GOOD MORNING

BLOOD SUPPLY OF HEAD

AND NECK
BY
DR. NILAY SHAH
2

CONTENTS
Circulatory System :
Definition
Types Of Circulatory Systems

Heart
Histology Of Blood Vesseles

Blood Supply Of Head And Neck :

Aorta
Common Carotid Artery
External Carotid Artery

External Carotid Artery :

Superior Thyroid Artery
Lingual Artery
Facial Artery

CIRCULATORY SYSTEM
It is a system which supplies nutrients ,

oxygen , hormones etc. throughout body

and carries away waste , carbon dioxide
etc. through blood.

Circulatory system

HEART

HISTOLOGY OF ARTERIES AND VEINS

AORTA

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

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 Right CCA has only a cervical part while left CCA has

cervical and thoracic parts.

CCA ascends diverging laterally, where it divides to

form EXTERNAL & INTERNAL CAROTID ARTERIES. At

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

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SURFACE ANATOMY

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RELATIONS
Anterolaterally:
Skin
Fascia

Sternocleidomastoid
Sternohyoid

Posterolaterally:
Transverse processes of the
lower four cervical vertebrae
Prevertebral muscles.

Sternothyroid
Superior belly of

omohyoid

14

Medially:
Larynx
Pharynx
Trachea
Esophagus

Laterally:
Internal jugular vein
Vagus nerve
(Posterolaterally)

Lobe of thyroid gland

15

APPLIED SCIENCE
Carotid pulse : The

pulse is taken by
palpating the artery
just deep to the
anterior border of the
Sternocleidomastoid
muscle at the level of
the superior border
of the thyroid
cartilage.
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CAROTID SINUS
At the point of division, the terminal part of

CCA or beginning of ICA shows a localized

dilatation.

Serves as a reflex pressure receptor.

in BP causes slowing of heart and

vasodilatation of arterioles.

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CAROTID BODY
Small structure that lies posterior to the point

of bifurcation of CCA.

Chemoreceptor : sensitive to CO2 and O2

in blood.

Hence, produces a rise in BP and HR.

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CAROTID SHEATH (Lincolns

Highway)

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EXTERNAL CAROTID ARTERY

Supplies : face, neck and
scalp
Origin: at the upper
border of thyroid cartilage.
Terminates : in parotid
gland by dividing into
terminal branches
superficial temporal and
maxillary arteries.
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BRANCHES

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RELATIONS
ANTEROLATERALLY:

MEDIALLY:

Sternocleidomastoid

Wall of pharynx
ICA
Glossopharyngeal nerve

Hypoglossal nerve
Stylohyoid muscle
Facial nerve (within

parotid gland)

Internal Jugular Vein

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SURFACE ANATOMY

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SUPERIOR THYROID
ARTERY
Origin : Arises at the level of the

greater cornu of hyoid bone.

Supplies : Thyroid gland and some

adjacent skin.

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LINGUAL ARTERY
Origin : Arises anteromedially from ECA

opposite to the tip of the greater cornu of

hyoid bone.

Short course lies deep to hyoglossus muscle,

finally leaves the muscle in the tongue to

anastomose with the fellow of opposite side.

Supplies the floor of the mouth and tongue

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COURSE AND RELATIONS

First part : in carotid triangle,
sup. To middle constrictor muscle.
forms an Upward loop crossed by hypoglossal n.

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Second part : deep to hyoglossus muscle

Sup. To middle constrictor.

Third part :
Runs upward ,
Then forwards,
Sup. To
genioglossus m.
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FACIAL ARTERY
Origin branch of external
carotid artery just above the
tip of greater cornu of hyoid
bone.

Course runs upwards in

neck, then on face; tortuous
in both places.

Two parts Cervical part

Facial part
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 Cervical branches :
Ascending palatine

artery
Tonsillar artery
Glandular branches

Submental

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Blood supply of palate

35

 Facial

branches :
Inferior

labial artery
Superior

labial artery
Lateral nasal

artery

36

Blood supply of lateral nasal wall

Kisselbachs plexus

Littles area

37

Surface Anatomy

38

Palpation

39

APPLIED
It is known as aneshtetist artery as it is easy to find

and large enough in size.

