ARTERIAL SUPPLY, VENOUS & LYMPHATIC DRAINAGE OF HEAD,

NECK AND FACE

Netika TharwaniMDS Part 2

CARDIOVASCULAR SYSTEM

OCarries nutrients, oxygen, hormones, etc throughout body.

OBlood circulates within a fast, high capacity system made up of heart, which is the central pump.

OARTERIES: lead away from the heart, carry the blood to the peripheral parts of the body.

OVEINS: return the blood to the heart.

OHeart can be thought of as a pair of muscular pumps,

O1) feeding a minor loop (PULMONARY) – serves lungs and oxygenates the blood

O2) feeding a major loop (SYSTEMIC) – serves the rest of the body

OEach system is a closed system of tubes, so that blood does not leave the circulation

OFrom the center to periphery, the vascular tree shows 3 modifications:

1) The arteries in number by sending out bifurcations.

2) The arteries in diameter .

3) Blood flow is faster near the heart than at the periphery.

OFunctionally, 3 main vessels are described:

1) Resistance vessels ( arteries, mainly arterioles)

2) Exchange vessels ( capillaries, sinusoids)

3) Capacitance vessels (veins)

RESISTANCE VESSELS

Mainly arterioles

Provide main source of peripheral resistance to blood flow

EXCHANGE VESSELS

OThey allow exchange between blood and the interstitial fluid

HISTOLOGY OF BLOOD VESSSELS

O3 concentric layers ( tunicae)1) Tunica intima - innermost

layer2) Tunica media – contains

muscle tissue, elastic fibres, collagen. Thickest in arteries and ansent in capillaries, Thin in veins.

3) Tunica adventitia – outer coat of the vessel

AV ANASTOMOSESODirect communications between

smaller arteries and veins.ONotable in the skin of nose lips,

ears, nasal mucosae, tongue, etc.OIn newborn, there are few AV

anastomoses but develop rapidly.OIn old age, they atrophy, sclerose

and diminish.

ARTERIAL SUPPLY OF HEAD AND NECK

AORTA

AORTA

Ascending aorta begins at the base

of left ventricle,

continues as aortic arch.

BRANCHES FROM THE ARCH

O3 Branches arise from convex aspect of arch:

1)Brachiocephalic trunk2)Left Common Carotid

Artery3)Left Subclavian Artery

APPLIED

OCoarctation of Aorta:OCongenital onditionOThe ductus arterioses remains patent, but rarely compensates.

CAROTID SINUSOAt the point of division, the

terminal part of CCA or beginning of ICA shows a localized dilatation.

OThe tunica media of the sinus is thinner, but adventitia is thicker.

OServes as a reflex pressure receptor.

O in BP causes slowing of heart and vasodilatation of arterioles

CAROTID BODY

OSmall structure that lies posterior to the point of bifurcation of CCA.

OGlossopharyngeal nOChemoreceptor : sensitive

to CO2 and O2 in blood.OHence, produces a rise in

BP and HR.

COMMON CAROTID ARTERY

RIGHT CCA LEFT CCA

ORIGIN FROM THE BRACHIOCEPHALIC ARTERY

DIRECTLY FROM THE ARCH OF AORTA

TERMINATION

AT THE LEVEL OF THE UPPER BORDER OF THYROID CARTILAGE

ORight CCA has only a cervical part while left CCA has cervical and thoracic parts.

OCCA ascends diverging laterally, where it divides to form EXTERNAL & INTERNAL CAROTID ARTERIES.

OAt the level of upper border of thyroid cartilage. (C3, C4 junction)

RELATIONS

OANTEROLATERALLY:OSkinOFasciaOSternocleidomastoi

dOSternohyoidOSternothyroidOSuperior belly of

omohyoid

OPOSTERIORLY:OTransverse

processes of the lower four cervical vertebrae

OPrevertebral muscles

RELATIONS

OMEDIALLY:OLarynxOPharynxOTrachea OOesophagusOLobe of thyroid

gland

• LATERALLY:• Internal

jugular vein• Vagus nerve

(posterolaterally)

APPLIED

OThe bifurcation of the CCA into the ICA and ECA at the ant border of SCM at the superior border of thyroid cartilage.

OCarotid pulse

EXTERNAL CAROTID A

OSupplies face, neck and scalpOOrigin: at the upper border of

thyroid cartilage and terminates in parotid gland by dividing into terminal branches superficial temporal and maxillary arteries.

RELATIONSOANTEROLATERA

LLY:

OSCMOHypoglossal

nerveOStylohyoid

muscleOFacial nerve

( parotid)O IJV

OMEDIALLY:

OWall of pharynx

OICAOGlossopharyn

geal n

BRANCHESAnterior : Superior thyroid Lingual Facial Posterior: Occipital Posterior auricular Medial: Ascending pharyngeal Terminal: Maxillary Superficial temporal

SUPERIOR THYROID ARTERY

OArises at the level of the greater cornu of hyoid bone.

