral pterygoid muscle

36. Branches
1.Deep temporal
2.Pterygoid
3.Masseteric
4.Buccal
Distribution
Temporalis
Lateral and
medial
pterygoid
Masseter
Buccinator

37. 3rd part (pterygopalatine):
 Terminal portion of the artery
passes between the two heads
of the lateral pterygoid muscle

38. Branches
1.Post superior alveolar
2.Infraorbital
3.Greater palatine
4.Pharyngeal
4.Artery of pterygoid canal
5.Sphenopalatine(terminal
part)
Foramina
Alveolar canals in the body of
maxilla
Infraorbital fissure
Greater palatine canal
Pharyngeal canal
Pterygoid canal
Sphenopalatine foramen
Distribution
Upper molar and premolar
teeth ; maxillary sinus
Lower orbital muscles,
lacrimal sac ,max sinus
Soft palate, tonsil, palatine
glands and mucosa,upper
gums
Root of nose , pharynx,
auditory tube,sphenoidal
sinus
Auditory tube, upper
pharynx, middle ear
Lateral and medial wall of
nose and air sinuses.

39.  Smaller of the two terminal
branches
 It begins in the substance of
the parotid gland, behind the
neck of the mandible
 Divides into two branches, a
frontal and a parietal
Superficial Temporal Artery

40.  Transverse facial branch
 Anterior auricular branch
 Frontal branch
 Parietal branch
 Zygomatico- orbital branch
Branches

41. Origin- It is one of the terminal branch of
common carotid artery originates along
with external carotid artery at the upper
border of thyroid cartilage at the disk of
third and fourth cervical vertebra.
Branches
Cervical part in the neck
Petrous part in the petrous temporal bone
Cavernous part in the cavernous sinus
Cerebral part in relation to base of brain

42. Cervical part
It ascends vertically in the neck from its origin to the base of
skull to reach the lower end of the carotid canal. This part is
enclosed in carotid sheath along with internal jugular and
vagus nerve. No branches arises from the internal carotid
artery in the neck.
Its initial part shows slight dilation, carotid sinus. Which acts
as a baroreceptor.

43. Within the petrous part of
the temporal bone,in the
carotid canal runs upword
forword & medially at rt.
Angle.
Branches
1) Caroticotympanic- enter
middle ear & anastomose
with ant. & post. Tympanic
branches
2) Artery of the Pterygoid Canal-
anastomose with greater
palatine artery

44. Within the Cavernous Sinus
Branches
1) Artery to trigeminal
ganglion
2) Superior & inferior
Hypophyseal artery

45. Lies at the base of the brain
after emerging from the
cavernous sinus
Branches
1.Ophthalmic.
2.Anterior Cerebral.
3.Middle Cerebral.
4.Posterior Communicating.
5. Ant. choroidal
On angiogram internal
carotid show ‘S’ shaped
figure ( carotid siphon )

48.  Venous drainage from the face is
entirely superficial
 All the venous drainage from the
head and neck terminate in the
internal jugular vein which join the
subclavian vein to form the
brachiocephalic vein behind the
medial end of the clavicle
Veins of the Head and neck

49.  It receive blood from the
brain, face and the neck.
 It emerges through the jugular
foramen, as a continuation of
the sigmoid sinus descend
down in the neck, first behind
then lateral to the internal
carotid artery inside the
carotid sheath
Internal jugular vein

50. Tributaries

51.  Is formed by the union of the
supraorbital and supratrochlear
veins to form the angular vein
 Communicate with the cavernous
sinus through the ophthalmic vein
via the supraorbital
Facial vein

52. • Runs downwards and backwards
behind the facial artery to the
lower border of the mandible
• To be joined by the anterior
division of the retromandibular
vein
Joins the:
 Pterygoid plexus through deep
facial vein
 Cavernous sinus through
superior ophthalmic vein

53.  Formed by the union of superficial
temporal and maxillary vein from
the pterygoid plexus
 Passes downwards in the substance
of the parotid gland emerging from
its lower border & divide into two
divisions
Retromandibular vein

54.  Anterior division
 joins the facial vein
 Posterior division:
 pierces the deep fascia and
join the posterior auricular
to form the external jugular.
 It empty into the
subclavian vein
Retromandibular vein

55.  A short trunk accompany the
first part of the artery.
 Formed by confluence of the
veins of the pterygoid plexus.
 It passes backward between the
sphenomandibular ligament and
the neck of the mandible
 Unite with the superficial
temporal vein to form the
retromandibular vein.
The maxillary vein

