Blood supply of head and neck

1. Presented By -
Dr. Parul Garg
PG 1ST YEAR
Department of Pediatric and Preventive
Dentistry

2. CONTENTS
 EMBRYOLOGY
 HISTOLOGY
 Common carotid artery
 External carotid artery
 Internal carotid artery
 Subclavian artery
 Veins
 Structure of veins
 Role of veins
 Classification of venous system
 Description of veins
 Internal jugularvein
 External jugular vein
 Anterior jugular vein
 Venous sinuses
 REFRENCES
DEVELOPMENT

3. DEVELOPMENT

4. FORMATION OF BLOOD
Blood is a specialized fluid connective tissue which acts as a major transport system within the body.
In 3rd week of embryonic life, formation of blood vessels and blood cells is first seen in wall of yolk sac.
Clusters of mesodermal cells aggregate to form blood islands.
These mesodermal cells are the converted to precursor cells called Haemangioblasts that give rise to blood
vessels and blood cells.
Cells which are present in center of blood island form the precursors of all blood cells called Haematopoietic
stem cells.And cells at the periphery of island form the precursors of blood vessels called Angioblasts.
In late embryonic period, the formation of blood starts in the liver till 6th month if intrauterine life.
At the time of birth, blood formation is mainly in the bone marrow.

6. AORTICARCHES
• The aortic arches are a series of six paired embryological vascular structures which give rise to
several major arteries.
• Aortic arches are short vessels connecting ventral and dorsal aortae on each side, they run within
branchial (pharyngeal) arches are based gradually in the 4th and 5th week, in 6 pairs in total.
• The first, second and fifth pairs soon disappear.

7. THE 1ST AORTIC ARCH – DISAPPEARS (A SMALL PORTION PERSISTS AND
FORMS A PIECE OF THE MAXILLARY
artery)
The 2nd aortic arch – disappears (small portion of this arch contributes to the hyoid and
stapedial arteries)
The 3rd aortic arch - has the same development on the right and left side it gives rise to
the initial portion of the internal carotid artery

8. The 4th aortic arch - has ultimate fate different on the right and left side
On the left - it forms a part of the arch of the aorta between left common carotid and left subclavian artery.
On the right - it forms the proximal segment of the right subclavian artery.
The 5th aortic arch - is transient and soon obliterates
The 6th aortic arch - pulmonary arch - gives off a branch on each side that grows toward the
developing lung bud
• The proximal part of the sixth right arch persists as the proximal part of the
right pulmonary artery while the distal section degenerates
The sixth left arch gives off the left pulmonary artery and forms the ductus arteriosus; this duct
remains pervious during the whole of fetal life, but then closes within the first few days after birth due
to increased O2concentration.

9. FATE OF ARCHES

11. • The outermost layer is known as the tunica externa
also known as tunica adventitia and is composed of
connective
tissue made up ofcollagen fibers.
• Inside this layer is the tunica media, or media, which is
made up of smooth muscle cells and elastic tissue (also
called connective tissue proper).
• The innermost layer, which is in direct contact with
the flow of blood is the tunica intima, commonly
called the intima. This layer is made up of
mainly endothelial cells. The hollow internal cavity in
which the blood flows is called the lumen.
Arteries form part of the circulatory system. They
carry blood that is oxygenated after it has been
pumped from the heart to the tissues, except
for pulmonary arteries,which carry blood to the
lungs for oxygenation.
STRUCTURE OF ARTERY

12. STRUCTURE OFVEIN
1. Veins are draining channels
which carry deoxygenated
blood from different parts of
body back to the heart.
2. InferiorVena Cava is the
largest vein.
3.The four pulmonary veins
carry oxygenated blood.
STRUCURE:
Veins are thin-walled. Lumen is
larger than that of
accompanying arteries.
The muscular and
elastic content of venous
walls is much less than
that of arteries.

13. STRUCTURE OF CAPPILARY
Capillaries are
networks of
microscopic
endothelial tubes
interposed b/w
arterioles and venules.

14. DIFFERENCES BETWEEN ARTERIES AND VEINS

15. MAJOR ARTERIES OF HEAD AND
NECK
1.COMMON CAROTID ARTERY
2.EXTERNAL CAROTID ARTERY
3.INTERNAL CAROTID ARTERY
• ADDITIONAL ARTERIES
1.BRANCHES OF SUBCLAVIAN
ARTERY

18. ARTERIES OF SCALP

19. COMMON CAROTID ARTERY

20. 15
COURSE
1. Carotid arteries are generally symmetric and both arteries have
similar course.
2. Each artery run upwards within carotid sheath.
3. In 75% individuals, CCA bifurcates at the level of C3-C4, roughly
at the upper border of thyroid cartilage.
4. In children, the carotid bifurcates one vertebral level higher.
5. Variation in the level of bifurcation
6. Highest seen in –C1 to C2
7. Lowest seen in –T1 to T2
COMMON CAROTID ARTERY

21. 16
CAROTID BODY
(CHEMORECEPTORS)
 It is normally 2.5x 5mm to 4 x 7
mm small, oval reddish brown
structure on the median and deep
side of the upper end of the
common carotid artery.
 Responds to changes in the oxygen,
carbon dioxide and pH content of
blood.
 Blood supply- from small vesssels
usually from ECA, termed as
GLOMIC ARTERY OR
ASCENDING PHARYNGEAL
ARTERY.
 Nerve supply- 9th and 10th cranial
nerve

22. 17
CAROTID SINUS (BARORECEPTORS)
 At the bifurcation of
common carotid
artery, a slight
dilatation known as
carotid sinus.
 Responsive to changes in the
arterial blood pressure.
 It acts as a baroreceptor
(pressure receptor) and
regulates blood pressure.
 BLOOD SUPPLY- Internal
carotid artery
 NERVE SUPPLY- carotid
sinus nerve or nerve of
hering.
• In some persons,
it may be
hypersensitive. In
such persons,
sudden rotation
of head may
cause slowing of
Heart.This
condition is called
as “Carotid Sinus
Syndrome”.

