Arterial Blood Supply of Head, Neck and Face
Presented By: Dr. Rahul Thanvi (MDS Part 1)
Department of Oral and Maxillofacial Surgery
-Netter
ORIGIN
-Grey’s Anatomy
The arteries of the oral apparatus and adjacent regions are, with few exceptions, branches of the external carotid artery.
Only parts of the nasal cavity and the upper parts of face are supplied by the internal carotid artery.
The external carotid artery sometimes termed as facial carotid while internal carotid artery is termed as cerebral carotid.
Introduction
-Grey’s Anatomy
Carotid Sinus Carotid sinus acts as a baroreceptor or a
pressure receptor and regulates blood pressure.
Carotid Body It acts a chemoreceptor and responds to the
changes in the oxygen and carbon dioxide and pH content of the blood.
Carotid Sheath
the common carotid artery as well as the internal carotid artery.
internal jugular vein. the vagus nerve. the deep cervical lymph nodes
-Journal of Applied Anatomy
Under the cover of anterior border of sternocleidomastoid muscle
Lateral wall of the pharynx
Submandibular traingle and retromandibular fossa
Parotid gland and neck of the mandible
Maxillary artery, Superficial Temporal artery
Anterior Posterior Medial Terminal Superior thyroid Occipital Artery Ascending Superficialartery Posterior auricular pharyngeal temporalLingual artery artery artery arteryFacial artery Maxillary artey
External Carotid Artery
-Netter
Superior Thyroid Artery
This artery arises from external carotid artery at or immediately above the bifurcation of the common carotid artery.Arising at some distance above the upper pole of the thyroid gland it curves anteriorly and downward to reach thyroid gland.
This arch of superior thyroid artery is a characteristic and can serve as a diagnostic landmark in the surgical exposure of the external carotid artery.
Anterior Branches
-Netter
Cricothyroid artery
Superior laryngeal artery
Muscular and hyoid branch
Anterior and posterior branches
Superior thyroid artery
It arises from the external carotid artery at the level of greater horn of the hyoid bone. Frequently it has a common origin with facial artery which is called as linguofacial trunk.
Lingual Artery
Linguofacial Trunk
International Journal of Morphologyversión On-line ISSN 0717-9502Int. J. Morphol. v.23 n.3 Temuco 2005
-Grey’s Anatomy
Deep Lingual Artery
Sublingual artery
Dorsal lingual artery
Hyoid branch
Lingual Artery
Facial Artery
The branches of facial artery can be divided into two sets
Cervical Facial
-Duke’s Anatomy
Most importatnt cervical branches are:a)Ascending palatine Arteryb)Submental Artery
Ascending Palatine Artery
Supply: Soft palate Small branches to pharyngeal muscles and
mucous membrane of pharynx Tonsillar artery (main artery to palatine tonsils)
Submental Artery
Supply:Lymph nodes in submandibular triangle.Anterior belly of digastric muscle.Mylohyoid muscle.
Anastomoses:Sublingual artery.Inferior labial artery.
Facial part of the Facial Artery
Angular artery
Lateral nasal branches
Inferior and superior labial arteries
Anastomoses Inferior labial artery anastomoses
with branches of the mental artery of the inferior alveolar artery of the maxillary artery.
Also inferior labial artery anastomoses with submental artery.
Angular artery anastomoses with with branches of opthalmic artery.
Posterior branches of the external carotid artery
Occipital Artery
Posterior Auricular Artery
Relations: Posterior belly of digastric muscle Atlas and mastoid process Trapezius and sternocleidomastoid muscle
Supply: Deep musculatures of neck Sternocleidomastoid Artery
Occipital Artery
-Grey’s Anatomy
-Netter
Anastomoses:
Descending branch of the occipital artery anastomoses with branches of deep cervical artery of the costocervical trunkof the subclavian artery.
It arises in the retromandibular fossa just above the stylohyoid muscle.
Supply: Outer ear and adjacent area of the scalp. Stylomastoid artery to tympanic cavity.
Anastomoses: It anastomoses with the branches of the occipital
artery and with the auricular branches of superficial temporal artery.
Posterior Auricular Artery
-Grey’s Anatomy
Ascending Pharyngeal Artery It is the only medial branch of the
external carotid artery.It supplies:1. Wall of the pharynx2. Stylopharyngeus, the tensor and levator
palati muscles3. Deep muscles in front of the vertebral column
Medial Branches of the external carotid artery
-Grey’s Anatomy
Ascending pharyngeal artery anastomoses with the:
Ascending palatine arteryAscending cervical artery of the
thyrocervical trunkPterygoid artery of the maxillary artery
Anastomoses
Terminal Branches of External Carotid Artery
Superficial temporal artery
Maxillary artery
It continues the course of external carotid artery in retromandibular fossa and ascending vertically it crosses the posterior root of zygomatic arch in front of outer ear and pulse of the artery can be felt at this place.
