contains arterial supply of head and neck, branches of each main artery, applied aspect of the arteries and ligation of the arteries.

1. BY: SHALINI SAMPREETHI. A
ORAL AND MAXILLOFACIAL SURGERY
SR. LECTURER IN MNR DENTAL COLLEGE AND HOSPITAL

2.  INTRODUCTION
 EMBRYOLOGY
 HISTOLOGY(MICROSCOPIC ANATOMY)
 PRINCIPAL ARTERIES OF THE HEAD AND
NECK
COMMON CAROTID ARTERY
EXTERNAL CAROTID ARTERY
INTERNAL CAROTID ARTERY
VERTEBRAL ARTERY
 APPLIED ANATOMY
 REFERENCES

3.  The word artery was originated from the
Greek word “arteria” meaning the “wind pipe”.
 “A vessel through which the blood passes
away from the heart to various parts of body”.
 Depending on the size, they are classified
into three types :
i)large or elastic arteries.
ii)medium or distributive arteries.
iii)small arteries or arterioles.

4.  Characteristic of arteries, regardless of size is
a well developed lumen, rounded or oval,
maintained by muscularity of vessel wall.

5.  Blood vessels initially develops from the core
of “blood islands” in the mesoderm.
 Angioblasts initially form small clusters(blood
islands) within the embryonic and extra
embryonic mesoderm.
 These blood islands extend and fuse together
making a primordial network.
 Within these islands the peripheral cells form
the endothelial cells while the core cells form
the hemocytoblasts.

6.  Recent work has shown that the formation of
initial endothelial tube is by a process of
coalescence of cellular vacuoles within the
developing endothelial cells, which fuse
together without cytoplasmic mixing to form
the blood vessel lumen.

7.  The common carotid artery is derived on
either side from part of the third arch,
proximal to the external carotid artery bud.
 The internal carotid artery is formed by the
portion of third arch distal to the bud, along
with the original dorsal aorta cranial to the
attachment of third arch artery.
 The external carotid artery arises from a bud
from the third arch artery.

9. The blood vessels are made of three layers,
called from the luminal side outward:
a)Tunica intima
b)Tunica media
c)Tunica adventitia
TUNICA INTIMA :
 Consists of an endothelium and any sub-
endothelial connective tissue.
TUNICA MEDIA :
 It is a layer of concentrically arranged
smooth muscle, autonomic control of
which can alter the diameter of vessel and
effect the blood pressure.
 Contains varying amounts of collagen
fibers, elastic fibers, elastic lamellae.
 Larger than that of veins.

10. TUNICA ADVENTITIA :
 Made chiefly of longitudinally arranged
collagen fibers.
 Thickest layer in veins.

11. THE COMMON CAROTID ARTERY :
 The common carotid artery is a
large bilateral vessel supplying
head and neck. It ascends to just
above the level of thyroid
cartilage’s upper border, where it
divides into:
i)External carotid artery-Supplying
the exterior of head, face and
most of the neck.
ii)Internal carotid artery-Supplying
cranial and orbital contents.

13.  ORIGIN:
• The right and left carotid
arteries differ in the length
and origin.
• The right carotid, exclusively
cervical, originates from the
brachiocephalic trunk behind
the right sternoclavicular
point.
• The left carotid originates
directly from the arch of aorta
immediately posterolateral to
the brachiocephalic trunk and
therefore has both thoracic
and cervical parts.

15. THORACIC PART OF LEFT COMMON CAROTID ARTERY :
• This part ascends until level with the left sternoclavicular
joint, where it enters the neck. At first it lies infront of the
trachea, then inclines to the left.
CERVICAL PART OF BOTH RIGHT AND LEFT COMMON
CAROTID ARTERIES :
• In the neck, both arteries have a similar course. Each artery
runs upwards within the carotid sheath, under cover of
anterior border of the sternocleidomastoid.
• CAROTID SHEATH
• In the lower neck the common carotids are separated by a
narrow gap into which projects the trachea. Above this the
thyroid gland, larynx and pharynx projects between the two
vessels.
• At the level of the upper border of thyroid cartilage the
artery ends by dividing into external and internal carotid
arteries.