23. RELATION OF COMMON CAROTID ARTERY
LATERAL
1. IJV
ANTEROLATERALLY
1. SKIN
2. FASCIA
3. STERNOCLEIDOMASTOID
4. STERNOHYOID
5. STERNOTHYROID
6. SUPERIOR BELLY OF
OMOHYOID
POSTEROLATERALLY
1. VAGUS NERVE
MEDIAL
1. PHARYNX
2. LARYNX
3. TRACHEA
4. OESOPHAGUS
5. LOBE OF THYROID GLAND
POSTERIOR
1. Transverse process of C3 C4
2. PREVERTBRAL FASCIA
3. SYMPATHETIC TRUNK

24. APPLIED ANATOMY
Cervical artery dysfunction- braces the whole cervical arterial system and the
range of pathologies that affect this system.
Carotid stenosis - It is a narrowing of the carotid arteries caused by a buildup
plaque (atherosclerosis) inside the artery wall that reduces blood flow to the
brain which my cause a stroke.
Carotid Sinus Hypersensitivity- External pressure on the carotid sinus can
cause bradycardia and hypotension, which can lead to dizziness or syncope.
Carotid artery aneurysm - A weak area of the carotid artery allows part of the
artery to bulge out like a balloon with each heartbeat.
Carotid artery vasculitis - Inflammation of the carotid artery, due to an
autoimmune condition or an infection.

25. EXTERNAL CAROTID ARTERY
Generally, it lies anterior to the
internal carotid artery.
It is the chief artery of supply to
structures in the front of the neck and
in the face.

26. SURFACE MARKING
.
B
A
 ECA is marked by joining the following
two points.
 Point on the anterior border of the
sternocleidomastoid muscle at the level of
the upper border of the thyroid cartilage.
 Second point on the posterior border of
the neck of the mandible.
 The artery is slightly convex forwards in
its lower half and slightly concave
forwards in its upper half

27. COURSE
 ECA begins in the carotid triangle at the level of upper border of thyroid cartilage opposite the disc between the
third and fourth cervical vertebrae.
 In the carotid triangle, it lies under cover of the anterior border of the sternocleidomastoid muscle
 It has a slight curved course.

28.  As the artery ascends, it passes deep to the posterior belly of digastric
and stylohyoid muscle and terminates behind the neck of the
mandible by dividing into the maxillary and superficial temporal
arteries.

29. BRANCHES
MNEMONIC-Some Anatomists Like Freaking Out Poor Medical Students
Superficial Temporal Middle Temporal
Transverse Facial
Maxillary
Facial
Ascending palatine and
tonsillar branch
Submental branch
lingual
Posterior belly of digastric
Common carotid
Posterior auricular
occipital
Descending
branch
Sternocleidomastoid
branch
Carotid
body
Internal carotid
Sternocleidomastoid
branch
Superior thyroid
Ascending pharyngeal

30. 28
External carotid artery
SUPERFICIAL
TEMPORAL
Maxillary
Facial
Lingual
Superior thyroid
Posterior
auricular

31. 29
SUPERIORTHYROID
ARTERY

32. 30
ORIGIN AND COURSE:
Arises from ECA immediately above the
bifurcation of CCA
Curves anteriorly and downwards to
enter Thyroid gland

33. 31
BRANCHES
MNEMONIC- I Shall Squeeze Charlie’s Glutes

34. RELATION WITH EXTERNAL LARYNGEAL
NERVE

35. APPLIED ANATOMY
• The artery and external laryngeal nerve are close to each
other higher up, but diverge slightly near the gland.
- So, ligature of superior thyroid artery in thyroid surgery
should be made close to the gland in order to avoid injury of
the external laryngeal nerve.
-Damage to the external laryngeal nerve causes some weakness
of phonation due to loss of tightening effect of the cricothyroid
on the vocal cord.

36. LINGUAL ARTERY
Origin-
Lingual Artery arises from the ECA opposite the tip of greater cornua of the
hyoid bone.
It is tortuous in its course.
It is divided into 3 parts by hypoglossal muscle:-
• First part- lies in carotid triangle.
• Second part- lies deep to hypoglossus.
• Third part- also called deep lingual artery.

37. Course-
•It is covered by the hypoglossal nerve, stylohyoid muscle, and posterior belly of
the digastric muscle
•Runs beneath the hyoglossus muscles
•Branches into deep lingual and sublingual arteries
•Supply the intrinsic muscles of tongue & floor of mouth

38. BRANCHES OF LINGUAL
ARTERY
Suprahyoid Branch
Dorsal Lingual Branch
Deep Lingual Artery
Sublingual Artery

39. APPLIED ANATOMY
• In surgical removal of tongue , first part of artery
is ligated before it gives any branches to the
tongue or tonsil.
LIGATION OF LINGUAL ARTERY:
Incision – circling the lower pole of
submandibular gland.
• Skin, platysma, deep fascia incised, submandibular
gland exposed , lifted, tendon of digastric visible.

40.  Free border of mylohyoid muscle seen, hypoglossal
nerve identified.
 Digastric tendon pulled downwards –enlarges the
digastric triangle, hyoglossus muscle visible.
 Muscle divided bluntly, in the gap of its vertical
fibers lingual artery found & ligated.

41. SUBLINGUAL ARTERY
Injury occurs in premolar & molar region, when sharp instrument
or rotating disks slips off a lower molar & injure the floor of mouth.
May present problems to the surgeon attempting to ligate its source
because it may arise from the submental branch of the facial artery
rather than from the lingual artery.

42. FACIAL ARTERY

43. FACIAL ARTERY
Facial artery is the chief artery of the face
COURSE
Arises from the ECA just above the greater cornua of the hyoid bone
It has two parts, first cervical part in the neck
and facial part.
It enters the face by winding around the base of the mandible down
over the submandibular gland
Angle of mouth
Side of Nose
Terminates near the medial aspect of eye

44. Clinical significance-
 At the anteroinferior angle of the masseter muscle, it can be palpated here
and is called as an “anaesthetist’s artery”

45. •SURFACE MARKINGS- ANTERO INFERIOR BORDER OF MASSETER
1.25 CM LATERAL TO ANGLE OF
MOUTH MEDIAN ANGLE OF EYE
•PULSATIONS FELT AT- LOWER BORDER OF MANDIBLE

46. BRANCHES OF CERVICAL
PART
1. Ascending palatine artery- it supplies to root of tongue & tonsil.
2. Tonsillar artery
3. Submental artery- it is a large artery which accompanies the
mylohyoid nerve, and supplies the submental triangle and sub
lingual salivary gland.
4. Glandular branches that supplies submandibular salivary gland
and submental lymph nodes.

