seminar

1. BLOOD SUPPLY OF HEAD AND
NECK AND PERIODONTAL
TISSUES
By Dr. Ayushi Singh
MDS 1st year
DEPARTMENT OF PERIODONTOLOGY
SCHOOL OF DENTAL SCIENCES
SHARDA UNIVERSITY.

2. CONTENTS
 Introduction
 Arterial supply of head and neck
 Aorta
 Common carotid artery
 External carotid artery
 Internal carotid artery
 Subclavian artery.
 Arterial supply of face and scalp

3. CONTENTS
 Venous drainage of head and neck
 Subclavian Veins
 Internal jugular Veins
 External jugular veins
 Anterior jugular veins
 Venous drainage of face and scalp
 Lymphatic drainage of head and neck
 Introduction
 Lymph nodes of head and neck
 Blood supply of periodontal tissues.

4. INTRODUCTION
 The blood supply of head and neck consists of an arterial supply and venous drainage
and carried out by the arteries and veins respectively.
 Arteries are main transporters of oxygenated blood except pulmonary artery .
 Veins are main transporters of deoxygenated blood except pulmonary vein.
 Blood vessels are a source of infection spread to the head and neck.

5. ARTERIAL SUPPLY OF HEAD AND NECK
 Arteries carry blood away from the heart.
 The flow of blood depends on the pumping action of the heart.
 The arteries that supply the head and neck are :
 Subclavian artery
 Common carotid artery.
 The main arteries of head and neck are :
 Right and left common carotid arteries , each of which divides into
 An external carotid artery.
 An internal carotid artery.

6. AORTA
 It is the largest artery in the body.
 It originates from the left ventricle.
 It is divided into 3 parts.
1. Left subclavian artery.
2. Left common carotid artery.
3. Brachiocephalic trunk
i. Right subclavian artery
ii. Right common carotid artery

7. COMMON CAROTID ARTERY
 Chief artery of head and neck.
 ORIGIN-
 RIGHT COMMON CAROTID
ARTERY- branch of brachiocephalic
artery
It begins in neck behind right
sternoclavicular joint.
 LEFT COMMON CAROTID
ARTERY- branch of aorta.
It arises in thorax and ascends to the
back of left sternoclavicular joint and
enters the neck.

8. COURSE , TERMINATION AND RELATION –
In neck both arteries ( right and left) have similar course.
Each artery runs upwards from sternoclavicular joint to the upper border of the lamina of
thyroid cartilage ( opposite to the disc between the third and fourth cervical vertebrae)
where it terminates by dividing into internal and external carotid arteries.
The internal carotid artery is considered as continuation of common carotid artery .
They are named as internal and external because former supplies structure within the skull
and later outside the skull.
BRANCHES -
Common carotid artery gives only two terminal branches i.e. external and
internal carotid artery

9. EXTERNAL CAROTID ARTERY
 Supplies the structure external to head and in front of neck.
COURSE AND RELATION –
 It extends upwards from level of upper border of lamina of thyroid cartilage to a point
behind the neck of mandible , where it terminates in the substance of parotid gland by
dividing into the superficial temporal and maxillary arteries.
 External carotid artery has a slight curved course so that it is anteromedial to internal
carotid artery in its lower part and anterolateral to internal carotid artery in its upper
part.

10. BRANCHES
8 branches
Anterior -
1. Superior thyroid
2. Lingual
3. facial
Posterior -
1. occipital
2. posterior auricular.
Medial – ascending pharyngeal
Terminal –
1. maxillary
2. superficial temporal.

11. 1.SUPERIOR THYROID ARTERY-
It arises from front of external carotid artery just below the tip of greater cornu of
hyoid bone.
It runs downwards and forwards parallel and superficial to the external laryngeal nerve
to reach upper pole of thyroid gland which it supplies.
BRANCHES
 INFRAHYOID BRANCH- which anastomoses with its fellow of opposite side.
 STERNOMASTOID BRANCH - to the sternomastoid muscle.
 SUPERIOR LARYNGEAL ARTERY- accompanies internal laryngeal nerve,
passes deep to thyrohyoid muscle and pierces the thyrohoid membrane to supply
the larynx.

12.  CRICOTHYROID BRANCH- passes across the cricothyroid ligament and
anastomoses with its counterpart of opposite side.
 GLANDULAR BRANCHES – to thyroid gland , one of which anastomoses
with its fellow of opposite side along upper border of isthmus of thyroid
gland.

