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DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

SEMINAR ON
THE EXTERNAL CAROTID ARTERY
AND ITS APPLIED ANATOMY

Date:16/01/10
Presented by:
MODERATOR: Dr. PAVAN TENGLIKAR
DR.SYED AHMED MOHIUDDIN
PG OMFS 1ST YEAR
Proff & H.O.D
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 CONTENTS

1. INTRODUCTION.
2. HISTOLOGY OF ARTERIES.
3. COMMON CAROTID ARTERY.
4. EXTERNAL CAROTID ARTERY.
5. COURSE AND RELATIONS.
6. BRANCHES
7. APPLIED ANATOMY
8. REFERENCES.
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 INTRODUCTION

► ECA is one of the terminal branches of the

CCA.
► Lies anterior to the ICA
► Chief artery of supply to structures in front
of the neck and in the face.

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HISTOLOGY OF ARTERIES

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 General structure

► Three layers
 Tunica intima
 Tunic media
 Tunic externa

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 Tunica intima

► INNERMOST LAYER
 Endothelial lining
 Basal lamina
 Sub endothelial
connective tissue
 Elastic fibers –elastic
lamina
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 Tunica media

► MIDDLE LAYER
► Elastic fibers/Smooth
muscle
 Circularly arranged
fibers.
► Thickest layer in
arteries
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 Tunica externa
► Adventitia
► Loose connective
tissue/collagen fibers
predominant.
► Thickest layer in veins
► Merges with surrounding
tissue
► Prevents
Stretching/distension
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 COMMON CAROTID ARTERIES

► Rt CCA is branch of brachiocephalic trunk,

begins in neck behind rt sternoclavicular
joint.
► Lt CCA branch of arch of aorta, begins in
thorax in front of trachea opposite to a point
a little left to the centre of manubrium.
► At the level of upper border of thyroid
cartilage it divides into ECA & ICA.

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EXTERNAL CAROTID ARTERY

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Course & relations:

► Begins –in carotid triangle.

► Terminates –behind the neck of the
mandible.
► Slightly curved course
► Anteromedially -ICA-lower part of its course
► Anterolaterally –ICA-upper part

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 IN CAROTID TRIANGLE

► Lies under the cover of sternomastoid.

► Crossed superficially:
1. Cervical branch of facial nerve
2. Hypoglossal nerve.
3. Facial nerve
4. Lingual nerve
5. Superficial thyroid veins

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 Above carotid triangle

► Lies deep to substance of parotid gland

► Within gland lies superficial to
retromandibular vein & facial nerve.
► Deep to ECA
–ICA
-Superior laryngeal nerve
-supr cervical sympathetic
ganglion
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► Between ICA & ECA
- styloglossus, stylopharyngeus
muscles
- glossopharyngeal &pharyngeal
branch of vagus nerves
- styloid process & part of
parotid gland

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 Branches of ECA
► Thereare 8 branches
1.Anterior: a) Superior thyroid
b) Lingual
c) Facial
2.Posterior:
a) Posterior auricular
b) Occipital
3.Medial: Ascending pharyngeal
4.Terminal: a) Superficial temporal
b) Maxillary
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 SUPERIOR THYROID ARTERY

► Arises from the ECA just below the greater

cornu of the hyoid bone.
► Runs downwards, forwards parallel to
external laryngeal nerve.
► Passes deep to the infrahyoid muscles to
reach lateral lobe of thyroid gland.
► Branches: superior laryngeal artery,
sternomastoid branch, cricothyroid branch,&
terminal branches to the thyroid gland 25
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 LINGUAL ARTERY

► Arises from the ECA opposite of the greater

cornu of the hyoid bone.
► Course: divided in to 3 parts
► 1st :lies in carotid triangle, forms
characteristic loop, crossed by hypoglossal
nerve.
► 2nd :lies deep to hypoglossus along the
upper border of hyoid bone, superficial to
middle constrictor of the pharynx.
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► 3rd :called arteria profunda linguae, or deep
lingual artery,
► Runs upwards along the border of
hypoglossus, and then forwards on the
undersurface of the tongue.
► During surgical removal of tongue, the first
part is ligated before it gives any branch to
tongue or tonsil
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 FACIAL ARTERY

► Arises just above tip of greater cornu of

hyoid bone.
► Studied under 2 parts.
► Cervical part
► Facial part.