47. ASCENDING PALATINE ARTERY
Origin from highest point of facial artery
Courses cranially along the superior constrictor of
pharynx to reach soft palate
Small branch to pharyngeal muscles
Tonsillar branch supplying palatine tonsil (may arise
directly from facialy artery)
Terminal branches supply soft palate

48. SUBMENTAL ARTERY
Runs horizontally below the inferior border of
mandible
Tranverses horizontally to reach mylohyoid
muscle
Supplies submandibular nodes, mylohyoid and
surrounding muscle
Anastamose with sublingual and inferior labial
artery

49. BRANCHES OF FACIAL
PART
1. Superior labial- supplies to upper
lip & antero-inferior part of nasal
septum.
2. Inferior labial- supplies to lower
lip.
3. Lateral nasal- to the ala &
dorsum of nose.
4. Angular – supplies the lacrimal
sac and orbicularis oculi.

50. FACIAL PART:
INFERIOR LABIAL ARTERY:
Originates near the corner of the mouth, passes deep to
the depressor anguli oris muscle, and pierces the
orbicularis oris muscle.
The artery courses superficial to that muscle, supplying
it as well as the substance of the lower lip.
It forms an anastomosis with its counterpart of the
other side and with branches of the mental and
submental arteries.

51. SUPERIOR LABIAL ARTERY
•Arises just above the inferior labial artery.
•It passes superficial to the orbicularis oris muscle in the
upper lip to serve that muscle as well as the substance
of the upper lip.
•It sends a small twig, the SEPTAL BRANCH to supply
anteroinferior part of the nasal septum and another
one, the ALAR BRANCH, into the wing of the nose.
•The terminus of the vessel will anastomose with its
counterpart of the opposite side.

52. LATERAL NASAL ARTERY
Small branch arising at and passing into the wing and bridge
of the nose.
This supplies ala and dorsum of the nose. This vessel will
anastomose with various other arteries in its vicinity.
ANGULAR ARTERY
Is the terminal continuation of the facial artery, supplying the
tissues in the vicinity of the medial corner of the eye and
anastomosing with dorsal nasal branch of the ophthalmic
artery.

53. VARIATIONS

54. APPLIED ANATOMY
Facial Artery Compression
• Applying pressure to the
facial artery as it passes
over the inferior border of
the mandible just anterior
to the angle will diminish
blood flow to that side.
• Can be injured –during
operative procedures on
lower premolars &
molars, if instrument
enters the cheek at
inferior vestibular
fornix., also while
attempt to open a buccal
abscess or mucocoele.

55. • In mandibular 1st molar region
care must be taken not to injure
the facial artery while extending
the vertical incision down the
vestibule during surgical
extraction of mandibular
impaction.
• So it is recommended that start
vertical incision from the
vestibule in upward direction.
• While excising the submandibular
gland, the facial artery should be
ligated at two points and should be
secured before dividing it,
otherwise it may retract through
stylomandibular ligament causing
serious bleeding.

56. MEDIAL BRANCH

57. ASCENDING PHARYNGEAL
ARTERY
 A small branch arises
from medial side of ECA
 Long, slender vessel,
deeply seated in the neck
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.

58. BRANCHES
• PHARYNGEAL BRANCHES
• PALATINE BRANCH
• PREVERTEBRAL BRANCH
• INFERIOR TYMPANICARTERY
• MENINGEAL BRANCHES

59. POSTERIOR BRANCHES

60. POSTERIOR AURICULAR
ARTERY
 Small and arises above the
posterior belly of digastric
 It runs upwards and backwards
deep to the parotid gland,
crosses the base of the mastoid
process and ascends behind the
auricle.
 Stylomastoid branch

61. OCCIPITALARTERY
ORIGIN
• Arises in carotid triangle from posterior aspect of ECA,
opposite the origin of facial artery.
• It is crossed at its origin by hypoglossal nerve.
COURSE
• Passes backwards and upwards along & under cover of lower
border of posterior belly of digastric, crossing carotid sheath,
hypoglossal & accessory nerves.
• Then it runs deep to the mastoid process and muscles
attached to it i.e.,sternocleidomastiod, digastric etc.

62. •Then crosses the rectus capitus lateralis, superior oblique, and
semispinalis capitus muscle at the apex of the posterior triangle.
•Finally it pierces the trapezius muscle and ascends in a tortuous
course in the superficial fascia of the scalp.
•Its terminal portion comes to lie along the greater occipital nerve.

63. BRANCHES
IN THE CAROTID TRIANGLE
STERNOCLEIDOMASTOID BRANCHES –
• Two in number
• Upper branch accompanies the accessory nerve and lower
branch arises near the origin of the occipital artery.
• Supplies sternocleidomastoid muscle.
IN THE POSTERIOR TRIANGLE and SCALPREGION
AURICULAR BRANCH
• Passes superficial to the mastoid process to reach and
supply the back of the auricle.

64. • MASTOID BRANCH
Enters cranial cavity through mastoid foramen, supplies
mastoid air cells in the dura and diploe.
MENINGEAL BRANCH
• Ascends with the internal jugular vein and enters the skull
through jugular foramen & condylar canal, supplies dura of
posterior cranial fossa.
MUSCULAR BRANCH
• Supply the Digastric
• Stylohyoideus
• Splenius
• Longissimus capitis.

65. DESCENDING BRANCH :
• The largest branch of the occipital, descends on the
back of the neck, and divides into a superficial and
deep portion.
• The superficial portion runs beneath the
Splenius, giving off branches which pierce that
muscle to supply the Trapezius and anastomose
with the ascending branch of the transverse
cervical artery.
• The deep portion runs down between the
Semispinales capitis and colli

66. • The terminal branches of the occipital artery (occipital
branches) are distributed to the back of the head
• They are very tortuous, and lie between the integument and
Occipitalis, anastomosing with the artery of the opposite side
and with the posterior auricular and temporal arteries
• Supplying the Occipitalis, the integument, and pericranium

67. APPLIED ANATOMY
Superficial branch anastomosis with
ascending branch of transverse cervical artery.
Deep branch of descending branch of occipital
artery anastomosis with deep cervical artery.

