Vascular Supply of Head and Neck with applied anatomy and clinical relevance.

1. VASCULAR SUPPLY OF
HEAD AND NECK
Dr. Balraj Shukla
(Department of Pedodontics & Preventive Dentistry)
College of Dental Sciences & Research Centre, Ahmedabad

2. CONTENTS
•INTRODUCTION TO BLOOD VESSELS
•ARTERIAL SUPPLY OF HEAD & NECK
•VENOUS SUPPLY OF HEAD & NECK
•CONCLUSION
•REFERENCES

3. BLOOD VESSELS

4. ARTERIAL SYSTEM
ARTERIAL SYSTEM: VESSELS & DIAMETER
Aorta – 25 mm
Arteries – 4 mm
Arterioles - 30μ
Terminal arteriole - 10μ
Capillaries – 8μNervi Vascularis – Nerve supply of the arteries

5. VENOUS SYSTEM
VENOUS SYSTEM: VESSELS & DIAMETER
Venule: 20
Veins: 5 mm
Vena Cava: 30 mm

6. ARTERIAL SUPPLY

7. COMMON CAROTID ARTERY
- Formed from the 3rd & 4th aortic
arches
- A part of carotid sheath along
with Internal Jugular Vein and
Vagus Nerve.
- Rarely gives branches in the neck
- Divides at the level of thyroid
cartilage at C4 into Internal and
External Carotid arteries.
- RCC arises above
sternocleidomastoid in 12% cases

8. • ANTERIOR: Sternohyoid & Sternothyroid
• POSTERIOR: Trachea, Oesophagus & Left recurrent nerve
• LATERAL: Left subclavian artery, Inf. Thyroid veins & Phrenic nerve
• SUPERIOR: Platysma, Omohyoid, Post. Belly of Digastric
• INFERIOR: Longus Colli & Longus Capitis
Relations
of
CCA

9. CLINICAL SIGNIFICANCE
Common Carotid Artery
• Measuring pulse (Carotid Sinus)
• Carotidynia: Soreness of the carotid artery at the bifurcation
• Carotid Stenosis: Constriction of CCA due to atherosclerosis
• Carotid Sinus Hypersensitivity: Occurs at the dilated area at the
beginning of the Internal Carotid Artery.
• Potato Tumour: Tumour of carotid body which is continuously
pulsating due to the common carotid artery

10. EXTERNAL CAROTID ARTERY

11. INTRODUCTION & COURSE
• Chief arterial supply of face & the front of neck
• Smaller than Internal Carotid Artery in children
• In adults, it is the same size as that of
Internal Carotid Artery (4.9 mm)
COURSE:
Begins at T4  Curves upward & forward 
Inclines behind the neck of mandible  Divides
into 8 branches

12. RELATIONS OF THE ECA
IN THE CAROTID TRIANGLE:
Superficial: Sternocleidomastoid, Facial N.,
Facial, Lingual & Sup. Thyroid veins
Deep: Wall of pharynx, Sup. Laryngeal Nerve,
Ascending pharyngeal artery
ABOVE THE CAROTID TRAINGLE:
Superficial: Retromandibular vein
Deep: ICA, Styloglossus, Stylopharyngeus,
Sup. Laryngeal N., Sup. Cervical Sympathetic
Ganglion

13. BRANCHES OF EXTERNAL CAROTID ARTERY

14. SUPERIOR THYROID ARTERY
• COURSE:
Below the greater cornu of hyoid  Upwards & forwards in the carotid triangle  Arches
downwards beneath omohyoid, sternohyoid and sternothyroid
• RELATIONS:
Inferior constrictor of
pharynx & External
branch of superior
laryngeal nerve
• BRANCHES:
- Infrahyoid branch
- Sternocleidomastoid branch
- Cricothyroid branch
- Superior Laryngeal branch:
- Larger branch (within the
thyroid): Supplies the anterior
portion of the gland & the isthmus
- Smaller branch (within the
thyroid): Supplies the posterior
portion of the gland
Should not be affected
while ligating Sup.
Thyroid artery else the
patient will have
difficulty in phonation

15. LINGUAL ARTERY
• 4 PARTS (divided by hyoglossus):
- First part: Upwards & Oblique,
rests on middle constrictor
- Second part: Rests on middle
constrictor, covered by digastric,
stylohyoid, hyoglossus
- Third part: Lies between
Genioglossus & Hyoglossus
- Fourth part: a.k.a Profunda
Linguae, travels the length of the
tongue till the tip

16. • BRANCHES:
• Arteriae Dorsales Linguae:
supplies glossopalatine arch,
tonsils, soft palate & epiglottis
• Sublingual branch: Supplies the
sublingual gland & gives 2
branches in mylohyoid muscle
• Suprahyoid branch: Upper
border of hyoid, anastomoses
LINGUAL ARTERY
Protrude the tongue if
there is excessive
bleeding caused due to
lingual artery

17. FACIAL ARTERY
• COURSE:
In the neck covered by Platysma
Beneath the stylohyoid & digastric muscle
Lies on medial superior constrictor
S-Bend over submandibular gland
Pierces deep to cervical fascia at masseter
Ascends to the medial angle of the eye
Terminates by supplying the lacrimal sac
Anastomoses with dorsal nasal branch of ophthalmic artery
ANAESTHETIST’S
ARTERY