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Anastomosis
The superior and inferior

labial branches have large

anastomoses with their
counterparts of the other
side. So, in case of an injury
to that region, the cut
arteries spurt from both
ends.

41

Third Molar Impaction

Incision extended too high
May cause profuse bleeding
Because of anastomosing

branches between facial

and lingual branches.

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Submandibular incision

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GOOD MORNING

Contents
External Carotid Artery (cont.)
Occipital Artery
Ascending Pharyngeal artery

Maxillary Artery
Superficial Temporal Artery

Internal Carotid Artery

Ophthalmic Artery
Circle of willis

46

OCCIPITAL ARTERY
Origin posteriorly from the external carotid, 2
cm after 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 ,
sternomastoid , stylomastoid and some parts of
auricle.
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BRANCHES
1. Sternomastoid branch
2. Stylomastoid branch
3. Auricular barnch

4. Mastoid branch
5. Meningeal branch

6. Occipital branch

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POSTERIOR AURICULAR
Origin: From the external carotid artery above
the Digastric muscle and Stylohyoid muscle ,
opposite the apex of the styloid process .
Course : It ascends posteriorly beneath
the parotid gland , along the styloid process of
the temporal bone , between the cartilage of the
ear and the mastoid process of the temporal bone.

Supplies : to the scalp posterior to the auricle

and to the auricle itself.

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ASCENDING PHARYNGEAL
ARTERY
Origin : posterior part of the external
carotid.

Course : ascends vertically between

the internal carotid and the side of

the pharynx , to the under surface of the
base of the skull, lying on the longus
capitis .

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MAXILLARY ARTERY
Varied region of blood supply:
1) External and middle ear, auditory tube
2) Dura mater
3) Upper and lower jaws
4) Muscles of temporal and infratemporal regions
5) Nose and paranasal air sinuses

6) Palate
7) Root of pharynx
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 3 parts:
1) Mandibular part
2) Pterygoid part
3) Pterygopalatine part
57

Mandibular part
The first or mandibular

portion passes horizontally forward,

between the neck of the mandible and
the sphenomandibular ligament,
where it lies parallel to and a little
below the auriculotemporal nerve ;
it crosses the inferior alveolar nerve ,
and runs along the lower border of
the lateral pterygoid muscle.
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1) Deep auricular
2) Anterior

tympanic

3) Middle meningeal
4) Accessory

meningeal
5) Inferior alveolar

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INFERIOR ALVEOLAR ARTERY

Origin :It descends with the inferior alveolar
nerve to the mandibular foramen on the
medial surface of the ramus of the mandible.
Course : It runs along the mandibular
canal in the substance of the bone,
accompanied by the nerve, and opposite the
first premolar tooth divides into two branches,
incisor and mental.

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 Mylohyoid branch : As the inferior alveolar

artery enters the foramen, it gives off a mylohyoid
branch which runs in the mylohyoid groove , and
supplies the mylohyoid muscle
Molar branches : to each root of he molars.

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 Incisor branch : during course gives branches to

cancellous bone .
A series of branches which correspond in number to the roots

of the teeth : these enter the minute apertures at the

extremities of the roots, and supply the pulp of the teeth.

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 Mental branch : The mental branch escapes

with the nerve at the mental foramen , supplies
the chin, and anastomoses with
the submental and inferior labial arteries .

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Inferior Alveolar Nerve Block

Positive aspirations

during IANB is around

10%.

To Prevent :
1. Depth of penetration of

needle should not be

more than 8-10 mm in
children.

2. Always achieve bone

contact before you

inject.

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Pterygoid part
The second or pterygoid portion runs

obliquely forward and upward under cover of

the ramus of the mandible and insertion of
the temporalis , on the superficial (very
frequently on the deep) surface of the lateral
pterygoid muscle ; it then passes between the
two heads of origin of this muscle and enters
the fossa.

Supplies the muscles of mastication.

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1) Deep temporal
2) Pterygoid
3) Masster

4) Buccal

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Pterygopalatine part

The third or pterygopalatine portion lies

in the pterygopalatine fossa in relation with
the pterygopalatine ganglion .