68. TERMINAL BRANCHES

69.  Larger of the two terminal branches.
 Arises behind the neck of the mandible, and is embedded in the substance of the
parotid gland
 It supplies the deep structures of the face
MAXILLARY ARTERY

71. BRANCHES
1st part (Mandibular) :
•Lies medial to mandible
•runs along the lower border of lateral pterygoid muscle
 Deep auricular artery
 Anterior tympanic artery
 Middle meningeal artery
 Accessory meningeal artery
 Inferior alveolar artery

72. BRANCHES AND ITS SUPPLY
Branches Foramen transmitting Distribution
External acoustic
meatus,outer surface of
tympanic membrane
Inner surface of tympanic
membrane
5th and 7th nerve, middle
ear, tensor tympani
Meninges, Structures in
the infra temporal fossa
Lower teeth and mylohyoid
muscle
1.Deep auricular Foramen in the floor of
external acoustic meatus
2.Anterior tympanic Petrotympanic fissure
3.Middle meningeal Foramen spinosum
4.Accessory meningeal Foramen ovale
5.Inferior alveolar Mandibular foramen

73.  Largest artery that
supplies the dura
 It ascends to the foramen
spinosum through which
it enters the cranium
 Divides into two
branches, anterior and
posterior.
 It supplies the dura mater
(the outermost
meninges) and the
calvaria.
MIDDLE MENINGEAL ARTERY

74. INFERIOR ALVEOLAR ARTERY
 Runs downward & forward
medial to ramus of
mandible to reach
mandibular foramina.
 Before entering mandibular
foramina gives off lingual
and mylohyoid arteries.
 In canal gives branches
to mandibular teeth.
 After coming out of canal
supply chin via mental
artery.

75. BRANCHES
BEFORE ENTERING MANDIBULAR CANAL:
• Lingual branch to the tongue.
• Mylohyiod branch to the mylohyiod
muscle.
WITHIN THE MANDIBULAR CANAL:
•Branches to the mandible
•Branches to the roots of each teeth upto midline (dental branches)
•Incisor branch anastomoses with the branch from opposite side
AFTER EMERGING FROM MENTAL FORAMEN
• Mental branch escapes with the nerve at the mental foramen, supplies
the chin, and anastomoses with the submental and inferior labial
arteries

76. 2ND PART (PTERYGOID PART) :
 Artery runs forward & upward superficial to the lower
head of the lateral pterygoid muscle

77. BRANCHES
Branches
1.Deep
temporal
2.Pterygoid
3.Masseteric
4.Buccal
Distribution
Temporalis
Lateral and medial
pterygoid
Masseter
Buccinator

78. 3RD PART
(PTERYGOPALATINE):
 Terminal portion of the artery passes between the two
heads of the lateral pterygoid muscle

79. THIRD PART
Branches
1.Post superior
alveolar
2.Infraorbital
3.Greater
palatine
4.Pharyngeal
5.Artery of pterygoid
canal
6.Sphenopalatine(terminal
part)
Foramina
Alveolar canals in the body
of maxilla
Infraorbital
fissure
Greater palatine
canal
Pharyngeal
canal
Pterygoid
canal
Sphenopalatine
foramen
Distribution
Upper molar and
premolar teeth ;
maxillary sinus
Lower orbital
muscles, lacrimal
sac ,max sinus
Soft palate, tonsil,
palatine glands and
mucosa,upper gums
Root of nose , pharynx,
auditory
tube,sphenoidal sinus
Auditory tube,
upper pharynx,
middle ear
Lateral and medial wall
of nose and air sinuses.

80. APPLIED ANATOMY
 Site of hematoma during PSA block.
 Produces largest and most esthetically unappealing
hematoma.
 Blood effuses until extravascular pressure exceeds
intravascular pressure or clotting occurs.
 Infratemporal fossa into which bleeding occurs accommodates large
amount of blood.
 Prevented by aspirating before giving LA inthe site.
 Digital pressure can be applied medial and superior to the
maxillary tuberosity.

81. APPLIED ANATOMY
In case of abscess from palatal root of first
molar, incision should be made in a
antero-posterior direction parallel to the
artery.

82. During Lefort I Osteotomy:
• Greater palatine artery is easily injured during osteotomy of the
medial or lateral maxillary sinus walls, pterygomaxillary dysjunction
or during down fracturing of maxilla.
• The average distance from the piriform rim to the descending palatine
artery is 35.4 mm, range is 31 to 42 mm.
• The average length of the greater palatine canal above the nasal floor is
10mm, range is 6 to 15 mm.
• The average distance between the pterygomaxillary fissure and the
greater palatine foramen is 6.6mm.

83. GUIDELINES TO AVOID INJURY:
• Osteotomy of lateral wall of maxillary sinus should extend just
beyond the second molar.
• Osteotomy of medial wall of maxillary sinus should usually extend 30
mm posterior to the piriform rim in females, and in males it can be
carried back to 35mm.
• Because the descending palatine artery travels in an anterior-inferior
direction as it enters the greater palatine canal, injury can be
prevented by closely adaptin the cutting edge of the osteotome or the
saw to the pterygomaxillary fissure.

84. APPLIED ANATOMY OF MAXILLARYARTERY
Surgeries involving condyle
• Avoid injury to maxillary
artery as it lies medial to
condyle.
• Ankylotic mass of TMJ may
encircle the artery. So it is
advisable to remove ankylotic
mass in pieces rather than in
total.
• Trismus involving lateral
pterygoid comprises blood
supply to the nose.

85. LITTLE’S AREA or KIESSELBACH’S PLEXUS
1. Near the anteroinferior part or vestibule
of the septum.
2. Contains anastomoses between
• Superior labial branch of facial
artery
• Branch of sphenopalatine artery
• Anterior ethmoidal artery
• Greater palatine artery
This is common site of bleeding
from nose or epistaxis.

86. Smaller of the two terminal branches
It begins in the substance of the
parotid gland, behind the neck
of the mandible
Divides into two branches, a
frontal and a parietal
SUPERFICIAL TEMPORAL
ARTERY

87.  Transverse facial branch
 Anterior auricular branch
 Frontal branch
 Parietal branch
 Zygomatico- orbital
branch
BRANCHES

88. Transverse Facial Artery
ORIGIN
• From STA before it leaves parotid gland.
COURSE
• Running forward through the substance of the gland, it passes
transversely across the side of the face, between the parotid duct and
the lower border of the zygomatic arch. This vessel rests on the
Masseter, and is accompanied by one or two branches of the facial
nerve.
SUPPLIES
• The parotid gland and duct, the Masseter, and the integument, and
anastomose with the external maxillary, masseteric, buccinator,
and infraorbital arteries.

89. Middle Temporal Artery
 Arises immediately above the zygomatic arch, and, perforating the temporal
fascia, gives branches to the Temporalis, anastomosing with the deep temporal
branches of the internal maxillary artery.
It occasionally gives off a zygomaticoorbital branch, which runs along the
upper border of the zygomatic arch, between the two layers of the temporal
fascia, to the lateral angle of the orbit.
This branch, which may arise directly from the superficial temporal artery,
supplies the Orbicularis oculi, and anastomoses with the lacrimal and palpebral
branches of the ophthalmic artery.