17.  RELATIONS :
ANTERIORLY –
• The common carotid artery is crossed by the superior
belly of omohyoid at the level of cricoid cartilage.
• Above the omohyoid,related to : medial margin of
sternocleidomastoid,descendens hypoglossal nerve,
superior thyroid vein,sternothyroid,ansa cervicalis.
• At the level of omohyoid : the sternocleido
mastoid,omohyoid,the sternohyoid,ansa cervicalis.
• Below the omohyoid : (the artery is deeply situated)
and is covered by sternocleidomastoid, anterior jugular
vein,sternohyoid, sternothyroid and middle thyroid
vein.

18. POSTERIORLY –
• Transverse process of vertebrae c4,5,6,7 , and
the muscles attached to their anterior
tubercles ( longus colli,longus capitis,scalenus
anterior),prevertebral fascia,the sympathetic
chain,inferior thyroid artery crosses medially at
the level of cricoid cartilage,vertebral artery.
MEDIALLY –
• Thyroid gland, larynx and pharynx,
trachea,oesophagus,and recurrent laryngeal
nerve.
LATERALLY –
• Internal jugular vein.
• Posterolaterally by vagus nerve.

19. • The external carotid
artery begins lateral to
upper border of thyroid
cartilage & b/w 3rd & 4th
cervical vertebrae.
• From its origin the artery
runs upwards &
terminates behind the
neck of the mandible.
• Chief artery of supply to
structures in the front of
the neck and in the face.

20.  The external carotid artery has a slightly curved
course, so that it is anteromedial to the internal
carotid artery in its lower part, and anterolateral
to the internal carotid in its upper part.
In the carotid triangle –
 ECA is comparatively superficial,lies under cover
of anterior border of sternocleidomastoid.
 The artery is crossed superficially by – cervical
branch of facial nerve,hypoglossal
nerve,facial,lingual and superior thyroid veins.
 Deep to the artery – wall of pharynx,superior
laryngeal nerve,ascending pharyngeal artery.

21. Above the carotid triangle –
• The ECA lies deep in the substance of the
parotid gland.
• Within the gland, it is related superficially to
the retromandibular vein and facial nerve.
• Deep to the ECA are – the internal carotid
artery, styloglossus,stylopharyngeus,IXth
nerve, pharyngeal branch of Xth,styloid
process.

22. The external carotid artery gives off eight branches which may be
grouped as follows :
 Anterior.
 Superior Thyroid
 Lingual.
 Facial.
 Posterior.
 Occipital.
 Posterior Auricular.
 Ascending.
 Ascending Pharyngeal.
 Terminal.
 Superficial Temporal.
 Maxillary.

23.  ANTERIOR :
Superior thyroid artery :
 It arises from the front of the ECA just
below the level of the grater cornua of the
hyoid bone.
 It runs downwards and forwards parallel
and just superficial to the external
laryngeal nerve.
 It passes deep to the three long infra hyoid
muscles to reach the upper pole of lateral
lobe of the thyroid gland.
 Branches :
a. Infrahyoid artery
b. Superior laryngeal artery
c. Sternocleidomastoid artery
d. Cricothyroid artery
 Its relationship to the external branch of
superior laryngeal nerve – important to
surgeon during thyroid surgeries.

24. Lingual artery :
 Chief blood supply of tongue & floor of the mouth.
 Arises from the ECA opposite the tip of the greater cornua of the hyoid
bone.
 It forms a characteristic upward loop which is crossed by the hypoglossal
nerve.
 1st part of the artery lies in the carotid triangle, superficial to the middle
constrictor muscle of the pharynx.
 2nd part lies deep to the hyoglossus muscle, which separates it from
hypoglossal nerve.
 3rd part/ deep part runs upwards along the anterior margin of the
hyoglossus & then forwards to the tip of the tongue.
 Branches :
a. Suprahyoid branch.
b. Sublingual branch
c. Dorsal lingual branch

25. The facial artery :
 Arises anteriorly from the ECA in
carotid triangle above the
greater cornua of hyoid bone.
 First runs upwards in the neck
(cervical part) & then on the face
(facial part).
 The course of the artery in both
places is tortuous. The tortuosity
in the neck allows free
movement of the pharynx during
deglutition. On the face it allows
free movement of the mandible,
the lips & the cheek during
mastication & various facial
expressions.
 The cervical part of the artery
runs upwards on the pharynx
deep to the posterior belly of the
digastric & to the ramus of the
mandible.
 Then the artery makes a s-bend(
two loops), 1st winding down
over the submandibular gland, &
then up over the base of the
mandible.