13. 2.LINGUALARTERY -
It arises from front of external carotid artery opposite the tip of greater cornu of hyoid
bone.
- main artery to supply blood to tongue.
- Divided into 3 parts by hyoglossus muscle
a) First part lies in carotid triangle and forms a characteristic loop with convexity
upwards above the greater cornu.
b) Second part lies deep to hyoglossus muscle along upper border of hyoid bone.
c) Third part (or deep lingual artery) first runs upwards along the anterior border of
hyoglossus muscle and then forwards on undersurface of tongue where it
anastomoses with its fellow of opposite side.

14. BRANCHES-
a) FROM FIRST PART – Suprahyoid branch.
b) FROM SECOND PART - dorsae linguae – usually 2 in number , to dorsum of tongue
and tonsil.
c) FROM THIRD PART- Sublingual artery , to sublingual gland.

15. 3.FACIALARTERY –
Arises from front of external carotid artery just above the tip of greater cornu of hyoid bone.
It is divided into 2 parts –
a. Cervical part- Ascends deep to the digastric and stylohyoid muscle
Passes deep to ramus of mandible where it grooves posterior border of
submandibular gland then it makes S shaped bend , first bending down over
submandibular gland and then up over the base of mandible.
BRANCHES
a) ASCENDING PALATINE ARTERY – mainly supplies palate.
b) TONSILLAR ARTERY – main artery of tonsil.
c) GLANDULAR BRANCHES – supply submandibular gland.
d) SUBMENTAL ARTERY- supply mylohyoid muscle and submandibular &
sublingual salivary gland.

17. b. Facial part –
Begins where facial artery winds around the lower border of body of mandible
at the anteroinferior angle of masseter.
BRANCHES
a) INFERIOR LABIAL ARTERY – supply lower lip.
b) SUPERIOR LABIAL ARTERY- supply upper lip.
c) LATERAL NASAL ARTERY- supply ala and dorsum of nose .
d) MUSCULAR BRANCHES –small, unnamed and arise from posterior
aspect of artery.

18. 4.OCCIPITALARTERY -
arise from posterior aspect of external carotid artery at the same level as the facial artery. It
supplies most of back of scalp.
BRANCHES-
a) STERNOMASTOID BRANCH- usually 2 in number ; supply sternocleidomastoid
muscle.
b) MASTOID BRANCH – supplies mastoid air cells.
c) MENINGEAL BRANCH - supply dura mater of posterior cranial fossa.
d) MUSCULAR BRANCHES- supply adjoining muscles.
e) AURICULAR BRANCH – supplies cranial surface of auricle.
f) DESCENDING BRANCH- divide into superficial & deep branches. It provide chief
collateral circulation after ligation of external carotid or subclavian artery.

19. 5.POSTERIOR AURICULAR ARTERY-
arise from posterior aspect of external carotid artery a little above occipital artery.
Crosses superficial to stylohyoid muscle.
BRANCHES -
a) STYLOMASTOID ARTERY- enters stylomastoid foramen to supply middle ear,
mastoid air cells & facial nerve.
b) AURICULAR BRANCH - supplies both cranial & lateral surface of auricle.
c) OCCIPITAL BRANCH – supplies scalp above and behind the auricle.

20. 6.ASCENDING PHARYNGEALARTERY –
slender artery that arise from medial aspect of external carotid artery near its lower end.
It runs vertically upwards between side walls of pharynx & internal carotid artery upto the
base of skull.
BRANCHES –
a) PHARYNGEAL AND PREVERTEBRAL BRANCH – to corresponding
muscles.
b) MENINGEAL BRANCHES – which transverse foramina in the base of skull.
c) INFERIOR TYMPANIC- supplies medial wall of tympanic cavity.
d) PALATINE BRANCHES – which accompany levator veli palatini to the palate.

21. 7.SUPERFICIAL TEMPORAL ARTERY -
It is smaller but more direct terminal branch of external carotid artery . It begins behind the
neck of mandible deep to the upper part of parotid gland. It runs vertically upwards crossing
the root of zygoma in front of tragus where its pulsation can be felt.
BRANCHES-
a) TRANSVERSE FACIAL ARTERY – runs forwards across the masseter below
zygomatic arch.
b) ANTERIOR AURICULAR BRANCH- supplies lateral surface of auricle and external
auditory meatus .
c) ZYGOMATICO-ORBITAL ARTERY- runs forward along the upper border of zygomatic
arch between 2 layers of temporal fascia and reaches the lateral angle of eye.
d) MIDDLE ( DEEP) TEMPORAL ARTERY- runs on temporal fossa deep to temporal
muscle and supplies temporal muscle and fascia.
e) ANTERIOR (FRONTAL) & POSTERIOR (PARIETAL) TERMINAL BRANCHES-
The anterior branch supplies the muscle and skin of frontal region . The posterior branch
supplies skin and the auricular muscles.