90. Anterior Auricular Branches
• Distributed to the anterior portion of the auricle, the
lobule, and part of the external meatus, anastomosing
with the posterior auricular.

91. Frontal Branch
•Runs tortuously upward and forward to the forehead
•Supplying the muscles, integument, and pericranium
in
•This region, and anastomosing with the supraorbital and
frontal arteries.
Parietal Branch
•Larger than the frontal, curves upward and backward on
the side of the head
•Lying superficial to the temporal fascia
•Anastomosing with its fellow of the opposite side
•With the posterior auricular and occipital arteries.

92. INTERNAL CAROTID ARTERY
PRINCIPAL ARTERY OF BRAIN AND EYE
• 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 vertebra.

93. • It supplies two of the four major arteries
supplying blood to the brain.
• CCA CAROTID CANAL (petrous part of
temporal bone) MIDDLE CRANIAL
FOSSA(dorsum sellae of sphenoid bone)
• Supplies the hypophsis cerebri, orbit, and most of
the supratentorial part of the brain.

94. BRANCHES
• CERVICAL PART- No branches in the neck
• PETROUS PART-
1. Caroticotympanic branch
2. Pterygoid branch
• CAVERNOUS PART-
1. Branches to trigeminal ganglion and hypophysis cerebri
• CEREBRAL PART-
1. Opthalmic
2. Anterior cerebral
3. Middle cerebral
4. Anterior choroidal

95. CEREBRAL PART

96. SEGMENTS
• 1996 –bouthillier divided ICA into 7 anatomical segments.
• MNEMONIC- Come, Please Let Children Consume Our Candy
• C1-Cervical part in the neck
• C2-Petrous part in the petrous temporal bone
• C3-lacerum
• C4-Cavernous part in the cavernous
sinus
• C5-clinoid
• C6-opthalmic
• C7-communicating
CEREBRAL
PORTION

98. 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.
• Its initial part shows slight dilatation, carotid sinus.
• Which acts as a baroreceptor.

99. PETROUS PART
• Within the petrous part of
the temporal bone,in the
carotid canal runs upward
forward & medially at right
angle.
Branches-
1) Caroticotympanic- enter
middle ear & anastomose
with anterior & posterior
tympanic branches
2) Artery of the Pterygoid
Canal- anastomose with
greater palatine artery

100. CAVERNOUS PART
Within the Cavernous Sinus
• Branches
1)Artery to trigeminal ganglion
2)Superior & inferior Hypophyseal artery

101. CEREBRAL PART
• Lies at the base of the brain
after emerging from the
cavernous sinus
Branches
1.Ophthalmic.
2.Anterior Cerebral.
3.Middle Cerebral.
4. Posterior Communicating.
5. Anterior choroidal
On angiogram internal
carotid show ‘S’ shaped
figure ( carotid siphon )

102. CIRCLE OF
WILLIS
The circle ofWillis is a circulatory anastomosis that supplies blood to the
brain and surrounding structures.
It is named after Thomas Willis (1621– 1675), an English physician
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)
Basilar artery
IMPORTANCE:
The arrangement of the brain's arteries into
the circle of Willis creates collaterals in the cerebral circulation.
If one part of the circle becomes blocked or narrowed (stenosed) or one of the
arteries supplying the circle is blocked or narrowed, blood flow from the other
blood vessels can often preserve the cerebral perfusion well enough to avoid the
symptoms of ischemia.

103. CIRCLE OF
WILLIS

104. SUBCLAVIAN ARTERY
• MAIN ARTERY OF UPPER
LIMB
ORIGIN-
1.RIGHT- BRACHIOCEPHALIC
ARTERY
2.LEFT- ARCH OF
AORTAE
COURSE
1. MEDIAL
2.POSTERIOR
3.LATERAL

107. Veins (vena) are blood vessels that carry blood towards the heart.
Most veins carry deoxygenated blood from the tissues back to
the heart
Exceptions are the pulmonary and umbilical veins
Usually travel witharteries

108. STRUCTURE OF VEIN
 Veins are thin walled than arteries.
 Large lumen.
 Valves, maintain unidirection blood flow.
 3 concentric layers (tunicae)
1) Tunica intima - innermost layer(endothilial cells &
internal elastic lamina)
2) Tunica media –Middle layer ( contains muscle
tissue, elastic fibres, collagen , external elastic
lamina)
3) Tunica adventitia – outer coat (elastic and collegen
tissue, muscle fibres)

109. 1) Return of deoxygenated blood toheart
2) Cushion associated arteries fromjaw
movements (periarterial plexus)
3) Protect against extensive intracranialpressure.

110. VEINS OF THE HEAD AND NECK
 Venous drainage fromthe face is entirelysuperficial
 All the venous drainage from the head and neck terminate in the internal
jugular vein which join the subclavian vein to form the brachiocephalic
vein behind the medial end of the clavicle
 Two brachiocephalic veins unite to form superior vena cava

112. VEINS
Systemic veins Pulmonary Veins
-Right Pulmonary vein
-Left Pulmonary vein
Head & Neck Abdomen & Thorax Upper limb Lower limb

113. External veins
a) Supratrochlear
b) Supraorbital
c) Superficial temporal
d) Facial vein
e) Maxillary vein
f) Retromandibular vein
g) Posterior auricular vein
Veins of neck Internal group
a) Diploic veins
b) Emissary veins
a) Thyroid vein
b) Lingual vein
c) Posterior external
jugular
d) Anterior jugular
e) Cervical vein
f) Suprascapular vein

114.  It receive blood fromthe
brain, face and theneck.
 It emerges through the jugular
foramen,as a continuation of the
sigmoid sinus descend down in the
neck, first behind thenlateral to the
internal carotid artery inside the
carotidsheath
 Terminate beneath thetriangular
interval between the sternal and the
clavicular head of the
sternocleidomastoid muscle joining
the subclavian vein to form the
brachiocephalicvein

115. BULBS OF VEIN:
a) Superior bulb: located in
jugular fossa on inferior surface
of temporal bone beneaththe
floor of middle earcavity.
b) Inferior bulb: located atthe
termination of the vein,lies
beneath the lesser
supraclavicular fossa

116. RELATIONS:
a) Superficially
• Sternocleidomastoid
• Posterior belly ofdigastric
• Superior belly ofomohyoid
• Parotid gland
• Styloid process
• Accessory vein
• Posterior auricularartery
• Occipital artery
• Sternocleidomastoid artery
• Lower root of ansacervicalis
• Infrahyoid muscle
• Anterior jugular vein
• Deep cervical lymph nodes
• Internal carotidartery
• 9th, 10th,11th & 12th nerve

