A brief Note on Arterial Supply of Head n Neck, Main Concern for Prosthodontists

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2. ARTERIALAND
VENOUS
DRAINAGE OF
HEAD & NECK
DR. MANOHAR. B
FIRST YEAR GRADUATE
DEPT OF PROSTHODONTICS
SIBAR INSTITUTE OF DENTAL
SCIENCES
GUNTUR

3. Previously Asked Questions includes
1. Maxillary artery - 10 marks – (2002)
2. Circle of Willis 05 marks- 05 marks –(2003)
3. Innervation of Muscles and tongue 10 marks, 05 marks –(2002)
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4. CONTENTS:
▪ Introduction
▪ Embryology
▪ Arterial supply of head and neck
- External carotid artery and its branches
- Internal carotid artery and its branches
▪ Venous drainage of head and neck
- Internal jugular vein
- External jugular vein
▪ Applied anatomy
▪ Conclusion
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5. • THE CIRCULATORY SYSTEM
• transports fluids throughout the body; it consists of the cardiovascular and lymphatic
systems.
• The heart and blood vessels make up the blood transportation network, the
cardiovascular system. Through this system, the heart pumps blood through the body’s
vast system of blood vessels. The blood carries nutrients, oxygen, and waste products to
and from the cells.
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6. ▪ Components of Circulatory System
Heart- It is the muscular organ that pumps the blood (oxygenated) to the body by artery
and receives (deoxygenated) blood trough the veins
Artery- Main transporter of oxygenated blood
Vein- carries blood that is low in oxygen content from the body back to the heart
Arterioles- Diameter of the artery is adjusted to regulate the blood flow.
Capillaries- Diffusion occurs in these walls
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8. Embryology
Aortic arches are short vessels connecting the ventral and dorsal aorta on each side they
run within brachial (pharyngeal) arches { Seen in 4th and 5th week of I.U life}
There are total of 6 pairs in total [ 1st, 2nd, & 5th pairs soon disappear]
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9. The 1st aortic arch – Disappears (a small portion persists and forms a piece of 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
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10. The 4th aortic arch - has ultimate fate different on the right and left side
On the right - it forms the proximal segment of the right subclavian artery.
On the left - it forms a part of the arch of the aorta between left common carotid and left
subclavian artery and termination as ductus arteriousus.
The 5th aortic arch - is transient and soon obliterates
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11. 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
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12. Arterial supply of Head & Neck
AORTA
Branches of Arch of Aorta
1. Left Subclavian artery.
2. Left Common Carotid artery.
3. Brachiocephalic trunk.
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13. Carotid Body
▪ The carotid body (carotid glomus or glomus caroticum) is a small cluster
of chemoreceptors and supporting cells located near the fork (bifurcation) of the carotid
artery (which runs along both sides of the throat).
▪ The carotid body detects changes in the composition of arterial blood flowing through it, mainly
the partial pressure of oxygen, but also of carbon dioxide. Furthermore, it is also sensitive to
changes in pH and temperature.
▪ It receives a rich supply of nerves supply from glossopharyngeal, vagus & sympathetic nerves.
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14. Common Carotid Artery
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16. ▪ The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and
face. There are two carotid arteries, one on the right and one on the left.
Right common carotid body is a branch of brachiocephalic artery, begins in the neck
behind the right sternocephalic joint
Left common carotid body is a branch of the Arch of Aorta, begins in the thorax in front of
the trachea opposite to the little left of the centre of the manubrium and ascends back of the
sternoclavicular joint and enters the neck.
In the neck, both the arteries have the same course, They run upwards along with the
carotid sheath, under the cover of the anterior border of the sternocleidomastoid.
At the level of upper border of the Thyroid cartilage, the artery ends by dividing into
EXTERNAL & INTERNAL CAROTID ARTERY
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17. Carotid Sinus
The termination of carotid artery/ the begging of the Internal carotid artery, shows a slight dilation
known as Carotid Sinus.
In this region the tunica media is thin, but the adventitia is thick and receives a rich innervation
from glossopharyngeal and sympathetic nerves.
The Carotid Sinus acts as a Baroreceptor, and regulates B.P
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18. External Carotid Artery
External carotid body (ECA) is a branch of Common carotid body
Chief artery of supply to structures in the front of the neck and the face.