This is considered the terminal branch of the

maxillary artery.

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1) Posterior

Superior
Alveolar

2) Infraorbital
3) Greater

palatine

4) Pharyngeal
5) Artery of

pterygoid
canal

6) Sphenopalatin

artery

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POSTERIOR SUPERIOR ALVEOLAR

ARTERY
Origin : Descending upon the tuberosity of
the maxilla .
Supplies : divides into numerous branches,
some of which enter the alveolar canals , to
supply the molar and premolar teeth and the
lining of the maxillary sinus , while others are
continued forward on the alveolar process to
supply the gingiva .
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Posterior Superior Alveolar Nerve Block

Very high chances of

positive aspirations and

injecting into pterygoid
plexus of veins or if needle
is inserted too deep then
Maxillary Artery ,also.

Prevention :
1. Depth of the penetration

should not be more than

10-14 mm.

2. Always aspirate in Two

different planes.

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Infra Orbital Artery

Origin : The infraorbital artery appears, from
its direction, to be the continuation of the
trunk of the Maxillary artery.
Course : It runs along the inferior orbital
groove and canal , and emerges on the face
through the infraorbital foramen..

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Branches
1.

Orbital Branches :
supply the rectus
inferior and inferior
oblique and
the lacrimal sac

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2. Anterior Superior
Alveolar Artery Descend through the
anterior alveolar canals
to supply the
upper incisor and canine
teeth and the mucous
membrane of
the maxillary sinus.

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Infra Orbital Nerve Block

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Caldwell-Luc Surgery

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Blood supply of palate ( Palatine

artery )

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Blood supply of lateral nasal wall

Kisselbachs plexus

Littles area

78

Incision in palate
Should be parallel to

the course of palatine

arteries

Otherwise profuse

bleeding can occur.

Due to rich vascular

supply and ease of

operative field it can
be used for free tissue
graft harvesting.
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SUPERFICIAL TEMPORAL
ARTERY
Arises in the parotid gland behind the neck of

the mandible

1) Transverse Facial

2) Auricular artery
3) Zygomatico- orbital artery
4) Middle temporal
5) Frontal (Anterior branch)
6) Parietal (Posterior branch)
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Palpation

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Pre Auricular Incisions

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INTERNAL CAROTID
ARTERY
Divided into Cervical (has no branches)
Petrous
Cavernous
Cerebral

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PETROUS PART
Caroticotympanic branch or artery:-

anastomosis with
anterior tympanic artery
Pterygoid artery :-anastomosis with branch

of greater palatine

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CAVERNOUS PART
Within the cavernous sinus
Branches:
1) Cavernous branches to the trigeminal

ganglion

2) The superior and inferior hypophyseal

branches to hypophysis cerebri.

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CEREBRAL PART
Lies at the base of brain after emerging from

cavernous sinus

Branches:

1) Ophthalmic
2) Anterior cerebral
3) Middle cerebral

4) Posterior communicating
5) Anterior choroidal
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Ophthalmic
Artery

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 Circulus arteriosus

(circle of willis)

Lies at base of brain

Branch Of Internal Carotid

Artery

Vertebral Arteries

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APPLIED
Stroke : A stroke is the acute development of a

focal neurological deficit as a result of localized

or diffuse cerebral hypoperfusion.

causes

: most commonly, cerebral embolus and

cerebral thrombosis, cerebral hemorrhage,
subarachnoid hemorrhage.

Within five minutes the tissue in the region of the

obstruction is dead

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 Transient ischemic attacks (TIAs)- in tia

recovery is usually complete within 24 hours. They serve

as a warning that treatment may be necessary.

lifestyle, control of hypertension (if present), and

drug treatment to inhibit platelet aggregation (e.g.,

aspirin), to decrease the chance of clots forming and

embolizing into the cerebral circulation.

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Intracerebral aneurysms
Cerebral aneurysms arise from the vessels in and

around the cerebral arterial circle (of Willis).

They typically occur in and around the anterior

communicating artery, the posterior communicating

artery, the branches of the middle cerebral artery, the
distal end of the basilar artery , and the posterior
inferior cerebellar artery.

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Surgical approach to middle

meningeal artery

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THANK YOU
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