22. 8.MAXILLARYARTERY –
Larger terminal branch of external carotid artery.
It arises behind the neck of mandible , runs horizontally forwards up to the lower border of
lower head of lateral pterygoid. Now it turns upwards and forwards , crosses the lower head
of lateral pterygoid superficially ( sometimes deep ) .
After emerging between the two heads of lateral pterygoid it enters the pterygo-palatine
fossa by passing through pterygo-maxillary fissure. Here it ends by giving its terminal
branches.
It supplies-
-Upper and lower jaws
-muscles of temporal and infratemporal fossae
-nose and paranasal sinuses
-palate and roof of pharynx
-External and middle ear
-pharyngotympanic tube
-dura mater

25. INTERNAL CAROTID ARTERY
 ORIGIN – It is one of the terminal branch of common carotid artery originates along
with external carotid artery at the upper border of thyroid cartilage at the disc of third
and fourth cervical vertebrae.
COURSE –
 CERVICAL PART in the neck
 PETROUS PART in the petrous temporal bone
 CAVERNOUS PART in the cavernous sinus
 CEREBRAL PART in relation to base of brain.

26. CERVICAL PART
- It ascends vertically in the neck from its origin to the base of skull to reach the lower end of
the carotid canal . This part is enclosed in carotid sheath along with internal jugular and
vagus nerve .
- No branches arises from the internal carotid artery in the neck.

27. PETROUS PART
 In the carotid canal , the artery first runs upwards and then turns forwards and medially at
right angles .
 Emerges at apex of petrous temporal bone in the posterior wall of foramen lacerum.
Branches-
 Caroticotympanic – enters middle ear and anastomose with anterior and posterior
tympanic branches .
 Artery of the pterygoid canal – anastomose with greater palatine artery.

28. CAVERNOUS PART
Within the cavernous sinus .
Branches-
a) Artery to trigeminal ganglion
b) Superior and inferior hypophyseal artery.
CEREBRAL PART
Lies at the base of the brain after emerging from cavernous sinus.
Branches –
a) Ophthalmic
b) Anterior cerebral
c) Middle cerebral
d) Posterior communicating
Anterior choroidal

29. SUBCLAVIAN ARTERY
 It is so called because it is located
beneath the clavicle.
 It is a main source of supply to the
upper limb hence it is called artery of
upper limb. However it also supplies
the considerable part of thoracic wall,
head, neck, and brain through its
branches.
 RIGHT SUBCLAVIAN ARTERY-
Arises from brachiocephalic artery .
 LEFT SUBCLAVIAN ARTERY- arises
from the arch of aorta.

30. On each side the subclavian artery is divided into 3 parts by scalenus anterior muscle
These are-
FIRST PART- extends from origin to medial border of scalenus anterior.
Branches-
 Vertebral artery - it is further divided into 4 parts- cervical , vertebral, suboccipital and
intracranial .
Branches- in the neck ( cervical branches)- comprising of spinal branches which arise
from 2nd part , supplies the upper five or six cervical segments of spinal cord and
muscular branches which arise from first and third part and supplies deep muscles of
neck and muscles of suboccipital triangle.
 Thyrocervical trunk – inferior thyroid artery- supplies thyroid and parathyroid glands
Transverse cervical artery
Suprascapular artery
 Internal thoracic artery

32. SECOND PART- lies behind the scalenus anterior muscle
Branches-
Costocervical trunk comprising of highest intercostal artery and deep cervical artery.
THIRD PART- Extends from lateral border of scalenus anterior to the outer border of first rib
Sometimes a large branch arise from it known as descending scapular artery or dorsal scapular artery
which replaces deep branch of transverse cervical artery then only the superficial branch arise from the
costocervical trunk and is called superficial cervical artery .

34. ARTERIAL SUPPLY OF FACE AND SCALP

37. VENOUS DRAINAGE OF HEAD AND NECK
The major veins draining head and neck
are –
 Subclavian
 Internal jugular
 External jugular
 Anterior jugular.
The internal jugular vein is the principal
vein of head and neck region as it drains
the brain as well as most of other tissues of
head and neck.