26. Branches of the artery may be divided into two groups :
Cervical (in the neck )
Facial ( on the face )
Cervical Branches.
 Ascending Palatine.
 Tonsillar.
 Glandular.
 Sub mental.
 Muscular.
Facial Branches.
 Inferior Labial.
 Superior Labial.
 Lateral Nasal.
 Angular.

27. Occipital artery :-
 arises from the posterior part of the external carotid,
opposite the origin of the facial artery,it runs backwards
and upwards deep to the lower border of the posterior belly
of digastric,crossing the carotid sheath and the accessory
and hypoglossal nerves
Next it runs deep to the mastoid process and the muscles
attached to it.
Finally.pierces the trapezius from the midline and comes to
lie along the greater occipital nerve.
In the superficial fascia of scalp it has tortuous course.
Branches—The branches of the occipital artery are:
 Stylomastoid
 Auricular.
 Sternocleidomastoid.
 Mastoid
 Meningeal.
 Descending.

28. i. The artery gives two sternocleidomastoid branches in the carotid
triangle.
ii. The stylomastoid - enters the stylomastoid foramen to supply the
middle ear.
iii.The Auricular branch – supplies the pinna.
iv.The Descending Branch the largest branch of the occipital,
descends on the back of the neck, and divides into a superficial &
deep branch.
 The superficial branch anastomoses with the superficial branch
of the transverse cervical artery.
 The deep branch descends b/w the semispinalis capitis &
cervicis, & anastomoses with the vertebral & deep cervical
arteries.
 The anastomosis between these vessels assists in establishing
the collateral circulation after ligature of the common carotid or
subclavian artery.

29. The Posterior auricular artery:
 The artery arises from the ECA just above the posterior belly of the
digastric muscle.
 Passes backwards & upwards deep to the parotid gland to reach
the mastoid process.
Branches.—Besides several small branches to the Digastricus,
Stylohyoideus, and Sternocleidomastoideus, and to the parotid
gland, this vessel gives off three branches:
Stylomastoid.
Auricular.
Occipital.

30. ASCENDING PHARYNGEAL
ARTERY :
• This is a small branch that arises from the
medial side of the external carotid artery.
• Arises very close to the lower end of the
external carotid artery.
• Runs vertically upwards between the side
wall of the pharynx,tonsil,medial wall of
middle ear,auditory tube.
• Sends meningeal branches into the cranial
cavity through foramen lacerum,the jugular
foramen and the hypoglossal canal.
 Branches.—Its branches are:
 Pharyngeal.
 Prevertebral.
 Palatine.
 Inferior Tympanic.
 Posterior Meningeal.

31. MAXILLARY ARTERY :
• This is the larger terminal branch of the external carotid
artery.
• Begins behind the neck of the mandible under cover of the
parotid gland.
• Runs forward deep to the neck of the mandible below the
auriculotemporal nerve, and enters the infratemporal fossa
COURSE :
Divided into three parts(by the lateral pterygoid) :
1. Mandibular part.
2. Pterygoid part .
3. Pterygopalatine part.

32. I. Branches of the First or
Mandibular Portions.
1) Anterior Tympanic.
2) Middle Meningeal.
3) Deep Auricular.
4) Accessory Meningeal
5) Inferior Alveolar.

33. 1) Anterior Tympanic Artery :-
 Supplies the middle ear including the medial surface
of the tympanic membrane.
2) The Deep Auricular Artery:-
 supplies the external acoustic meatus, the tympanic
membrane & the temporomandibular joint.

34. 3) Middle Meningeal Artery :-
Is the largest of the arteries, which supply the dura
mater.
 anterior branch :spreads out and supplies between the
dura mater and internal surface of the cranium
 The posterior branch :supplies the posterior part of the
dura mater and cranium.

35. 4) Accessory Meningeal Branch
It enters the cranial cavity through the foramen
ovale. Apart from the meninges it supplies
structures in the infratemporal fossa.