Superficial temporal artery
Transverse facial artery anastomose with palpebral arteries.
In the scalp branches of the temporal artery anastomose with branches of posterior auricular and occipital arteries.
Zygomatico-orbital artery anastomoses with the branches of lacrimal artery.
Middle temporal artery anastomoses with branches of the posterior deep temporal artery of the maxillary artery.
Anastomoses
It arises from the external carotid artery just below the level of the mandibular neck in the substance of the parotid gland.It is deeply situated on the inner surface of the mandible and in relation to lateral pterygoid muscle.
Maxillary artery is divided into 4 parts…1. Mandibular part.2. Pterygoid/Muscular part.3. Maxillary part.4. Pterygopalatine part.
Maxillary Artery
Mandibular part:1. Middle meningeal artery2. Inferior alveolar artery
Pterygoid/Muscular part:1. Muscular branches to the temporal,
pterygoid massetric and buccal arteries.
Maxillary part:1. Posterior superior alveolar artery2. Infraorbital artery
Pterygopalatine/sphenopalatine branch:1. Sphenopalatine artery.2. Descending palatine artery.
Inner surface of tympanic membrane
Anterior tympanic artery
Lining of external acoustic meatus and outer surface of tympanic membrane
Deep auricular artery
Mandibular part
Inferior Alveolar Artery
Blood Vessels
Incisive branch
Mental Artery
Mylohyoid Artery
Inferior Alveolar Artery
Dental Arteries
Alveolar arteries
-Grey’s Anatomy
Buccal artery
Pterygoid branches
Massetric Artery
Posterior and anterior deep temporal arteries
Muscular/Pterygoid part
Anterior superior alveolar artery
Towards the inferior muscles of eyeball and lower eyelid
Anterior part of the cheek and root of the upper lip
Infraorbital Artey
Nasopalatine branch
Major palatine artery
Inferior posterior nasal branches
Descending palatine artery
-NetterSphenopalatine Artery
-Duke’s Anatomy
Branch to the pharynx
Posterior septal artery
Posterior lateral nasal artery
Lateral and septal branches
Sphenopalatine artery
The artery ascends from its origin along the lateral wall of the pharynx to the base of the skull. In the lateral wall of pharynx External and Internal carotid arteries are separated by styloglossal and stylopharyngeus muscles.
At the base of the skull, the internal carotid artery enters the carotid canal and passes through it into the cranial cavity.
Internal carotid artery can be divided as
Internal Carotid Artery
Cervical
Cranial
Internal carotid artery releases few branches while in the carotid canal like
1. caraticoiotympanic branches to enter the tympanic cavity
2. Supplying dura matter around the cavernous sinus3. Fine twigs to the opthalmic nerve and pituitary
gland
Supply
Dosral nasal branch
Supraorbital and Supratrochlear branches
Anterior and Posterior ethmoidal arteries
Medial and Iateral palpebral branches
Lacrimal artery
Central artery of retina and cilliary arteries
Opthalmic artery
-Grey’s Anatomy
Anastomoses Supraorbital and frontal branches anastomose with
each other and with the anterior branch of superficial temporal artery.
Dorsal nasal branch anatomoses with the angular and infraorbital artery.
Ligation of Arteries
Major arteries being accidently cut while operating may lead to huge blood loss.
Also clean and dry operating field is always preferred.
When to Ligate? Hemorrhages occurring during lancing of
abscesses. Accidents during routine operations on the
teeth or injuries sustained by external force.
Why To Ligate?
Three arteries are endangered during minor surgical procedures:
1. Anterior Palatine artery2. Sublingual artery3. Facial artery
Arteries endangered during minor surgical procedures or
during dental treatment
The facial artery can be easily exposed at the point where it crosses the lower border of the mandible to pass from the submandibular region into the face.
Contracted masseter muscle is used as a landmark to feel the pulse.
ProcedureThe incision is made at least half inch below the border of the mandible and parallel to it.The skin, platysma muscle, and deep fascia are cut, and then the soft tissues are bluntly retracted upward until the palpating finger can feel the pulse of the facial artery.The artery then can be isolated, tied and cut.
Ligation of Facial Artery
Lingual ArteryThe exposure of lingual artery is
done in the submandibular triangle.The submandibular gland is
palpated through the skin and incision is given in such a way that posterior part should point toward the tip of the mastoid process and the anterior part point towards the chin.
The artery can be exposed in 2 areas
External Carotid Artery
Carotid Triangle
Retromandibular Fossa
Carotid Triangle
Retromandibular Approach