117. b) Posteriorly
• Rectus capitis lateralis
• Transverse process ofatlas
• Levator scapulae
• Scaleneus medius
• Cervical plaxus
• Scalenus anterior
• Phrenic nerve
• Thyrocervical trunk
• Inferior thyroid artery
c) Medially
• Internal carotid artery
• Common carotid artery
• Vagus nerve

118. Tributaries
1. Inferior petrosalsinus
2. Pharyngeal veins
3. Common facial vein
4. Lingual vein
5. Superior thyroid vein
6. Kocher vein
7. Occipital vein
8. Thoracic duct (left)
9. lymphatic duct(right)

119. Communications
1. With external jugular by obliquejugular
2. With cavernous sinus by inferior petrosal sinus

120. APPLIED ANATOMY:
1. Infection from middle earspreads to IJV
2. Surgical removal of deep cervical nodes canpuncture
IJV
3. Easy accessibility between two heads of
sternocleidomastoid muscle for introductionof
cannula
4. Thrombophlebitis can occur by spread of infectionin
caverous sinus
5. Queckenstedt’s test – to find out block in CSF circulation
the test is perform during lumbar puncture

121. Jugular venous pulse(JVP)
• Determine activityof
atrium
• Seen better then felt
• Preferable overEJV
• Elevation of JVP indicative
of cardiac failure
Hepato Jugularreflex
• Elicited by deepcompression
of right lobe of liver

122. FACIAL VEIN
• Origin – junction of veins of forehead andnose
• Upper part – angularvein
book

123. Angular veinreceives:
1. Frontal vein
(anterior partsof
scalp)
2. Supraorbital vein
(eyebrows)
3. Superior
ophthalmic vein
(opens into
cavernous sinus)

124. ANASTOMOSIS OF FACIAL VEIN

125. APPLIED ANATOMY:
A. Facial vein is common source of bleedingfollowing
surgery involving posterior vestibule lateral to
mandible
B. Infection from face can spread in a retrograde direction
and cause thrombosis of the cavernous sinus. This is
specially occur in presence of infection in upper lip and
lower partof nose. Called dangerous area of the face.
Dangerous area of theface.

126. LINGUAL VEIN
 The lingual veins begin onthe dorsum,
sides, and under surface of
the tongue, and,passing
backward along the courseof the
lingual artery, endin
the internal jugularvein.
 Drains tongueand
sublingual region
 Three branches
a) Dorsal lingual veins
b) Deep lingualveins
c) Sublingual vein

127. • Anteriordivision:
• joins the facial vein
• Posterior division:
• pierces the deep fascia and join the posterior
auricular to form the externaljugular.
• It empty into the subclavianvein

128. SUPERFICIAL TEMPORAL VEIN
•It begins on the side and vertex of the skull in a
plexus which communicates with the frontal vein
and supraorbital vein, with the corresponding
vein of the opposite side, and with the posterior
auricular vein and occipitalvein.
•From this network frontal and parietal branches
arise, and unite above the zygomatic arch to
form the trunk of the vein, which is joined by the
middle temporal
vein emerging from thetemporalis muscle.

129. 1. It then crosses the posterior root of the zygomatic
arch, enters the substance of the parotid gland, and
unites with the internal maxillary vein to form the
posterior facialvein.
2. It drains the lateralscalp
3. It drain into and formthe retromandibular vein with
the maxillary vein

130. Maxillary vein
• It begins in the infratemporalfossa
•It collects blood from thepterygoid Plexus
•Through the pterygoid plexus It receives the middle meningeal,
posterior superior alveolar, inferior alveolar and other veins from the
nose and palate (areas served by The maxillaryartery)
•After that it merges with the superficial temporal vein toform the
retromandibularvein

131. g)
POSTERIOR AURICULARVEIN
•The posteriorauricular
vein begins upon the side ofthe head, in
a plexus which communicates with the
tributaries of theoccipital
vein and superficial temporal veins.
•It descends behind
the auricula, and joinsthe
posterior divisionof
the posterior facial vein to form the
external jugular.

132. OCCIPITAL VEIN
 The occipital vein begins
as a plexus at the posterior
aspect of the scalp from the
external occipital
protuberance and superior
nuchal line to the backpart
of the vertex of theskull.
 From the plexus emerges a
single vessel, whichpierces
the cranial attachment of
the Trapezius and, dipping
into the venous plexus of
thesuboccipital
triangle, joins the deep
cervical and vertebral veins.

133.  Occasionally it follows the course of the occipital
artery and ends in the internal jugular; in other
instances, it joins the posteriorauricular vein and
through it opens into theexternal jugular
 The parietal emissary vein connects it with
the superior sagittal sinus; and as it passes across the
mastoid portion of the temporal bone, it receives the
mastoid emissary vein which connects it with the
transversesinus.
 The occipital diploic vein sometimes joins it

134. DRAINS MAJOR PART OF FACE &
SCALP
•Begins behind the angle of the mandible by the union of theposterior
auricular and posterior division of the retromandibular veins.
•It descend obliquely, deep to the platysma, receive the posterior
external jugular vein pierce the deep fascia just above the clavicle and
drain into the subclavian vein

135. TRIBUTARIES:
 Formative
 Occipital vein
 Oblique jugular
 Posterior external jugular
 Terminal
 Transverse cervical
 anterior jugular
 Suprascapularvein

136. APPLIED
ANATOMY
• Injury to the vein cause air embolism
• Vein becomes dilated above compression levelduring
Valselva’s manoevre
• Surgical division of sternocleidomastoid musclerequires
special care of thevein
• Increased venous pressure indicates congestive cardiac
failure

137. •Start below the chin, pass
beneath the platysma tothe
suprasternal notch.
•Pierce the deep fascia and is
connected to the other side
by an anastomosing veinthe
jugular arch
•angle laterally to pass deep
to sternocleidomastoid and
open in theexternal

138. Tributaries:
1. Skin
2. Superficial tissues of neck
Applied anatomy:
1. Special care required to
preserve the vein during
surgical treatment
of wry neck

139. FORMATION:
• Venous spaces between the osteal and meningeal layers of
duramater
• Formed by reduplication of meningeallayer
Features:
• Lined by endothelium
• Receive blood from
a) Brain
b) Orbit
c) Internal ear
d) CSF
• Valveless
• Bidirectional flow