36. 5) The Inferior alveolar artery
A. The incisor branch is
continued forward beneath
the incisor teeth as far as the
middle line, where it
anastomoses with the artery
of the opposite side
B. mental branch escapes with
the nerve at the mental
foramen, supplies the chin,
and anastomoses with the
submental and inferior labial
arteries.
C. A lingual branch which
descends with the lingual
nerve and supplies the
mucous membrane of the
mouth
D. mylohyoid branch which runs
in the mylohyoid groove, and
ramifies on the under surface
of the Mylohyoid muscle.

37. II.Branches of the Second or
Pterygoid Portion :-
i. Deep Temporal.
ii. Masseteric.
iii. Pterygoid.
iv. Buccinator.
i. The Deep Temporal
Branches :-
 supplies the muscle, and
anastomose with the
middle temporal artery;
the anterior
communicates with the
lacrimal artery .

38. ii. The Pterygoid Branches
 Irregular in their number and origin, supply the Pterygoid
iii. Masseteric Artery :-
 It supplies the muscle, and anastomoses with the masseteric
branches of the external maxillary and with the transverse
facial artery.
iv. Buccinator Artery :-
 It supplies the Temporalis, to the outer surface of the
Buccinator, to which it is distributed, anastomosing with
branches of the external maxillary and with the infraorbital.

39. III. Branches of the Third or Pterygopalatine
Portion :-
1) Posterior Superior Alveolar.
2) Artery of the Pterygoid Canal.
3) Infraorbital.
4) Pharyngeal.
5) Greater Palatine.
6) Sphenopalatine.

40. 1) The Posterior Superior Alveolar Artery :-
 Arises just before the maxillary artery enters the
pterygomaxillary fissure.
 supplies the molar and premolar teeth and the lining of
the maxillary sinus, while others are continued forward
on the alveolar process to supply the gums.
2) Infraorbital Artery:-
 Arises just before the maxillary artery enters the
pterygomaxillary fissure. It enters the orbit through the inferior
orbital fissure
 it gives off :
 (a) orbital branches which assist in supplying the inferior
rectus, inferior oblique and the lacrimal sac, and
 (b) anterior superior alveolar branches which descend
through the anterior alveolar canals to supply the upper
incisor and canine teeth and the mucous membrane of the
maxillary sinus.

41. 3) The Greater Palatine Artery
Branches are distributed to the gums, the palatine glands,
and the mucous membrane of the roof of the mouth;
while in the pterygopalatine canal it gives off twigs which
descend in the lesser palatine canals to supply the soft
palate and palatine tonsil, anastomosing with the
ascending palatine artery.
4) The Artery of the Pterygoid Canal
It is distributed to the upper part of the pharynx and to
the auditory tube, sending into the tympanic cavity a
small branch which anastomoses with the other tympanic
arteries.

42. 5) The Pharyngeal Branch
 Is very small; it runs backward through the pharyngeal canal
with the pharyngeal nerve, and is distributed to the upper part
of the pharynx and to the auditory tube
6) The Sphenopalatine Artery
Here it gives off its
 posterior lateral nasal branches which spread forward
over the conchae and meatuses, anastomose with the
ethmoidal arteries and the nasal branches of the
descending palatine, and assist in supplying the frontal,
maxillary, ethmoidal, and sphenoidal sinuses.
 posterior septal branches; these anastomose with the
ethmoidal arteries and the septal branch of the superior
labial; one branch descends in a groove on the vomer to
the incisive canal and anastomoses with the descending
palatine artery

43. The superficial temporal artery:-
 This is the second terminal branch of the ECA.
 Begins behind the neck of the mandible in the substance of the
parotid gland.
 Runs upwards behind the TMJ & remifies in the scalp over the
temporal region.
 Accompanied by the auriculotemporal nerve .

44. • Principal artery of brain and the eye.
• Origin: Begins at the level of upper border of
thyroid cartilage opposite the disc between the
third and fourth cervical vertebrae,and ends
inside the cranial cavity by supplying the brain.
 COURSE IS DIVIDED INTO 4 PARTS
1. CERVICAL
2. PETROUS
3. CAVERNOUS
4. CEREBRAL

45.  CERVICAL PART :
• It ascends vertically in the neck from its origin
to the base of the skull to reach the lower end
of the carotid canal. This part is enclosed in
the carotid sheath.
• No branches.
• Its initial part usually shows a dilatation-the
carotid sinus.
• The lower part of the artery ( In the carotid
triangle) is comparatively superficial. The
upper part above the posterior belly of the
digastric is deep to the parotid gland, the
styloid apparatus.