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 CERVICAL PART
► Runs upward on the pharynx deep to posterior belly
of Digastric & to ramus of Mandible.
► Grooves posterior border of Submandibular gland.
► Makes an S bend.
► Branches.
a. Ascending palatine.
b. Tonsillar.
c. Submental.
d. Glandular

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 FACIAL PART

► Enters by winding around base of mandible. & by

piercing antero-inferior angle of masseter.
► Course is very tortuous which prevents artery from
being stretched during movements of pharynx
during deglutition. On face allow free movements
of mandible, lips & cheek during mastication &
various facial movements.
► Branches:
► Inferior labial
► Superior labial
► Lateral nasal
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 POSTERIOR AURICULAR ARTERY

► Arises from the posterior aspect of the ECA just

above the posterior belly of Digastric.
► Runs upwards , backwards deep to the parotid
gland, but superficial to the styloid process.
► Crosses the base of the mastoid process, and
ascends behind the auricle.
► Supplies: back of auricle, skin over mastoid
process, back of the scalp.
► Branch: stylomastoid branch-supplies middle ear

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 OCCIPITAL ARTERY

► Arises from the posterior aspect of ECA, opposite

the origin of facial artery.
► Runs backwards and upwards deep to the lower
border of the posterior belly of Digastric, crossing
carotid sheath, and the accessory and hypoglossal
nerves.
► Next it runs deep to mastoid process and muscles
attached to it, finally pierces trapezius 2.5cm from
midline.
► Branches : Mastoid, Meningeal, Muscular

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 MAXILLARY ARTERY

► This is the larger terminal branch of ECA, given

off behind the neck of mandible.
► Supplies:
1. External & middle ear, Auditory tube.
2. Dura matter
3. Upper and lower jaw.
4. Muscles of temporal infratemporal region
5. Nose and Para nasal sinuses.
6. Palate
7. Root of the pharynx
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 Course and Relation
► Divided in to 3 parts:
1. First- Mandibular part: runs horizontally
forwards, between the neck of mandible and the
sphenomandibular ligament, below the
Auriculotemporal nerve , then along the lower
border of the lateral pterygoid
2. Second-pterygoid part: runs upwards and
forwards either superficially or deep to the lower
head of the lateral pterygoid.
3. Third – Pterygoplatine part: passes between two
heads of lat pterygoid and through
Pterygomaxillary fissure, to enter Pterygopalatine
fossa
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 Branches

► First part – ► Second part-

1. Deep auricular artery 1. Deep temporal
2. Anterior tynphanic branches
artery 2. Br to pterygoid and
3. Middle meningeal masseter
artery 3. Buccal branch
4. Accesory meningeal
artery
5. Inferiopr alveolar
artery
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► Third part-
1. Posterior superior alveolar artery
2. Infraorbital artery
3. Greater palatine artery
4. Pharyngeal branch
5. Artery to the pterygoid canal
6. Sphenopalatine artery

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SUPERFICIAL TEMPORAL ARTERY

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► Itis the smaller terminal branch of ECA,
► Begins behind the neck of the mandible under
cover of the parotid gland.
► Runs vertically upwards, crossing the root of the
zygoma (pre-auricular point), where its pulsation
can be easily felt.
► 5cm above zygoma it divides in to anterior and
posterior branches which supply temple and scalp
► Other branches: Transverse facial artery and
middle temporal artery.
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APPLIED ANATOMY

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 CAROTID SINUS

► Present at the termination of CCA. (or

beginning of ICA.)
► Tunica media is thin, tunica adventia is thick
► Acts as BARORECEPTOR/PRESSURE
RECEPTOR.
► Regulates Blood Pressure.

