A VERY GOOD

MORNING

Monday, 16th July, 2012

 ARTERIAL SUPPLY OF
HEAD AND NECK REGION
Presented by
Dr. Jomi Porinchu

Moderated by:
Dr. (Brig) K. Ravi Shankar VSM
PROFESSOR
AN OVERVIEW
INTRODUCTION

CLASSIFICATION

ARTERIES OF THE HEAD AND

NECK

CONCLUSION

REFERENCES
 INTRODUCTION
Arteries:
A vessel in which blood
flows away from the
heart, in the systemic
circulation carrying
oxygenated blood.

-Dorlands Pocket
Medical Dictionary 27th
Edition
THE BASIC CONDUCTING
SYSTEM
 EMBRYOLOGY OF BLOOD
VESSELS
Vasculogenesis:
Refers to the formation of new vascular
structures in an embryo from the
mesenchyme

Angiogenesis:
Formation of blood vessels by sprouting
from the existing blood vessels as seen
in variety of situations from healing
process to tumor vascularisation, et. c.
Based on Function: Blood Vessels

CLASSIFICATION OF BLOOD
VESSELS
ARTERIES OF THE HEAD AND NECK
COMMON
CAROTID ARTERY
BRANCHES OF COMMON
CAROTID
 VARIATIONS IN COMMON
CAROTID ARTERY BIFURCATIONS
 EXTERNAL CAROTID
ARTERY
Origin:
Lateral to the upper border
of the Thyroid cartilage,
between C3&C4

Courses upwards&
forwards inclines to a
point behind the neck of
the mandible,where it
terminates by branching
into maxillary and
 BRANCHES OF EXTERNAL
CAROTID ARTERY
MEDIAL Ascending
pharyngeal
ANTERIOR superior
thyroid, lingual, facial.
POSTERIOR occipital,
posterior auricular
TERMINAL superficial
temporal and maxillary.
 SUPERIOR THYROID
ARTERY
Origin front of ECA just
below the greater Cornu of
hyoid
Sometimes arises from the
CCA (Thyroidia Ima)
Branches:
SCM Branch
Sup Laryngeal Branch
Cricothyroid Branch
Hyoid Branch.
 LINGUAL ARTERY

Origin

Opposite to tip of the

greater Cornu of hyoid.

Its course is divided into 3

parts by hyoglossus muscle.

Branches
Hyoid
Sublingual.
Dorsales lingu.
Profunda lingu.
 ASCENDING PHARYNGEAL
ARTERY
Ascends vertically along
the side wall of the pharynx
upto the base of the skull

Branches
Pharyngeal supply
constrictors &
Stylopharyngeus.
Inferior tympanic medial
wall of tympanic cavity.
Meningeal Duramater and
adjacent bone.
 FACIAL ARTERY

Origin-
Immediately above
the greater cornu of
the hyoid bone.
about the lower
border of
digastric,
sheltered by the
ramus of the
mandible,
Branches in Neck
Ascending
palatine.
Tonsillar.
Submental.
Glandular.

Branches on the
Face
Include:
Superior Labial
Inferior Labial
Small branches
to Masseter
 OCCIPITAL ARTERY
Origin:
post aspect of ECA
opp to the origin of
Facial artery.
Crossed byXII N at
its origin superficially
goes upwards & deep
to the post belly of
the digastric muscle.
Most significant
branch is branch to
SCM muscle.
 POSTERIOR AURICULAR ARTERY
arises above the
Digastric and
Stylohyoid,
It ascends, under cover
of the parotid gland, on
the styloid process of
the temporal bone, to
the groove b/w the
cartilage of the ear&
mastoid process,
immediately above
which it divides into its
auricular
occipital
 MAXILLARY ARTERY
Origin
In parotid gland b/w ramus
and sphenomandibular
ligament.
Three parts:
1st part(MANDIBULAR)
branches:
deep auricular,
anterior tympanic,
middle meningeal,
accessory meningeal
inferior alveolar.
 2nd part (PTERYGOID) lies superficial to
lateral pterygoid muscle.
Branches:
Buccal, Masseteric, Pterygoid Branches,
and Anterior and Posterior Deep
Temporal
3rd part (PTERYGOPALATINE) enters pterygopalatine
fossae through pterygomaxillary fissure.
Branches:
Posterior Superior alveolar vessel.
Infraorbital.
Anterior superior alveolar branches.
Descending palatine
Artery to Pterygoid Canal
 VARIATIONS IN MAXILLARY
ARTERY
Superficial or Lateral to Lateral Pterygoid

60% of the cases

Medial or Deep to Lateral Pterygoid

DESCENDING PALATINE ARTERY
Greater Palatine artery

Passes through the Greater palatine

foramengrooveto the incisive canal
It supplies hard palate, gingiva and
lateral nasal wall.

Lesser palatine artery

Arises in the Greater palatine

canal as a branch of the
greater palatine artery and
descends through the lesser
palatine foramen to supply the
soft palate and tonsil
 MIDDLE MENINGEAL
ARTERY
Runs upwards and medially
deep to the Lateral
Pterygoid and superficial to
the sphenomandibular
ligament..
here it passes through the 2
loops of auriculo temporal N.
Largest artery which
supplies durameter, enters
the cranial cavity through
foramen spinosum.
Frontal branch

Runs obliquely parallel to

and little in front of the

central sulcus of cerebral

hemisphere

Most commonly ruptured

vessel in extradural

hemorrhage.
Variations in Middle Meningeal
Artery
 SUPERFICIAL TEMPORAL ARTERY

Origin
It begins in the
substance of the parotid
gland, behind the neck of
the mandible,
crosses over the
posterior root of the
Zygomatic arch,
abt 5 cm above this it
divides into two
branches, frontal and
parietal
 TRANSVERSE FACIAL
ARTERY
Given off before the vessel quits the parotid gland;
Runs forward through the substance of the gland, b/w
the parotid duct &the lower border of the Zygomatic
arch,
Supplies