56.  A network of very small veins,
lie around and within the lateral
pterygoid muscle in the
infratemporal region
 Receive some of the veins that
correspond to the maxillary
vein, inferior ophthalmic vein
(internal carotid blood) and the
deep facial vein.
Pterygoid plexus

57.  Drain into a pair of large,
short maxillary veins
which join the superficial
temporal vein to form the
retromandibular.
 Deep facial vein drain the
plexus into the facial vein
if the maxillary is
occluded
Pterygoid plexus

58.  Begins behind the angle of the
mandible by the union of the
posterior auricular and posterior
division of the retromandibular
veins.
 It descend obliquely, deep to the
platysma, receive the posterior
external jugular vein
 Pierce the deep fascia just above
the clavicle and drain into the
subclavian vein
External jugular vein

59.  Posterior auricular vein
Posterior division of retro mandibular vein
Posterior external jugular vein
Transverse cervical vein
Suprascapular vein
 Anterior jugular vein
Tributaries

60. The external jugular vein was formed by the continuation of undivided
retromandibular vein.
The facial vein presented a normal course from its origin up to the base of the
mandible lying posterior to the facial artery at the anterior border of masseter
muscle. It joined with submental vein in submandibular region and ultimately drained
into external jugular vein. JK SCIENCE Vol. 12 No. 4, Oct-December 2010 203-4

61. Journal of Clinical and Diagnostic Research. 2011 Feb, Vol-5(1):24-27
Of the 35 specimens that were studied, 29 of the common facial veins were found to confirm to the
normal pattern of formation and drainage. 6 specimens showed variations in their terminations.
In one cadaver, there was no division of the retromandibular veins into the anterior and posterior veins
on both sides. The common trunk of the retromandibular veins joined with the anterior facial veins to
form the common facial veins The external jugular veins were absent bilaterally. The common facial
vein terminated directly into subclavian vein of respective side

62. Undivided retromandibular vein forming external jugular vein and drainage of
common facial vein into internal jugular

63. In three specimens, the common facial vein opened into the
external jugular vein.
Journal of Clinical and Diagnostic Research. 2011 Feb, Vol-5(1):24-27

66. Unpaired sinuses Paired sinuses
Superior sagittal Transeverse
Inferior sagittal Sigmoid
Straight Cavernous
Occipital Superior petrosal
Anterior intercavernous Inferior petrosal
Posterior intercavernous Spheno-parietal
Basilar venous plexus Petro-squamous
Middle meningeal

67. Superior sagittal sinus
It lies within the convex attached margin of the falx cerebri.
The sinus begins at the crista galli and is continuous with the
right transeverse sinus.

68. Communications
With the veins of the scalp through the parietal emissary vein.
A vein from the nose through the foramen caecum.
Cavernous sinus through superior anastomotic vein.
Thrombosis of the superior sagittal sinus may take place due
to spread of infection from the nose and scalp.
This will lead to increased intracranial tension resulting in
defective absorption of C. S. F.

69. Inferior sagittal sinus
It occupies the posterior two thirds of the lower free margin
of the falx cerebri.
It collects blood from the falx ceribri, medial surfase of the
cerebrum and terminates into the straight sinus.

70. Cavernous sinuses
These paired sinuses are situated on each side of the body of
sphenoid bone
Extend from superior orbital fissure in front to the apex of
petrous temporal behind.

71. Structures passing through the sinus
Internal carotid artery
Abducent nerve
Occulomotor nerve
Trochlear nerve
Ophthalmic nerve
Maxillary nerve

72. Septic thrombosis of cavernous sinus may be caused by the
numerous communications from the dangerous area of face,
orbit and pharynx.
If the internal carotid artery is ruptured as a result of fracture
of the base of skull.
Manifested by pulsating exophthalmos, oedema of the eye
lids and loud systolic murmur.

73. Applied Anatomy

74. Facial artery -During the surgical removal of the
submandibular salivary gland the incision is made ½ inch
below the lower border of the mandible parallel to
mandibular branch of facial nerve.
Facial artery can be severed during the attempts to open
buccal abscess of the first molar.
An adult female presented with a 22-year history of pain on
the right side of her jaw. Digital palpation over the facial
artery at the inferior border of the mandible elicited and
exacerbated the pain. Surgical exploration revealed a coiled,
tortuous facial artery. Removal of the aberrant artery
provided complete pain relief.
J Craniomandib Disord1992 Fall;6(4):296-9.

75. Lingual artery- During surgical removal of the tongue, the
first part of artery is ligated in the lingual triangle before it
gives any branch to the tongue or tonsil.
Superior thyroid artery- The artery and External laryngeal
nerve are close to each other above the gland but diverge
slightly near the gland. So the artery is ligated as near to the
gland as possible
Superficial temporal artery- crossing the zygomatic arch
the artery is palpable through the skin and fascia and easily
compressed here to control the temporal hemorrhage.
This vessel is well protected by dense tissue. Its branches
anastomose so freely that a partially detached scalp may be
successfully replaced as long as one vessel is intact.