46. PETROUS PART
Traverse the petrous part of the temporal bone.
Enters the cranial cavity through the carotid canal.
To reach below the trigeminal ganglion.
BRANCHES
1. CAROTICOTYMPANIC BRANCHES
2. BRANCH OF THE PTERYGOID CANAL

47. From foramen lacerum through the lingula of
sphenoid bone and enters the cavernous sinus.
Passes medial to the cavernous sinus along with the
abducent nerve.
 BRANCHES
1. INFERIOR HYPOPHYSEAL ARTERY
2. MENINGEAL ARTERY
3. CAVERNOUS BRANCH TO THE TRIGEMINAL
GANGLION

48.  Gives branches to the brain.
 Anastomoses with the branches of the vertebral artery.
 Forms the circle of willis in the area of the optic chiasma.
 With anterior, middle cerebral and posterior
communicating branches.

49.  OPTHALMIC ARTERY
 POSTERIOR COMMUNICATING A
 ANTERIOR CHOROID A
 ANTERIOR CEREBRAL A
 MIDDLE CEREBRAL A

50. FORMED BY:
1. TWO POSTERIOR CEREBRAL
ARTERY ( originate from basilar
artery; further formed by joining
of right & left vertebral artery)
2. POSTERIOR COMMUNICATING
BRANCH
3. ANTERIOR CEREBRAL ARTERY
4. INTERNAL CAROTID ARTERY
5. ANTERIOR COMMUNICATING
BRANCH

51. CIRCLE OF WILLIS

52. VERTEBRAL ARTERY :
First and the largest branch of the first part of
the subclavian artery.
It runs a long course and ends in the cranial
cavity by supplying the brain.
Arises from the upper and back of the first
part of the Subclavian Artery.
Ascends in foramina in the transverse
processes of the upper six cervical
vertebrae.

53.  It is divided into 4 parts.
1st part:- It extends from its origin to the transverse
process of the 6th cervical vertebra.
2nd part:- Runs through the foramina transversaria
of upper six cervical vertebrae.
3rd part:- Lies in the suboccipital triangle after
emerging from the foramen transversarium of the
atlas, winds medially around the posterior aspect of
the lateral mass of the atlas.
4th part:- Extends from the posterior atlanto-
occipital membrane to the lower border of the Pons.

54. Cervical Branches:
 Spinal.
 Muscular
Cranial Branches:
 Meningeal.
 Posterior Spinal.
 Anterior Spinal.
 Posterior Inferior Cerebellar.
 Medullary.

55. Basilar Artery
 Formed by the junction of the two
vertebral arteries.
 Extends from lower to upper border of the
Pons, lying in its median groove.
 Ends by dividing into the two Posterior
Cerebral arteries.

56. Basilar Artery Branches
 Pontine
 Internal Auditory
 Anterior Inferior Cerebellar
 Superior Cerebellar
 Posterior Cerebral

58. 1.Carotid Sinus and carotid body:
 Is responsive to changes in arterial blood pressure, leading
to reflex hemodynamic modification.
 Its position on the main artery of brain accounts for its role
as a baroreceptor in control of intra cranial pressure.
 In case of Carotid sinus hypersensitivity, pressure on one or
both carotid sinus can cause excessive slowing of heart rate,
A fall in blood pressure, and cerebral ischemia with fainting.
 Carotid body is a small oval reddish brown structure situated
behind the bifurcation of common carotid artery.
 Acts as a chemoreceptor and responds to changes in oxygen
and co2 and pH content of blood
2.Carotid Pulse
 Bifurcation of common carotid artery into the internal and
external carotid arteries can be easily palpated just beneath
the anterior border of the sternocleidomastoid muscle. This
is a convenient site to take the carotid pulse.