39. SUBCLAVIAN VEIN
 CONTINUATION OF AXILLARY VEIN
 Extends from outer border of first rib to medial border of scalenus anterior where it
joins the internal jugular vein to form brachiocephalic vein .
 It is the principal vein of upper limb

40. - Its tributaries are-
 The external jugular vein
 The dorsal scapular vein
 The thoracic duct on the left
side and
 Right lymphatic duct on right
side
Sometimes it may also receive
 Anterior jugular vein
 Small branch from cephalic
vein.

41. INTERNAL JUGULAR VEIN
 LARGEST VEIN IN THE NECK
 Begins as the direct continuation of the
sigmoid sinus at the base of the skull
below the jugular foramen and
descends vertically downwards to end
behind the sternal end of the clavicle by
joining the subclavian vein to form the
brachiocephalic vein.
 The right internal jugular vein is
usually larger than the left because it
drains the blood from the larger
superior saggital sinus .

42. Tributaries
 Inferior petrosal vein - is usually the
first tributary joins the internal jugular
vein immediately below the jugular
foramen.
 Pharyngeal veins – from pharyngeal
plexus
 Common facial vein
 Lingual vein
 Superior thyroid vein
 Middle thyroid vein
 Occipital vein ( only sometimes)

43.  In addition to the previously mentioned tributaries , the
right lymphatic duct on the right side and thoracic duct
on the left side Usually open into internal jugular vein or
into the junction between the internal jugular vein and
the subclavian vein.
In the upper part of the neck internal jugular vein may
communicate with the external jugular vein by an oblique
jugular vein across the anterior border of
sternocleidomastoid muscle.

44. EXTERNAL JUGULAR VEIN
 It begins just below the angle of the mandible by the union of posterior
division of retromandibular vein and posterior auricular vein.
 It then runs almost vertically downwards across the sternocleidomastoid
under the cover of platysma to pierce the deep cervical fascia in the antero-
inferior angle of the posterior triangle about 2.5cm above the clavicle along
the posterior border of sternocleidomastoid and enters the supraclavicular
space finally terminating into subclavian vein.

45. TRIBUTARIES
 POSTERIOR AURICULAR
 RETROMANDIBULAR VEIN
 POSTERIOR EXTERNAL JUGULAR
VEIN
 OBLIQUE JUGULAR VEIN
 TRANSVERSE CERVICAL VEIN
 SUPRASCAPULAR VEIN
 ANTERIOR JUGULAR VEIN.

46. ANTERIOR JUGULAR VEIN
 It begins below the chin in the submental region by the union of small unnamed veins
from the chin.
 It descends in the superficial fascia about 1 cm lateral to the midline.
 At about 2.5cm above the suprasternal notch , it pierces the investing layer of deep
cervical fascia to enter the suprasternal space where it turns sharply laterally and passes
deep to sternocleidomastoid and terminates in external jugular vein .
 The anterior jugular veins are united across the midline in the suprasternal space by a
jugular venous arch.

48. VENOUS DRAINAGE OF FACE AND SCALP

49. LYMPHATIC DRAINAGE OF HEAD AND
NECK
INTRODUCTION
 All the lymph from the region of head and neck drains into deep cervical lymph nodes
either directly from the tissues or indirectly after passing through the outlying groups of
lymph node.
 The efferents from deep cervical nodes form the jugular trunk , which on the right side
drains into the right lymphatic duct and on the left sideinto the thoracic duct.
 The right lymphatic duct and thoracic duct generally empty into the junction of the
subclavian and internal jugular veins on their respective sides.

50. LYMPH NODES AND DRAINAGE

51. Out of total 800 lymph nodes in the body 300 are located in head and neck only.
Lymph nodes in region of head and neck are broadly classified into two groups – peripheral
and terminal.
PERIPHERAL LYMPH NODES
- Also called as outlying lymph nodes
- Usually found in groups which are arranged in outer and inner circles
 OUTER CIRCLE – formed by lymph node groups which form the pericervical or
cervical collar at the junction of the head and neck ( craniocervical junction) . these
include

52.  Submental nodes – 3 or 4 in number , situated
across midline below the chin in submental
triangle.
 Submandibular nodes- usually 3 in number ,
situated in submandibular triangle .
 Parotid ( preauricular) nodes- these lie both
superficial and deep to fascial capsule of
parotid gland as well as within the gland.
 Mastoid ( postauricular) nodes- these are
situated superficial to sternomastoid near its
origin from mastoid process.
 Occipital nodes- situated at apex of posterior
triangle along the occipital artery.

