Nikhil .

O
P.G Trainee
DEPARTMENT OF
OMFS
 The ARTERIES of the oral apparatus with few
exceptions are the branches of external
carotid artery termed FACIAL CAROTID supplying
superficial and deep structures of the face where as
internal carotid or CEREBRAL CAROTID which send
its blood exclusively to brain
.
• COMMON CAROTID ARTERY

Rt
Lt

EXTERNAL CAROTID ARTERY INTERNAL CAROTID ARTERY

FACE
BRAIN

BRACHIOCEPHALIC
AORTIC
• Superior thyroid artery

• Lingual artery

• Facial artery
 SUPERIOR THYROID
SUPERIOR THYROID ARTERY ARTERY

The arch of the artery is a characteristic to serve as a diagnostic

The arch in
andmark of the
the artery is aexposure
surgical characteristic to serve
of the as a carotid
external diagnostic landmark
artery
in the surgical exposure of the external carotid artery

Superior thyroid
Superior laryngeal LARNYX
Superior thyroid artery
cricothyroid

Superior laryngeal cricothyroid

LARYNX
• LINGUAL ARTERY

• Arise at the level of greater horn of hyoid bone

• .
• Course horizondally forward to posterior border of hyoglossus muscle and continue on de
surface
• .
• Covered by the muscle the artery runs steeply upwards to reach space between
• Genioglossus and inferior longitudinal muscle

• Before it turns in the body of the tongue releases sublingual artery situated in the floor of the m
supplying gland,mucous of the floor of the mouth
• .
• Then it is situated in the body of the tongue called deep lingual artery in the inferior
• Surface of the tongue
Hyoid branch
• Before it enters tongue
Dorsal lingual branch
FACIAL ARTERY
Arises just below posterior belly of digastric muscle .The facial part of the

artery called FACIALARTERY

crosses lower border of mandible

directed towards the corner of mouth
following lateral border nose to the
inner corner of eye.Here it ends as
the ANGULAR ARTERY
anostomosing with the branches of
ophthalmic artery of internal carotid
The horizondal part of the artey
above submandibular gland is
directed obliquely,anteriorly,laterally
and downward to the lower border of
mandible.
• The cervical branch are ASCENDING PALATINE ARTERY SUPPLYING
• PHARYNGEAL MUSCLES AND TONSIL

• SUBMENTAL ARTERY : Supplies the lymphnode of submandibular

• triangle.In region of the chin ,the terminal branch turns upward in to
• face,where it anostomosis with branches of inferior labial artery.

• In the lower part of the face ,the important

• branches are SUPERIOR and INFERIOR LABIAL ARTERIES.These
• vessels arise at variable distance from the corner of the mouth to enter
• lips.In the lower and upper ,the right and left labial artery anastomose widely
• in the midline to form the arterial circle surrounding oral fissure.
• OCCIPITAL ARTERY – Runs obliquely upward parallel to the
• lower border of the posterior belly of digastric
muscle ,between transverse process of atlas and mastoid
process.In dense connective tissue,perforate the
aponeurotic connective tissue between trapezius and
sternomastoid.
• POSTERIOR AURICULAR ARTERY

• Arises just above posterior belly of digastric runs

upwards ,backwards deep to the parotid gland , but
superficial to the styloid process.It crosses the surface of the
mastoid process and ascends behind the auricle.It supplies
behind the auricle and skin of mastoid process, back of
scalp.Styloidmastoid branch supplies mastoid antrum and
semilcircular canals
• ASCENDING PHARYNGEAL ARTERY

• This is only the medial branch arising from external carotid

artery.Arising from the lower end of the external carotid ,it runs
vertically upwards between the side wall of the pharnyx and the
internal carotid artery,up to the base of the skull.

• Supplies- side wall of pharnyx,tonsil,medialwall of

the middle ear and auditary tube
– TERMINAL BRANCHES OF EXTERNAL CAROTID

1 COMMON CAROTID

2 EXTERNAL CAROTID

4 3 MAXILLARY ARTERY

4 SUPERFICIAL TEMPORAL
3 5 FACIAL ARTERY

1
• SUPERFICIAL TEMPORAL ARTERY

• The artery continue the course of external carotid artery in

retromandibular fossa., ascending vertically in the posterior
root of zygomatic arch in front of outer ear. Before leaving
the parotid gland ,it gives transverse facial artery originating
at the level of mandibular neck ,turns horizontally between
parotid gland and masseter muscle