15% (ECA) originates lateral to Internal Carotid Artery, this variation occurs more frequently on
the right (3:1)
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19. Course and Relations
▪ External carotid artery begins in the carotid triangle, the level of the upper border of the
thyroid cartilage opposite the disc between the 3rd and 4th cervical vertebrae.
▪ Runs upwards & slightly backwards and laterally, terminating behind
the neck of the mandible as maxillary and superficial
temporal artery.
▪ It has slightly curved course, i.e anteromedial to the internal
carotid artery in its lower part and anterolateral to the internal
carotid artery in upper part
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20. Branches of ECA
 Anterior
 Superior thyroid
 Lingual
 Facial
 Posterior
 Posterior auricular
 Occipital
 Medial
Ascending pharyngeal
 Terminal
 Superficial temporal
 Maxillary
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21. Superior Thyroid Artery
 Origin : Below the level of the greater cornua of the hyoid bone.
 Course : Runs downwards and forward parallel and just superficial to the external
laryngeal nerve.
It passes deep to the deep to the long infra hyoid muscle to reach the upper pole
of the lateral lobe of thyroid gland
 Branches : Hyoid
Sternocleidomastoid branch
Superior Laryngeal artery
Cricothyroid muscle
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22. Lingual Artery
 Origin : Arises from ECA opposite in the tip of the greater cornua of the hyoid bone.
 Course : Its course is divided into 3 parts
1st – lies in the carotid triangle, forms a loop which is closed by the hypoglossal
nerve, this loop permits the movement of hyoid bone.
2nd – lies deep in hypoglossus muscle along the upper border of hyoid bone.
3rd – also called as arteria profunda linguae/ deep lingual artery , runs upwards
along the anterior border of hyoglossus and horizontally forward on the under surface of the
tongue
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23. Branches :
 Suprahyoid Branch
 Dorsal Lingual Branch
 Deep Lingual Artery
 Sublingual Artery
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24. Facial Artery
Main artery of the face
 Origin : Arises from the ECA just above the tip of the greater cornua of the hyoid bone,
It has 2 parts 1st cervical part and 2nd fascial part.
 Facial part : Runs upwards on the superior constrictor of the pharynx deep to the posterior
belly of digastric with the stylohyoid and the ramus of the mandible
At the antero inferior angle of the masseter muscle, it can be palpated called
as Anaesthetic artery
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25. Branches of facial part :
▪ Superior labial- supplies to upper lip &
antero-inferior part of nasal septum.
▪ Inferior labial- supplies to lower lip.
▪ Lateral nasal- to the ala & dorsum of nose.
▪ Angular – supplies the lacrimal sac
and orbicularis oculi.
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26. ▪ Branches of the cervical part
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.
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27. Muscles supplied by the facial artery include:
▪ buccinator
▪ levator anguli oris
▪ levator labii superioris
▪ levator labii superioris alaeque nasi
▪ levator veli palatini
▪ masseter
▪ mentalis
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 mylohyoid
 nasalis
 palatoglossus
 palatopharyngeus
 platysma
 procerus
 risorius
 styloglosus
 transverse portion of the nasalis

28. Occipital Artery
 Origin : Arises from the posterior aspect of ECA, opposite to the origin of facial artery
 Course : It is crossed in the region by he hypoglossal nerve.
In Carotid triangle, the artery give 2 branches to the sternocleidomastoid muscle.
The upper branch accompanies the accessory nerve and the lower branch
occipital artery.
Ends in scalp
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29. Post Auricular Artery
Origin : Arises from the posterior aspect of the ECA just above the posterior belly of the
digastric
 Course : Runs upwards and backwards deep to the parotid gland, crosses the base of the
mastoid process and ascends behind the auricle.
 Branches : Stylomastoid
Supply- facial nerve, tympanic cavity, mastoid antrum, air cells & semicircular
canals.
Auricular branch
Occipital branch
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30. Ascending Pharyngeal
 Origin : Small branch arises from the medial side of the ECA, deep inside the neck.
 Course : It runs vertically upwards between the side wall of the pharynx, the tonsil, the
medial wall of the middle ear and the auditory tube.