-parotid gland and duct,

-Masseter
Anastomoses with the Facial, Masseteric, Buccinator,
and Infraorbital arteries.
 INTERNAL CAROTID
ARTERY

ORIGIN

IT MAY BE DIVIDED INTO

CERVICAL
PETROUS
CAVERNOUS
CEREBRAL.
BRANCHES INTERNAL CAROTID
ARTERY
Cervical Part:
No branches Cerebral Part
Ophthalmic
Anterior
Petrous Part: Cerebral
Caroticotympani Middle Cerebral
c Posterior
Pterygoid Communicating
Anterior Choroid
Cavernous Part
Cavernous
Hypophyseal
Meningeal
CIRCLE OF WILLIS
 ARTERIES OF NECK
Subclavian artery&its
branches.
Vertebral artery
Internal thoracic artery
Thyrocervical trunk
Inferior thyroid artery
Transverse cervical artery
Suprascapular artery
Dorsal scapular artery
Costocervical trunk
Deep cervical artery
Superior intercostal
COLLATERAL
CIRCULATION

Definition: It is an
accessory circuit which
consist of preexisting
anastomoses between
branches of
arteries,when one
occludes then these
channels become patent
above or below the site
of occlusion.
 FACTORS AFFECTING
COLLATEARAL FLOW
Pressure gradient across the site of occlusion

Anatomic site of block

Rate of occlusion

Extent of occlusion

Sympathetic activity
 LIGATION OF ARTERIES IN OMFS

INDICATIONS:
Ligation means AFTER
binding. AMPUTATION
UNCONTROLLED
HAEMMORAHAG
It is the tying of
E
vessels with ANEURYSMS
sutures or wires
IN MALIGNANT
TUMOURS TO
STOP BLOOD
ACCESS TO COMMON CAROTID

They are readily accessible in carotid triangle. Covered

anteromedially by skin fascia and platysma and
bilaterally by anterior margin of S.C.M.

Skin incision for ligation of CCA is done at level of hyoid

bone. Ligation is done in the Carotid triangle where
very few structures pass above it. Superior thyroid vein
and artery and anterior jugular vein are superficial to
artery.

IJV is best avoided by opening carotid sheath more

medially.

Collaterals after ligation

 COLLATERALS AFTER LIGATION
OF CCA
Through subclavian artery, inferior thyroid superior

thyroid arteries.

Either side of face ECA.

Deep cervical, transverse cervical and occipital arteries

anastomoses.

Circle of Willis
 LIGATION OF ECA
Ligation of ECA has no serious effects unless injury to ICA.

Usually done above superior thyroid artery & below

lingual artery.

Immediately following occlusion of CCA, collaterals

through ECA are less effective than through circle of Willis
hence ICA contributes blood to ECA.

Ligation of common carotid may reduce blood supply to

brain more than ligation of ICA. Similar to Subclavian
Steal
LIGATION OF LIGUAL
ARTERY

Submandibular
approach
through digastric
triangle

Ligationof deep lingual

artery incision on
floor of the mouth.
 SUBCLAVIAN STEAL
Occlusion of SCA
proximal to origin of
vertebral artery
results in vertebral
acting as collateral
to the other arm&
stealing flow from
the basilar artery.
 MAXILLARY SURGERY
After down fracturing maxilla the blood supply is

usually from greater palatine, ascending pharyngeal

arteries hence soft tissue pedicle should be

preserved.
 MANDIBULAR SURGERIES
Source:
Maxillary artery.
Facial artery.
Inferior alveolar
Retromandibular vein.
Pterygoid plexus.
During genioplasty muscular detachment, collection of
blood in floor of the mouth Airway obstruction
In vertical ramus osteotomy bleeding occurs due to
massetric vessels.
 HAEMORRHAGE DURING
SURGERY
Maxillary
Source of bleeding
Pterygoid plexus, Greater palatine vessels,
nasopalatine and maxillary artery.
Prevention:
Osteotomy cut should be as low as possible.
Swan neck osteotome is used.
Bleeding can be stopped by packing pterygoid fossae.
Complications:
AV fistula may occur.
Delayed hemorrhage due to rupture of false
aneurysm.
 TRAUMA
Mandibular fractures Bleeding can occur from

lacerations or cut labial arteries, stops by ligation or

suturing occasionally response to pressure.

Orbital plate fracture Hemorrhage tracks down under

conjunctiva appearing as a triangle.

 Retrobulbar hemorrhage

Consequence of midfacial trauma

Within the confines extraocular muscles rupture of

ciliary arteries increase intraconal pressure Reduced

retinal perfusion + venous congestion edema retinal

artery occlusion blindness.

Carotidocavernous fistula

Trauma in the middle cranial fossa

Pulsating the exophthalmous

EPISTAXIS
 Bleeding from
keisselbachs plexus.
Prevention pressure
pack, Silver nitrate
pack if fails
Surgical ligation of
sphenopalatine artery
or ECA or ethmoidal
arteries.
DIAGNOSTIC AIDS FOR ARTERIAL
SYSTEM
 CONCLUSION
It is imperative for a maxillofacial surgeon to
know in its totality the anatomical aspects of
the facial arterial system that in his day to day
surgeries he may steer clear of these major
vessels and thereby the catastrophic effects
that may arise from accidental puncturing of
them.
 REFERENCES
Text book of Anatomy Hollienshied

Synopsis of surgical anatomy McGregor

Text book of anatomy- B. D. Chaurasia.

Atlas of Human Anatomy Netter

Human Embryology Inderbher Singh

THANK YOU