• The pulse of the artery can be felt at this place

because superficial position of artery emerging from parotid
gland is covered by superficial fascia and skin
INTRERNAL MAXILLARY ARTERY arises just below the neck of the mandible
In the substance of the parotid gland. It is divided in to 4 parts

MANDIBULAR-medial to mandibular neck

MUSCULAR-rl to pterygoid muscle
MAXILLARY-posterior part of maxilla
PTERYGOPALATINE-Terminal branches
In the pterygopalatine space

MIDDLE MENINGEAL ARTERY

Enters foramen spinosum .Its branches
Are embedded deep on the inner
Surface of cranial bones

INFERIOR ALVEOLAR ARTERY

From its origin turns vertically downwards
To reach mandibular foramen. In the
Mandibular canal branches to marrow
Spaces to bone and teeth of alveolar
Process. MENTAL ARTERY supplies soft tissue of chin and anastomosis with branches
Of inferior alveolar artery
• BUCCAL ARTERY

At the outer surface of buccinator muscle breaks in to

terminal
Branches. supplies buccinator muscle and mucosal lining of
cheek and anastomosis with branches of facial artery

The maxillary segment is the

POSTERIOR SUPERIOR ALVEOLAR ARTERY, that winds around
the convexity of maxillary tuberosity where it is closely applied to the
periosteum of bone. It also supplies the mucosa covering buccal
surface of alveolar process of molar and premolar

SPHENO PALATINE ARTERY

Supplies large area of nasal cavity. Arises from
upper most part of pterygo palatine fossa through spheno palatine
foramen of nasal cavity. A branch also supplies pharynx
 INFRA OTBITAL ARTERY
• Enters orbit through inferior orbital fissure.It supplies inferior oblique
Muscle,inferior muscles of eye ball and inferior rectus.Emerging from
Infra orbital foramen,supplies anterior part of cheek ,root of upper lip and
Anastomosis with superior labial artery,facial and angular artery

DESCENDING PALATINE ARTERY

Arises in the pterygo palatine fossa.descending through fossa and
Pterygo palatine canal reaches oral cavity through major palatine foramen.
The main branch is MAJOR PALATINE ARTERY turns anteriorly from major
Palatine foramen in the submucosa of the hard palate in a groove between
horizondal palaine process of maxilla and inner plate of alveolar process

MASSETRIC ARTERY
Between condylar process of mandible and posterior border of tendon of
temporalis muscle,reaches inner deep surface of massteric muscle
• INTERNAL CAROTID ARTERY`
• ARTERIAL SUPPLY TO CEREBRUM

• ANTERIOR CEREBRAL ARTERY- Arises from

internal carotid artery lateral to optic chiasma. It crosses the
optic nerve to reach the longitudinal fissure separating the
two cerebral hemisphere. the arteries on either side are
united by ANTERIOR COMMUNICATING ARTERY.
Reaches the genu of corpus callosum running above its
body in its posterior part
• MIDDLE CEREBRAL ARTERY
• Origin from internal carotid artery runs laterally to the depth
of the stem of the lateral sulcus. curves to the superiolateral
surface and runs backwards in the depth of the posterior
ramus of lateral sulcus

• BASILAR ARTERY
• Is formed by the union of right and left vertebral. Arteries.
It ascends in the midline ventral to pons dividing in to right
and left posterior cerebral arteries.
 Middle cerebral

Anterior cerebral
parietal Internal carotid
temporal Posterior cerebral

Basilar
artery
• ANOTOMIC PECULIARITIES OF CEREBRAL ARTERIES
• CIRCLE OF WILLIS –Anastomosis in the form of circular
arteriosus.,anteriorly by anterior communicating artery and
posteriorly by basilar artery as it divides in to right and left posterior
cerebral artery and on each side by anterior cerebral, internal carotid,
posterior communicating and posterior cerebral artery

• BLOOD-BRAIN BARRIER-Formed by structures between blood and

nerve cells. vessel wall, arachnoid layer of perivascular sheath,pial
layer and Neuroglia and ground substance of the brain. It permits
selective passage of blood contents to nervous tissue.