141. CLASSIFICATION
Posterosuperiorgroup Anteroinferiorgroup
Unpaired
a) Superior sagittal
b) Inferior sagittal
c) Straight
d) Occipital
Paired
a) Transverse
b) Sigmoid
c) Petrosquamous
Unpaired
a) Anterior intercavernous
b) Posterior intercavernous
c) Basilar
Paired
a) Cavernous
b) Superior petrosal
c) Inferior petrosal
d) Sphenoparietal
e) Middle meningeal

142. t
Course:
•Begins antriorlyat crist a galliby union of tiny meningealveins.
•Communicate with veins of frontal sinus, occasionally with the veins of nose through
foramencaecum
• Runs upwards and backwards, and
large in size
•Ends near internal occipital protuberance by turning to one side usually right,
continuous with transervers sinus
Cross section: Triangular

143. Tributaries:
1. Veins from nose
2. Superior cerebralvein
3. Parital emissary vein
4. Venous lacunae
5. Communication with
cavernous sinus
Applied anatomy:
Infection from nose, scalp and diploe cause thrombosis
of this sinus

144. 1. SITUATED IN POSTERIOR 2/3 OF FALX
CEREBRI
2. Ends by forming straightsinus
3. It receives
1. Veins of falx cerebri
2. Veins from cerebrum

145. Situated at junction of falx cerebri and tentorium cerebelli
Continuation of inferior
sagittal sinus
Tributaries:
1. Inferior sagittal sinus
2. Great cerebral vein
3. Superior cerebellarveins

146. 1. Large paired sinus ,right
sinus larger thanleft
2. Situated in posterior partof
attached margin
of tentorium cerebelli
3. Begins as continuation of
superior sagittal sinus(right)
and straight sinus(left)

147.  Triangular crosssection
 Ends at mastoidangle
 Tributaries:
1. Superior petrosalsinus
2. Inferior cerebral vein
3. Posterior temporal deploicvein
4. Inferior cerebellarvein
5. Inferior anastomoticvein
6. Petrosquamous sinus

148. Confluence of sinus:
•The point where the superior
sagittal sinus, straight sinus
and occipital sinus unite
called Confluence of sinus
•Located on the right side of
the internal occipital
protuberance

149. • Each sinus right & left is
direct communication of
traservers sinus
• S- shaped
• Extends fromposteroinferior
angle of parietal bone to
posterior part of jugular
foramen, becomes the
superior bulb of jugularvein.
• Grooves the mastoid partof
temporal bone

150. Tributaries:
1. Communication with pericraniumveins
2. Communication with sub occipital venus plexus
3. Labyrinthine veins
4. Cerebellar veins
Applied anatomy
• Thromboisis of the sinus occur from the infection of
the in the middle ear & otitis media or in mastoid
process called mastoiditis
• During operation on mastoid process should be careful
about the sigmoid sinus, so that it not exposed.
• Otitic hydrocephalus

151. The occipital sinus is thesmallest of the cranial sinuses.
It is situated in the attached margin of the falx cerebelli, and is generally
single, but occasionally there are two.
Itcommences around the margin of the foramen magnum by several
small venous channels, oneof which joins the terminal partof the
transverse sinus
communicates with the posterior internal vertebral venousplexuses and
ends in the confluence of the sinuses.

152. 1. PAIRED SINUS, LARGE VENOUS SPACE
SITUATED IN MCF
2. Extent: petrous partof temporal bone to SOF

153. RELATION:
Medially Pituitary gland
Sphenoidal sinus
Laterally Temporal lobe withuncus
Superiorly Optic tract, opticchiasma,
Olfactory tract,ICA
Inferiorly Foramen lacerum , junction of body & greater
wing of sphenoid bone
Anteriorly Superior orbital fissure & apexof orbit
Posteriorly Petrous part of temporalbone

154. Structurepassing
through sinus
STRUCTURES
IN LATERAL
WALLOF
SINUS
ICA
VI cranial nerve
III cranial nerve
IV cranial nerve
V 1 and V2division
of V cranial nerve

155. TRIBUTARIES
From orbit
a) Superior ophthalmic
vein
b) Inferiorophthalmic
vein
c) Central vein ofretina
From brain
a) Middle cerebral vein
b) Inferior cerebralvein
Meningeal
a) Middle meningeal
vein
b) Sphenoparietal
sinus

156. Communicationwith:
a) Transverse sinus
b) IJV
c) Pterygoid venousplexus
d) Facial vein
e) Superior sagittalsinus
f) Opposite cavernoussinus

157. APPLIEDANATOMY:
1. Arterio – venous aneurysm occurs due to rupture of internal
cardiacartery
Symptoms:
a) Loud systolic thrill
b) Exophthalmos
c) Conjunctivitis
2. Thrombosis of the sinus resulting in meningitis due to
infections in dangerous area of face, nasal cavity and PNS
Symptoms:
a) pain in eye
b) Oedema of eye lids , cornea and root of nose
c) Exophthalmos

158. 1. Its originate from posterosuperior
corner of cavernous sinus , courses
posteriorly and laterallyalong the
superior crest oftemporal pyramid,
reaches transvers sinus, bends to
continue into sigmoid sinus
2. Connection between transverse and
cavernous sinus
3. Tributaries:
1. Cerebellarvein
2. Inferior cerebralvein
3. Veins from tympaniccavity

159. Shorter and wider
•Arises from the inferoposteriorcorner of the
cavernous sinus
•follow petro-occipital fissure backward to
the anterior borderof jugular foramen
•Crosse the 9th,10th & 11th nerve and empties
into superior bulb ofinternal jugular vein
Tributaries:
1. labyrinthine vein
2. veins from aqueduct ofcochlea
3. vein from medulla ponsand
cerebellum

160. Communicate cavernous sinus with superiorsagital
sinus
Unite to form
- parietal
- frontal
Liable to be tornduring skull fracture

161. COMMUNICATION
BETWEEN
INTRACRANIALVEINS &
EXTRACRANIALVEINS
Emissary
•Mastoid
•Parietal
•Condylar
•Occipital
•Sphenoid
•Zuckerkandl’s
Ophthalmic
•Superior
opthalmic
•Inferior
opthalmic
Venous
plexus
•Pterygoid
•Suboccipital
•Pharyngeal
Diploic
•Frontal
•Anterior
temporal
•Posterior
temporal
•Occipital

162. Superior opthalmicvein
•The superior ophthalmic vein begins at
the inner angle of the orbit in a vein named
the nasofrontal which communicates
anteriorly with the angular vein
•it pursues the same course as the
ophthalmic artery, and receives tributaries
corresponding to the branchesof that vessel.

