arterial blood supply of head, neck and face

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