OSupplies thyroid gland and some adjacent skin

OBranches

LINGUAL ARTERYOArises anteromedially from ECA

opposite to the tip of the greater cornu of hyoid bone.

OShort course lies deep to hyoglossus muscle, finally leaves the muscle in the tongue to anastomose with the fellow of opposite side.

OSupplies the floor of the mouth and tongue

BRANCHESO IN THE FLOOR OF MOUTH:

dorsal Lingual arteriesSublingualDeep lingual artery

SUPRAHYOID ARTERY: runs along the upper border of hyoid bone

FACIAL ARTERYOOrigin – branch of external carotid

artery just above the tip of greater cornu of hyoid bone.

OCourse – runs upwards in neck, then on face; tortuous in both places

OTwo parts-O Cervical partO Facial part

• Cervical branches– Ascending

palatine artery

– Tonsillar artery

– Glandular branches

– Submental

• Facial branches– Inferior

labial artery

– Superior labial artery

– Lateral nasal artery

OCCIPITAL ARTERY• Origin – posteriorly from the

external carotid, 2 cm from its origin

• Course – Runs backwards and upwards deep to lower border of posterior belly of digastric and ends posteriorly in scalp

SUPPLIES the occipital belly of occipitofrontalis and skin and pericranium associated with the scalp

POSTERIOR AURICULAR

• Origin- arises from the posterior part of ECA just above the posterior belly of digastric in the retromandibular fossa above stylohyoid muscle

• Course – follows upper border of stylohyoid muscle, anterior border of styloid process reaches groove between cartilage of outer ear and mastoid process.

• Distributes branches partly to ear and scalp.

ASCENDING PHARYNGEAL ARTERY

OSmallest branch

OMedially arises from the ECA

MAXILLARY ARTERYOVaried region of blood supply:1) External and middle ear, auditory

tube2) Dura mater3) Upper and lower jaws4) Muscles of temporal and

infratemporal regions5) Nose and paranasal air sinuses6) Palate7) Root of pharynx

O3 parts:1) Mandibular part

2) Pterygoid part

3) Pterygopalatine part

Mandibular part

1) Deep auricular2) Anterior tympanic3) Middle meningeal4) Accessory meningeal5) Inferior alveolar

Pterygoid partO Supplies the muscles of mastication1) Deep temporal2) Pterygoid3) Masster4) Buccal

Pterygopalatine part

1) Posterior Superior Alveolar2) Infraorbital3) Greater palatine4) Pharyngeal5) Artery of pterygoid canal6) Sphenopalatine artery

LITTLE’S AREA

• Antero-inferior part of nasal septum

• Form plexus of Kiesselbach.

SUPERFICIAL TEMPORAL ARTERY

O Arises in the parotid gland behind the neck of the mandible

1) Transverse Facial2) Auricular artery3) Zygomatico- orbital artery4) Middle temporal5) Frontal6) Parital

INTERNAL CAROTID ARTERY

Divided into-

OCervical

OPetrous

OCavernous

OCerebral

O CERVICAL part: has no branches

PETROUS PART

OCaroticotympanic branch or artery:-

anastomosis with

anterior tympanic artery

OPterygoid artery :-anastomosis with branch of greater palatine

CAVERNOUS PART

OWithin the cavernous sinusOBranches:1) Cavernous branches to the

trigeminal ganglion2) The superior and inferior

hypophyseal branches to hypophysis cerebri.

CEREBRAL PARTO Lies at the base of brainafter

emerging from cavernous sinusO Branches:

1) Ophthalmic2) Anterior cerebral3) Middle cerebral4) Posterior communicating5) Anterior choroidal

Enters through the optic canal

dividing into supratrochlear

and dorsal nasal branches

• Circulus arteriosus – polygonal

O Lies at base of brainO Br. Of ICAO Vertebral Arteries

THANK YOU

ARTERIAL SUPPLY, VENOUS & LYMPHATIC DRAINAGE OF HEAD,

NECK AND FACE

Netika TharwaniMDS Part 2

VENOUS DRAINAGE OF SCALP

OSUPRATROCHLEAR and SUPRAORBITAL veins unite to form ANGULAR vein continues down as FACIAL vein.

OThe SUPERFICIAL TEMPORAL VEIN joins the MANDIBULAR VEIN to form the RETROMANDIBULAR vein unites with FACIAL vein to form COMMON FACIAL vein which drains into IJV.

OThe POST AURICULAR vein and POST DIVISION OF RETROMANDIBULAR vein to form EXT JUGULAR vein and drains into SUBCLAVIAN.