• Central arteries are end arteries ,thrombosis of any of them causes

infarction
• OPHTHALMIC ARTERY

Supra trochlear

Lacrimal gland

Supra orbital

Central artery

ophthalmic

Internal
carotid
THANK YOU
• Grasping the lip between index finger and thumb
aids in excision and controlling the hemorrhage
• Superficial temporal artery-preauricular
• Posterior facial vein –post auricular
• Transverse facial artery-Arises from THE SUPERFICIAL
TEMPORAL ARTERY and crosses the face superficial to
masseter’approximately a finger breath inferior to zygomatic
arch.It anostomosis with the branches of facial artery
• The temporal incision at 45
degrees to the zygomatic arch and 3 cm long for th
acess of the joint. The temporal fascia incision is
depened to the temporal fascia and the zygomatic
arch.Branches of superficial temporal artery and
vein may be encountered here

• INTERNAL MAXILLARY ARTRERY

seen medial to the condylar stump in TMJ surgery
• MAXILLARY OSTEOTOMIES
• Greater palatine vessels
• Nasopalatine vessels
• Descending palatine artery
• Maxillary arteries

• MANDIBULAR OSTEOTOMIES
• Retromandibular vein
• Facial vessels
• Inferior alveolar arteries
• The bleeding vessel is identified,isolated and lumen closed by
securing a haemostat. The knot started by making a loop in the clock
wise direction around the needle holder.The tip of the needle holder
with the loop is used to secure the short end of the suture.The short
end is securely grasped and the loop is pulled down around the vessel
by applying tension on the both bend of the suture
• FACIAL ARTERY
• It can be easily exposed at the point where it crosses
lower
border of mandible to pass from submandibular region in to the face.
This point
is situated anterior to the attachment of masseter muscle to the
mandible.here
the pulse of the FACIAL ARTERY is felt,if contracted masseter muscle
is used
as the landmark.Incision is made half inch below the border of the
mandible,parallel to it.skin,platysma and deep fascia are cut and the
soft tissue

• are bluntly retractd until the palpating finger can feel the pulse of
facial artery.The artery isolated ,tied and cut
• LINGUAL ARTERY

• Submandibular gland is palpated, and a incision is made that circle the

lower pole of the gland.
• The posterior part of the incision should point to the tip of the mastoid
process
• and anterior part to the chin.skin,platysma ,deep fascia are incised ,lower
pole of
• the gland is exposed.If the gland is lifted from its bed,blunt dissection,the
• tendon of digastric muscle becomes visible,pulling digastric tendon
downwards
• helps to enlarge the triangle,at the floor of which bundle hyoglossus
muscle
• becomes visible.the muscle is divided bluntly and the gap between its
vertical
• fibres ,the LINGUAL ARTERY is found
.
• EXTERNAL CAROTID ARTERY

• POSITION – The patient should be positioned supine on the operating

table and tilted head up.A Sand bag is placed beneath the patients
shoulder to extend yhe neck

• EXPOSURE OF VESSELS- The sternocleido muscle is dissected

• Downward along its anterior border.The muscle can be retracted
posteriorly to expose IJv

• IDENTIFICATION- The jugular vein is mobilised by opening the

carotid sheath and freeing the jugular vein by dissection superiorly and
inferiorly

• The common carotid can be visualised lying medial tO internal jugular

vein
• Methods to control bleeding
• Digital pressure
• Elevation
• Packing
• Ribbon gauze impregnated with white head varnish
• Stay suture
• Clamping and ligation
• Cauterisation

• TTAE-Introducing a small catheter in to femoral artery,the involved vessel

identified using angiographic contrast media.the catheter is positioned proximal to
the bleeding vessel at a position that take collateral circulation of the
area.thrombogenic or occlusal material is delivered to the area-microfibrillar
collagen,platinium
• LIGATION OF EXTERNAL CAROTID
ARTERY
• Injuries of the upper part of the neck or the superficial and
deep structures of the facemay make ligation of the external
carotid artery.Ther are two points of which external carotid
artery can be tied.

• One method is exposing the origin of the

common carotid artery,the ligature being placed above the
origin of the superior thyroid from external carotid .
• Since the anastomosis of all the branches of the external
carotid and the anostomosis of the left and right artery are
so numerous ,ligature of these vessels will not stop
bleeding.
• LIGATION OF MAXILLARY ARTERY
• INDICATIONS- Arterial ligation is indicated when epistaxis that
continues despite adequate attempts at local control with anterior and
posterior nasal packing and use of a cautery

• OPERATION STEPS-The maxillary antrum is approached as for a

cald-well-luc procedure.local anaesthetia with epinephrine is
infiltrated in the soft tissue,canine fossa.The maxillary antrum is
entered and bone is widely removed from the entire face of the
antrum.The mucosa on the back side of the sinus is incised to develop
an inferiorly based flap.The bone of the back wall of the sinus is
cracked with a chisel,medially the dissection is limited by thick
orbital process of palatine bone.careshould be taken,posterior wall of
the antrum ,to penetrate the periosteum of the pterygopalatine fossa
and lacerate the artery
TT
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