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 LIGATION OF ECA

► Arterial hemorrhages during major

operations can be prevented.
► Due to wide anatomoses, and contra lateral
arteries , bilateral ligation is necessary.
► Abscess drainage, routine extraction of
teeth, external force.
► Consideration to be given to topographic
relation of incision to neighboring blood
vessels.
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 SURFACE MARKING

EXTERNAL CAROTID ARTERY

The artery is marked by joining the following
points.
a. A point on the anterior border of
sternomastoid muscle at the upper border
of the thyroid cartilage.
b. A second point on the posterior border of
the neck of the mandible.
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► There are two points at which the ECA can
be exposed and tied.

1. EXPOSURE IN THE CAROTID TRIANGLE

2. EXPOSURE IN THE RETROMANDIBULAR

FOSSA.

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EXPOSURE IN CAROTID TRIANGLE

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TRIANGLES OF NECK

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Surgical procedure:

► Incision –level of the angle of mandible just

behind the SCM, continued downward
parallel to lower border of mandible.
► Penetrating through skin, platysma,
superficial layer of SCM.
► Muscle is retracted to expose IJV & deep
layer of SCM.
► In front of IJV, fascia is cut to expose
Superior thyroid artery.
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► ECA is identified by its first anterior branch,
the superior thyroid artery, and then
isolated and tied a few millimeters above
the origin of the superior thyroid artery.

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EXPOSURE IN THE RETROMANDIBULAR
FOSSA

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► Behind the angle of the mandible.

► Thismethod is also called “ligation of ECA

at the stylomandibular ligament”.

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Surgical procedure

► The skin is incised in a line starting at the

tip of the mastoid process and circling the
mandibular angle, continuing below the
mandible for about 1 inch.
► After scapel has pased through the skin
and posterior fibres of platysma muscle,the
EJV and great auricular nerve is
located,tied,and cut.

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► Attachment of parotid capsule with SCM
must be severed with scapel.
► Parotid gland is retracted anteriorly and
upward.
► Underneath the parotid gland, the
posterior belly of Digastric , stylohyoid
muscle becomes visible.
► Above these muscles the upper border of
stylomandibular ligament can be palpated.
► Pulse is felt, artery is isolated, and tied.

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LIGATION OF THE FACIAL ARTERY

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► Can be easily exposed at the point where it
crosses the lower border of the mandible to
pass from submandibular region into the
face.
► This point is situated anterior the
attachment to the masseter muscle to the
mandible.

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► Incision is made ½ inch below the border of
the mandible and parallel to it.
► The skin, platysma muscle, and deep fascia
are cut and then the soft tissue are bluntly
retracted until the palpating finger can feel
pulse.
► Artery then can be isolated, tied, and cut.

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LIGATION OF LINGUAL ARTERY

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► Exposure
of lingual artery is done in the
submandibular digastric triangle

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► Submandibular gland is palpated, and an
incision is made that circles the lower pole
of this gland.
► Posterior part of incision should point
toward the tip of the mastoid process; and
anterior part points the chin .
► Skin, platysma and deep fascia is incised;
the lower pole of gland is exposed.
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► Gland is lifted exposing tendon of digastric
muscle.
► Following the tendon anteriorly mylohyoid
muscle and hypoglossal nerve can be seen.
► By pulling digastric tendon downward,
hypoglossal muscle with its vertical fibers
becomes visible.
► Muscle is divided bluntly, and in the gap
between vertical fibers the lingual artery is
found
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 CONCLUSION

► Severe arterial hemorrhages during major

operation can be prevented by a
preparatory ligation of the respective artery.
► One has to consider , first, the areas in
which an accident severing of the artery is
possible and means to avoid such an
occurrence, and , second, the anatomic
basis for ligating the afferent arteries of the
facial region
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 REFERENCES

► HUMAN ANATOMY-GRAY’S
► HUMAN ANATOMY-B.D.CHAURASIA
► ANATOMY FOR SURGEON’S- HOLLENSHEAD
► ORAL ANATOMY-SICHER
► SURGICAL ANATOMY-SKANDALAKIS, 2004
► CLINICAL ANATOMY-HAROLD ELLIS, 11TH
EDITION

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