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31. Maxillary Artery
Origin : Begins at the behind of the neck of the mandible and is imbedded in the substance of
the parotid gland
Course : Maxillary artery is divided into 3 parts
1st Mandibular – Runs horizontally forward, below the neck of the mandible & the
sphenomandibular ligament below the auriculotemporal nerve along with the lower
border of the lateral thyroid
2nd Pterygoid – Runs upwards and forwards superficial to the lower head of the lateral
pterygoid
3rd Pterygopalatine – Passes between the two heads of the lateral pterygoid and through
the pterygomaxillary fissure and enter pterygopalatine fossa
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32. Branches
1st part (mandibular) : Lies medial to mandible, it runs along the lower border of lateral
pterygoid muscle
 Deep auricular artery
 Anterior tympanic artery
 Middle meningeal artery
 Accessory meningeal artery
 Inferior alveolar artery
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33. Branches Foramen transmitting Distribution
1.Deep auricular Foramen in the floor of external acoustic
meatus
External acoustic meatus,outer
surface of tympanic membrane
2.Anterior tympanic Petrotympanic fissure Inner surface of tympanic membrane
3.Middle meningeal Foramen spinosum 5th and 7th nerve, middle ear, tensor
tympani
4.Accessory meningeal Foramen ovale Meninges, Structures in the infra
temporal fossa
5.Inferior alveolar Mandibular foramen Lower teeth and mylohyoid muscle
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34. ▪ 2nd part (pterygoid) – Supplies the masticatory muscles
Branches Distribution
1.Deep temporal Temporalis
2.Pterygoid Lateral and medial pterygoid
3.Masseteric Masseter
4.Buccal Buccinator
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35. 3rd part (pterygopalatine):
 Terminal portion of the artery passes between the two heads of the lateral pterygoid muscle
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36. Branches Foramina Distribution
1.Post superior alveolar Alveolar canals in the body of
maxilla
Upper molar and premolar teeth ;
maxillary sinus
2.Infraorbital Infraorbital fissure Lower orbital muscles, lacrimal sac
,max sinus
3.Greater palatine Greater palatine canal Soft palate, tonsil, palatine glands and
mucosa upper gums
4.Pharyngeal Pharyngeal canal Root of nose , pharynx, auditory tube,
sphenoidal sinus
5.Artery of pterygoid canal Pterygoid canal Auditory tube, upper pharynx, middle
ear
5.Sphenopalatine(terminal part) Sphenopalatine foramen Lateral and medial wall of nose and
air sinuses
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37. Superficial Temporal Artery
Origin : Begins in the neck of the mandible under the cover of the parotid gland.
Runs vertically upward, crossing the root of zygoma/preauricular point.
Course : Begins in the parotid gland behind the mandible neck, crosses the post. root of the
zygomatic process of the temporal bone.
About 5cm above this divides into ant. & post. Branches.
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38. Branches
 Transverse facial branch
 Anterior auricular branch
 Frontal branch
 Parietal branch
 Zygomatico - orbital branch
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39. Internal Carotid Artery
Origin : Terminal branches of Common Carotid Artery originates along the external carotid
artery at the upper border of thyroid cartilage at the 3rd and 4th vertebrae.
Cervical,petrous,cavernous and cerebral parts.
 Branches include Cervical part of the neck
Petrous part in the petrous temporal bone
Cavernous part in the cavernous sinus
Cerebral part in relation to base of brain
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40. ▪ 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.
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41. Petrous Part
Within the petrous part of the temporal bone in the carotid runs upward forward & medially at
right angle.
Branches
1) Caroticotympanic - enter middle ear & anastomose with ant. & post. Tympanic branches
2) Artery of the Pterygoid Canal- anastomose with greater palatine artery
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42. Cavernous Part
With in the Cavernous Sinus
Branches
1) Artery to trigeminal ganglion
2) Superior & inferior Hypophyseal artery
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43. Cerebral Part
 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)
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44. ▪ Circle of Willis
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45. Venous Supply of Neck

46.  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
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47. ▪ Veins include
1. Facial Vein
2. Maxillary vein
3. Superficial Temporal vein
4. Retromandibular vein
5. External jugular vein.
6. Internal jugular vein
7. Anterior jugular vein
8. Sub clavian vein
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48. Facial Vein
 Formed by the union of the supraorbital & supratrochlear veins to form the
angular vein
 Communicate with the cavernous sinus through ophthalmic vein via the
supraorbital.
