arterial supply & venous drainage of head and neck manohar

05/01/2023Arterial & Venous Supply Of Head & Neck- 61

ARTERIAL AND VENOUS DRAINAGE OF HEAD & NECK

DR. MANOHAR. B

FIRST YEAR GRADUATE

DEPT OF PROSTHODONTICS

SIBAR INSTITUTE OF DENTAL SCIENCES

GUNTUR

05/01/2023Arterial & Venous Supply Of Head & Neck- 61 3

Previously Asked Questions includes1. 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)

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

▪ References 05/01/2023Arterial & Venous Supply Of Head & Neck- 61 4

• 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.


▪ 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


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]


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


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


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


Arterial supply of Head & Neck

AORTA

Branches of Arch of Aorta

1. Left Subclavian artery.

2. Left Common Carotid artery.

3. Brachiocephalic trunk.


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.


https://en.wikipedia.org/wiki/Chemoreceptor

https://en.wikipedia.org/wiki/Chemoreceptor

https://en.wikipedia.org/wiki/Carotid_artery

https://en.wikipedia.org/wiki/Partial_pressure

https://en.wikipedia.org/wiki/Oxygen

https://en.wikipedia.org/wiki/Carbon_dioxide

https://en.wikipedia.org/wiki/PH

https://en.wikipedia.org/wiki/Temperature

Common Carotid Artery


▪ 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


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


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)


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


Branches of ECA

Anterior Superior thyroid Lingual Facial

Posterior Posterior auricular Occipital

Medial Ascending pharyngeal Terminal

Superficial temporal Maxillary


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


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


Branches :

Suprahyoid Branch

Dorsal Lingual Branch

Deep Lingual Artery

Sublingual Artery


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


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.


▪ Branches of the cervical part1. 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.



Muscles supplied by the facial artery include:

▪ buccinator

▪ levator anguli oris

▪ levator labii superioris

▪ levator labii superioris alaeque nasi

▪ levator veli palatini

▪ masseter

▪ mentalis

mylohyoid

nasalis

palatoglossus

palatopharyngeus

platysma

procerus

risorius

styloglosus

transverse portion of the nasalis

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


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 05/01/2023Arterial & Venous Supply Of Head & Neck- 61 29

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.


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


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


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


▪ 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


3rd part (pterygopalatine):

Terminal portion of the artery passes between the two heads of the lateral pterygoid muscle


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


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.


Branches

Transverse facial branch

Anterior auricular branch

Frontal branch

Parietal branch

Zygomatico - orbital branch


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


▪ 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.


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


Cavernous Part

With in the Cavernous Sinus

Branches

1) Artery to trigeminal ganglion

2) Superior & inferior Hypophyseal artery


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)


▪ Circle of Willis


Venous Supply of Neck

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 include1. Facial Vein2. Maxillary vein3. Superficial Temporal vein4. Retromandibular vein5. External jugular vein.6. Internal jugular vein7. Anterior jugular vein8. Sub clavian vein


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


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



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.

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


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


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


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


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



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

Venous sinuses


▪ 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

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 to Pulsating Exophthalmosis. 05/01/2023Arterial & Venous Supply Of Head & Neck- 61 58

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.


References

Human Anatomy Vol 3 Head,Neck & Brain - BD Chaurasia’s 4th Edition

Textbook of Anatomy Vol3 - Inderbir Singh 3rd Edition

2nd Edition – Grays AnatomyCunninghams Manaul of Practical Anatomy Vol 3, Head, Neck &

BrainAnatomy of the Head & Neck – M.J Ferenbach, S.W Herring 3rd

Edition 05/01/2023Arterial & Venous Supply Of Head & Neck- 61 60

arterial supply & venous drainage of head and neck manohar

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