163. • Forming a short single trunk, it passes between the
two heads of the Rectus lateralis and through the
medial part of the superior orbital fissure, and ends in
the cavernous sinus.
• The ethmoidal veins drain into thesuperior
ophthalmic vein

164. INFERIOR OPTHALMIC
VEIN
•Formed in floor and
medial wall of orbit
•Ends by joiningsuperior
opthalmicvein
Tributaries:
•Veins from rectus inferior, obliqus
inferior, lacrimal sac
•Communication withpterygoid plexus
Applied anatomy:
•Blood borne infections of nose or teeth spread into cavernous sinus

165. • situated in diploe of cranialveins
Characteristics
1. Valve less
2. Non-collapsable
3. Pouch like elevationat irregular interval
4. On x-ray of skull appear as transparent bands
5. Communicate with meningal, sinuses and veins of
pericranium
Types:
• Frontal
• Anterior temporal
• Posterior temporal
• Occipital

166. Characteristics:
1. Valve-less
2. Some veins are constant other inconstantor may be absent
3. Thin valves tightly attached to surroundingbones
Types:
1. parietal
2. occipital
3. mastoid
4. condylar
5. Spheniod
6. Zuckerkandl’s

167. Veins connecting cavernous sinus with pterygoid
venous plexus pass through different foramina
1. Foramen lacerum
2. Foramen ovale
3. Foramen vesali
4. Foramen spinosum
Applied anatomy:
• Inflammatory process due to infection pass
through these veins and give rise to thrombosis of
the sinus

168. a) PTERYGOID
LOCATION:
Between lateral and
medial pterygoid or
between temporal
and lateral pterygoid

169. Boundaries:
1. Anterior-maxillary
tuberosity
2. Superior-base of skull
Termination:
• Posteriorly these veins unite to form deepfacial or maxillary
vein

170. Tributaries:
1. Sphenopalatine
2. Deep temporal
3. Pterygoid
4. Masseteric
5. Buccal
6. Dental
7. Greater palatine
8. Middle meningeal
9. Inferior opthalmic

171. APPLIED ANATOMY:
 PSA block
• -haematoma
• -black eye
• Serves as media for spread of external infection to the cavernous
sinus

172. B) SUBOCCIPITAL:
1. Located in suboccipital triangle
2. Receives blood from
1. Muscular veins
2. Transverse sinus
3. Occipital veins
4. Internal vertebral venousplexus
5. Condylar emmissaryveins
3. Drains into vertebral veins

173. C) PHARYNGEAL VENOUS PLEXUS
1. Located on postero lateral region ofpharynx
2. Receives blood from
1. Pharynx
2. Soft palate
3. Pre vertebral region
3. Drains into internal jugular and facialveins

174. RONG KUANG1† , JING ZHOU1† , JIAQI DENG1 ,TIAN XIA2 AND MINGXING LI1
* 1 DEPARTMENT OF ULTRASOUND,THE AFFILIATED HOSPITAL OF SOUTHWEST MEDICAL
UNIVERSITY, LUZHOU, CHINA, 2 DEPARTMENT OF PATHOLOGY,THE AFFILIATED HOSPITAL OF
SOUTHWEST MEDICAL UNIVERSITY, LUZHOU, CHINA,2022
CASE REPORT
• A 19-month-old girl who suffered from pain and bleeding on the right cheek due to a puncture
from a glass bottle was presented to the local hospital.
• She was treated with local anesthesia and debridement and suturing. One week later, the suture
was removed. One week after the suture removal, the child had redness and swelling on the right
cheek wound which was aggravated for 3 days.
• Upon physical examination, the right cheek was red and swollen, the skin temperature was high, and
a black necrotic area with a diameter of about 0.5 cm was seen in the center.
• The surface was palpable and throbbing.When squeezed, the wound was painful and oozed pus.

175. A computerized
tomography (CT) scan of
the head and face showed
a short strips of “U”
shaped high density
structure (red arrow) due
to foreign body in the right
cheek space with a
diameter of about 1.8 cm

176. Upon ultrasound examination, an irregular
dark area was seen on the right cheek, a
“C” type strong echo was seen in the dark
area, and CDFI showed the red and blue
blood flow signals are shown as “yin and
yang sign”, which was continuous with a
branch of the facial artery

177. • Based on these findings, the patient was
diagnosed with a foreign body on the right
cheek with surrounding abscess and facial
artery pseudoaneurysm.
• Surgery was performed immediately.
• A ringshaped glass bottle with a length of
about 1.2 cm and a diameter of 0.5 cm and
three pieces of rice-sized glass slag were
removed during the operation.

178. • About 85% of craniofacial pseudoaneurysms involve the superficial temporal artery because the artery
passes through the frontal bone between the temporal and frontal muscles and lacks muscle tissue
protection.
• Other arteries that can be involved include the maxillary artery and the facial artery. Maxillary artery
pseudoaneurysm is usually caused by iatrogenic injury, and facial artery pseudoaneurysm is often
secondary to facial blunt injury as it is protected by facial soft tissues.
Ultrasonography is the best modality to assess these pseudoaneurysms, as a
non-invasive examination method, requires no radiation and the patient does
not need to remain stationary; thus, has diagnostic value for
pseudoaneurysms,particularly for the detection of facial artery
pseudoaneurysms in children.Thus, it is necessary to examine and follow up
the wound site after an acute facial injury.

179. • SICHER’S ORAL ANATOMY- 8TH EDITION
• LORE AND MEDINA-6TH EDITION
• PRINCIPLES OF SURGERY BY EDWARD WARN
HEAD AND NECK SURGERY- OTOLARYNGOLOGY
BY BYRON. J. BAILEY- 2ND EDITION
• Human Anatomy by B.D. Chaurasia, 6th Edition,Vol3.
• Grey’s Anatomy
• Netter atlas
• JOURNAL OF MAXILLOFACIAL AND ORAL SURGERY-
LOCATION OF DESCENDING PALATINE ARTERY DURING
LEFORT I OSTEOTOMY
• Int. JOURNAL OF Oral Maxillofac. Surg. 2017; 46: 845–
850 http://dx.doi.org/10.1016/j.ijom.2017.03.005,
• Kuang R, Zhou J, Deng J, Xia T and Li M (2022) Case
Report:A Case of a Child With Facial Foreign Body
Abscess and Facial Artery Pseudoaneurysm. Front.
Pediatr. 10:886031. doi: 10.3389/fped.2022.886031
REFERANCES