76. Middle meningeal artery- It get injured in head injuries
resulting in extradural hemorrhage.
The frontal or anterior branch is commonly involved. The
hematoma presses the motor area, giving rise to hemiplegia
of the opposite side.
The anterior division can be approached surgically by making
hole in the skull over the pterion,4 cm above the zygomatic
arch.
Rarely parietal or posterior branch is implicated, causing
contra lateral deafness. In this case hole is made 4 cm above
and 4 cm below the acoustic meatus.

77. Common carotid artery- It can be
compressed against the carotid tubercle,
the anterior tubercle of the transverse
process of vertebra C6 which lies at the
level of cricoid cartilage.
Carotidynia is a syndrome characterized
by unilateral (one-sided) tenderness of
the carotid artery, near the bifurcation.
Carotid Sinus
 Present at the termination of CCA. (or
beginning of ICA.)
 Tunica media is thin, tunica adventia is
thick
 Acts as BARORECEPTOR/PRESSURE
RECEPTOR.

78. Carotid sinus hypersensitivity (CSH) is an exaggerated
response to carotid sinus baroreceptor stimulation. It results
in dizziness or syncope from transient diminished cerebral
perfusion.
For these individuals, even mild stimulation to the neck
results in marked bradycardia and a drop in blood pressure.
Carotid Siphon of Angiogram
 Siphon region is the most common site for atherosclerotic
plaque formation in carotid artery

79.  Carotid body situated behind the bifurcation of CCA
 Act as a chemoreceptor & respond to change in the O2, CO2 and pH
content of the blood
 Carotid body paragangliomas are vascular lesions, and this is
reflected in their imaging appearance. These lesions splay apart the
internal (ICA) and external carotid arteries (ECA), and as it enlarges, it
will encase, but not narrow the ICA and ECA.
Head Neck Pathol. Dec 2009; 3(4): 303–306.
Carotid Body

80.  The facial vein is devoid of valves
and rests directly on the facial
muscle.
 The movement of facial muscles
might facilitate the spread of septic
emboli from the infected area of
upper lip and lower part of the nose
in retrograde direction.
 Cause thrombosis of cavernous sinus
with serious complication.
Danger Area of Face

81. Occlusive disease
It is the obstruction or blockage of the body's blood vessels,
including arteries in the head and neck.
Occlusive disease is caused by atherosclerosis
The most common symptom of occlusive disease affecting the
brain is a transient ischemic attack (TIA), or "mini stroke."

82. Temporal arteritis
Temporal arteritis occur when one or more arteries become
inflammed, swollen, and tender.
Temporal arteritis commonly occurs in the the arteries
around the temples (temporal arteries).
These vessels branch off from the carotid artery in the neck.

83. PHACE syndrome
Patients can have abnormalities of the
arteries that carry blood to the brain either in
the head (cerebral) or neck (cervical).
These blood vessels can have abnormal
shapes, sizes or paths through the neck and
head.
Dysgenesis
Narrowing
Non-visualization
Abnormal course or origin
Persistent fetal arteries

84. Shaken baby syndrome (SBS)
It is a form of child abuse. It refers to
brain injury that happens to the child.
It occurs when someone shakes a baby
or slams or throws a baby against an
object. A child could be shaken by the
arms, legs, chest, or shoulders.
What causes the brain injury?
Shaking or throwing a child, or
slamming a child against an object,
causes uncontrollable forward,
backward, and twisting head
movement.
Brain tissue, blood vessels, and nerves
tear. The child's skull can hit the brain
with force, causing brain tissue to bleed
and swell.

85. Mild injuries may cause subtle symptoms. A child may vomit or
be fussy or grouchy, sluggish, or not very hungry. More severe
injuries may cause seizures, a slow heartbeat, trouble hearing,
or bleeding inside one or both eyes

86.  Human Anatomy Vol 3 Head,Neck & Brain
- BD Chaurasia’s 4th Edition
 Textbook of Anatomy Vol3
- Inderbir Singh 3rd Edition
 Anatomy of the Head & Neck
- M J. Fehrenbach, S W. Herring 3rd Edition
 Operative maxillofacial Surgery
- Jhon. D.Langdon & Mohan F. Patel
 Textbook of Anatomy
- A. W. Rogers
 Deaver JB Surgical Anatomy of Human body
- Blakiston, Philadelphia
 www.wikipedia.org
References