53. Outlying extensions of lymph nodes of pericervical collar
 Facial nodes : extension of submandibular nodes and include a
small buccal node , a small mandibular node and a small
infraorbital node.
 Superficial cervical nodes : extensions of parotid nodes and are
situated superficially to sternomastoid along external jugular vein
 Anterior cervical nodes : extension of submental lymph nodes
and situated along anterior jugular vein.

54.  INNER CIRCLE- these lymph nodes lies deep to the
investing layer of deep cervical fascia .
 These contains following lymph nodes-
 Infrahyoid nodes – lie in front of thyrohyoid membrane.
 Prelaryngeal nodes- situated in front of cricothyroid
membrane
 Pretracheal lymph nodes – lie in front of trachea below
isthmus of thyroid gland.
 PARATRACHEAL NODES – these nodes flank the trachea
and oesophagus on either side along recurrent laryngeal
nerves.
 RETROPHARYNGEAL LYMPH NODE- lie posterior to
pharynx and in front of prevertebral fascia in retropharyngeal
space.

55. TERMINAL LYMPH NODES- these are deep cervical lymph nodes that lie along
and around the internal jugular vein.
These are grouped as –
 SUPERIOR GROUP OF DEEP CERVICAL LYMPH NODES
They lie above omohyoid .
One lymph node of this group is situated below the posterior belly of digastric
between the angle of mandible and anterior border of the sternocleidomastoid in
the triangle formed by posterior belly of digastric , facial vein and internal
jugular vein. It is called jugulo digastric node .
It drains the lymph primarily from palatine tonsil.
Also called as ‘ lymph node of the tonsil’

56.  LOWER GROUP OF DEEP CERVICAL LYMPH NODES
One of the lymph nodes of this group lies above the intermediate tendon of
omohyoid posterior to the internal jugular vein. It is called jugulo-omohyoid
lymph node.
It drains lymph primarily from the tongue hence it is called ‘ lymph node of the
tongue’.
Some nodes of this group extend into the supraclavicular fossa and are related to
brachial plexus and subclavaian vessels . These are termed as supraclavicular
lymph nodes ( virchow’s lymph nodes).

57. BLOOD SUPPLY TO THE PERIODONTIUM
The gingiva receives its blood supply mainly through supraperiosteal blood vessels which
are terminal branches of :
 sublingual artery
 buccal artery
 facial artery
 greater palatine artery
 infraorbital artery
 posterior superior artery

58. The DENTAL ARTERY which is the branch of inferior alveolar artery branch of maxillary
artery supplies the dental alveolus.
Blood supply originating from the vessels of periodontal ligament , which extend into the
gingiva and anastomose with capillaries in the sulcus area contribute to the blood supply
of free gingiva.
Arterioles which emerge from the crest of the interdental septa and extends parallel to the
crest of the bone to anastomose with vessels of periodontal ligament , with capillaries in
the gingival crevicular areas and vessels that run over the alveolar crest.

60. VENOUS DRAINAGE-
- buccal, lingual,greater palatine and
nasopalatine veins
- veins run into the pterygoid plexus.
VASCULAR SUPPLY OF TEETH
- MAXILLARY TEETH : BRANCHES
FROM THE SUPERIOR ALVEOLAR
ARTERIES
- MANDIBULAR TEETH :
BRANCHES FROM THE INFERIOR
ALVEOLAR ARTERIES

61. VENOUS DRAINAGE OF TEETH AND SUPPORTING STRUCTURES
- MAXILLARY TEETH AND SUPPORTING STRUCTURES : Veins
accompanying the superior alveolar arteries drain anteriorly into the facial vein
or posteriorly into the pterygoid venous plexus.
- MANDIBULAR TEETH : Veins from mandible collect either into larger vessels
in interdental septa/ into plexus around the root apices and hence into several
inferior alveolar veins.
- Some of the veins drain through the mental foramen to facial vein and other to
pterygoid venus plexus.

62. CONCLUSION
We must know the location of larger blood vessels of the head and neck because these
vessels may become compromised due to disease process or during surgical procedures.
Blood vessels also spread infection to the head and neck and also spread cancer cells from a
malignant tumor to distant sites (metastasis) and at a faster rate than lymph vessels.

63. REFERENCES
 Anatomy of head , neck and brain by Vishram Singh.
 B.D Chaurasia’s human anatomy for dental students – 3rd edition
 NEWMAN and CARRANZA’S Clinical Periodontology – 13th edition Newman
Takei Klokkevold Carranza
 Clinical periodontology and implant dentistry – 5th edition by Jan Lindhe
Niklaus P.Lang.