 Runs downwards & backwards behind the facial artery to the lower border of
mandible ,joined by the anterior division of the retromandibular vein.
 It anastomoses
 Pterygoid plexus through deep facial vein
 Cavernous sinus through superior ophthalmic vein
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49. Maxillary Vein
 Formed by confluence of the veins of the pterygoid plexus
 Passes backward between the spenomandibular ligament & the neck of the mandible.
 It unites with the Superficial Temporal Vein to form the Retromandibular Vein
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50. Superficial Temporal Vein
• Begins in a widespread network joined across scalp to contra-lateral vein and with
supratrochlear, supraorbital, posterior auricular and occipital veins, all draining same
network
• cross posterior root of zygoma & enters parotid gland to unite with maxillary vein to form
retromandibular vein.
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51. Retromandibular Vein
 Formed by the union of the superficial temporal and maxillary vein from pterygoid plexus
 Passes downward in the substance of the parotid gland emerging from its lower border &
divided into two parts
Anterior Division- Joins the facial vein
Posterior Division – pierces the deep facia & joins the post auricular to form
the External jugular vein & drains into Subclavian Vein
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52. External Jugular Vein
 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
▪ Posterior branch of retromandibular vein with posterior auricular vein.
▪ It drains into subclavian vein
Tributaries:
 Posterior external jugular
 Transverse cervical
 Suprascapular
 Anterior jugular
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53. Internal Jugular Vein
▪ 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
▪ Ends by joining subclavian vein to form brachiocephalic vein
 Tributaries:
 Inferior petrosal sinus
 Superior bulb
 Pharyngeal vein
 Lingual vein
 Superior thyroid vein
 Middle thyroid vein
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54. Pterygoid Plexus
▪ 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.
▪ 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
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55. Subclavian Vein
Continuation of axillary vein at the outer border of 1st rib.
Joins internal jugular vein to form brachiocephalic vein.
Tributaries:
▪ External jugular vein
▪ Dorsal scapular vein
▪ Thorasic duct of left side
▪ Right lymphatic duct on right side
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56. Brachiocephalic vein
▪ Formed by the union of IJV and subclavian vein.
▪ Right is shorter than left.
▪ Two brachiocephalic veins unite at the lower border of right first costal cartilage to form
superior venacava.
▪ Tributaries correspond to branches of first part of subclavian artery
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57. Venous sinuses
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▪ Name Drains to
▪ Inferior sagittal sinus - Straight sinus
▪ Superior sagittal sinus - Confluence of sinus
• Straight sinus - Confluence of sinus
• Occipital sinus - Confluence of sinus
• Confluence of sinuses - Transverse sinuses
▪ Cavernous sinuses - Superior and petrosal sinus
▪ Transvers sinus - Sigmoid sinus
▪ Superior petrosal sinus - Sigmoid sinus
▪ Inferior petrosal sinus - Internal Jugular vein
▪ Sigmoid sinus - Internal jugular vein

58. Applied Anatomy
Facial Artery : During surgical removal of the Sub mandibular salivary gland – Incision is given
half inch below the lower border of the mandible
Lingual Artery : Surgical removal of tongue, first the artery is ligated within the lingual triangle
before it gives off branches to the tongue & tonsil
Common Carotid Artery : Can be compressed against the carotid tubercle; the anterior tubercle
of the transverse process of vertebrae C6 which lies at the level of the cartilage.
A cervical rib may compress the subclavian artery diminishing the radial pulse.
Aneurysm in the 3rd part of the subclavian artery causes pressure on the brachial plexus leading
to weakness and numbness in the upper limb.
Right SCA may arise from descending aorta. Then it passes posterior to esophagus leading to
dysphagia lusoria.
▪ Communication between cavernous sinus and ICA may be produced during head injury leading
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59.  Danger area of face:
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.
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60. References
Human Anatomy Vol 3 Head,Neck & Brain
- BD Chaurasia’s 4th Edition
Textbook of Anatomy Vol3
- Inderbir Singh 3rd Edition
2nd Edition – Grays Anatomy
Cunninghams Manaul of Practical Anatomy Vol 3, Head, Neck &
Brain
Anatomy of the Head & Neck – M.J Ferenbach, S.W Herring 3rd
Edition
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