59. 3.The facial artery enters the
face by winding around the
base of the mandible, and by
piercing the deep cervical
fascia, at the anteroinferior
angle of masseter muscle. It
can palpated here and is
called “anesthetist's artery ”
4.Facial Anastamoses: The
large anterior branches
anastomose with similar
branches of the opposite
side and with the mental
artery. In the lips,
anastomoses are large, so
that cut arteries spurt from
both the ends(important fact
in labial injuries).
The second bend of the
facial artery where it
can be palpated

60. 5. Collateral Circulation—After
ligature of the common carotid,
the collateral circulation can be
perfectly established,
By the free communication
which exists between the
carotid arteries of opposite
sides, both without and within
the cranium, and by
enlargement of the branches
of the subclavian artery on the
side corresponding to that on
which the vessel has been tied.
The chief communications
outside the skull take place
between the superior and
inferior thyroid arteries, and
the profunda cervicis and
ramus descendens of the
occipital; the vertebral takes
the place of the internal
carotid within the cranium.

61. 6. Alkayat Bramley incision is a modified preauricular incision
which is given to expose the TMJ. This incision facilitates the
conservation of the vital structures like facial nerve,
superficial temporal artery.

62. 7. Arterial or Plexiform Haemangioma
It’s a type of congenital arterio venous fistula. There is
pulsatile swelling of arteries and the veins which become
arterialised i.e. tortuous and thick walled and pulsatile.
This is often called cirsoid aneurysm. Commonly seen on
the forehead or over the scalp in the temporal region.
It is treated by.
 Ligation of feeding vessels therapeutic embolisation of
the feeding artery. After ligation of the feeding vessels
excision of the lesion is done with diathermy. Injection of
sclerosing agents(1% sodium tetradecyl sulphate)

63. 8. Aneurysm
Dilatation of a localised segment of the arterial system
is known as aneurysm.
Clinically it is seen as a pulsatile swelling exhibiting
expansile pulsation in the course of an artery.
Pulsation diminishes if a pressure is applied, and refills
again if the pressure is released.
Treatment is
 arterial ligation.
 Wiring of aneurysmal sac.
 Wrapping of the aneurysmal sac.
 Excision and grafting

64. 9.Atherosclerosis of The Internal Carotid Artery
Extensive atherosclerosis of the internal carotid in the
neck can cause visual impairment or blindness of the
eye on the side of the lesion because of insufficient
blood flow through the retinal artery.
Motor paralysis and sensory loss may also occur on the
opposite side of the body because of insufficient blood
flow through the middle ear.

65. 10.Carotid siphon.

66.  The facial artery can be easily
exposed at the point where it
crosses the lower border of the
mandible to pass from the
submandibular region into the face.
This point is situated anterior to the
attachment of Masseter to the
mandible, the pulse of the facial
artery can be felt here. This artery
is accompanied by facial vein which
lies a little posterior to it. These
two structures are crossed
superficially by mandibular branch
of facial nerve.

67.  The mandibular branch of
facial nerve supplies the lower
lip, thus making it imperative
to plan the surgery in such a
way so as to preserve the
nerve.
 To achieve this end, this
incision is made ½ inch below
the border of mandible and
parallel to it. The skin,
platysma and deep fascia are
cut. Then soft tissues bluntly
retracted upward until the
palpating finger can feel the
pulse of the facial artery. The
artery then isolated tied and
cut.

68.  The submandibular gland is palpated over the
skin and an incision is made that circles the
lower pole of the gland. The posterior part of
the incision should point towards the mastoid
process; the anterior part of the incision
should point towards the chin. The skin,
platysma and deep fascia are incised ,the
lower pole of the submandibular gland is
exposed.

69.  If the gland is lifted from its bed by blunt
dissection and the entire flap is retracted
upward the tendon of the digastric becomes
visible. Following the tendon anteriorly ,the
free border of mylohyoid is ascertained where
it is crossed by the tendon not far above the
hyoid bone.

70.  The free border of mylohyoid is followed
upward and backward ,the hypoglossal
nerve can be identified by the
accompanying vein. Thus the lingual
triangle between the digastric tendon, the
posterior mylohyoid border, and the
hypoglossal nerve has been circumscribed

71.  Pulling the digastric tendon downward helps to enlarge this
triangle, at the floor of which the finely bundled hyoglossus
muscle with its vertical fibers become visible. This muscle is
divided bluntly and in the gap between its vertical fibers is
found.

72.  Gray’s Anatomy
 Chaurasia- Human anatomy
 Inderbir singh- Human anatomy& Embryology
 S.Das- Text Book of Surgery
 ANATOMY FOR DENTAL STUDENTS BY JOHNSON & MOORE(3RD
EDITION)