18. FACIAL ARTERY
• BRANCHES:

19. ASCENDING PALATINE
Passes between Styloglossus &
Stylopharyngeus. Travels till the
Superior constrictor & internal
Pterygoid
SUBMENTAL [Largest branch]
Runs forward to the mylohyoid,
beneath the digastric muscle.
Anastomoses with sublingual &
mylohyoid artery.
Divides into 2 branches at
symphysis menti
TONSILAR BRANCH
Ascends between internal
pterygoid & styloglossus
Perforates superior constrictor
Branches
of facial
artery

20. INF. LABIAL
Arises near angle
of mouth,
penetrates
orbicularis oris.
SUP. LABIAL
Similar course as
inferior labial
artery. More
tortuous.
GLANDULAR
3-4 large vessels.
LATERAL NASAL
Arises from side of the
nose.
MUSCULAR
Face: Masseter & Buccinator
Neck: Int. Pterygoid & Stylohyoid
ANGULAR (terminal)
Medial angle of orbit.
Branches
of facial
artery
EPISTAXIS

21. OCCIPITAL ARTERY
• COURSE:
Upwards & backwards to posterior belly of
digastric
Crosses carotid sheath, accessory & hypoglossal
nerves
Runs deep to mastoid process
Crosses rectus capitis, superior oblique &
semispinalis muscles
Pierces Trapezius from midline
Tortuous course in scalp, anastomoses with post.
Auricular & sup. Temporal arteries

22. MUSCULAR
Supplies digastric,
stylohyoid, splenius &
longissimus capitis
STERNOCLEIDOMASTOID
Can arise separately
from ECA
AURICULAR
Supplies back of concha,
dura mater, diploe &
mastoid cells
MENINGEAL
Ascends with
internal jugular
vein and supplies
the dura mater
DESCENDING
(Largest)
Descends on
back of neck and
gives 2
branches.
Branches of
occipital
artery

23. POSTERIOR AURICULAR ARTERY
• COURSE:
Arises above stylohyoid & digastric muscle  Ascends over the parotid gland  reaches styloid process
of temporal bone  grooves between cartilage of ear & mastoid process  divides into auricular &
occipital branches

24. OCCIPITAL BRANCH
Passes over the
sternocleidomastoid,
reaches scalp and supplies
the occipitalis.
STYLOMASTOID BRANCH
Supplies the tympanic
cavity, tympanic antrum,
mastoid cells & semi-
circular canals.
AURICULAR BRANCH
Ascends behind the ear and
divides into small branches
inside the auricula.
Branches of
posterior
auricular
artery

25. ASCENDING PHARYNGEAL ARTERY
- Smallest branch of External Carotid Artery
- Present under the stylopharyngeus
• COURSE:
Arises from the back part of ECA  Ascends
between ICA and side of pharynx till the
surface of base of the skull  lies on Longus
Capitis

26. PHARYNGEAL
- Supplies medial
& inferior
constrictor & the
stylopharyngeus
PALATINE
Supplies the soft
palate, tonsils &
auditory tube
PREVERTEBRAL
Supplies longus
capitis & longus
coli, sympathetic
trunk & lymphatic
glands
Branches of
ascending
pharyngeal
artery

27. MENINGEAL BRANCH
- Supplies the dura mater
- The Posterior Meningeal
branch enters through
jugular foramen
- Two other smaller branches
arise from foramen lacerum
& the hypoglossal canal
INFERIOR TYMPANIC ARTERY
- Passes through a small
foramen in the petrous part
of temporal bone
- Supplies medial wall of
tympanic cavity &
anastomoses with other
tympanic arteries
Branches of
ascending
pharyngeal
artery

28. SUPERFICIAL TEMPORAL ARTERY
• Smallest terminal branch
• Appears as continuation of ECA
COURSE:
Begins in the parotid gland,
behind the neck of mandible 
covered by auricularis anterior 
accompanied by auriculotemporal
nerve  divides into frontal &
parietal branches

29. TRANSVERSE
FACIAL
- Divides into
branches that
supplies the
parotid gland,
duct & masseter
MIDDLE TEMPORAL
- Supplies temporalis
ANTERIOR
AURICULAR
- Supplies the
anterior auricle,
the lobule & part
of external
meatus
PARIETAL & FRONTAL BRACHES
Branches of
Superficial
Temporal
Artery

30. MAXILLARY ARTERY
• COURSE (divided into 3 parts by lateral pterygoid):
Arises behind the neck of the mandible
Embedded in the substance of parotid
Passes between the ramus &
Sphenomandibular ligament [1st part]
Towards external pterygoid [2nd part]
Towards pterygopalatine fossa [3rd part]

31. FIRST PART
ANTERIOR TYMPANIC
- Enters tympanic cavity
through petrotympanic
fissure & forms vascular
circle at the tympanic
membrane
DEEP
AURICULAR
ACCESSORY
MENINGEAL
MIDDLE MENINGEAL
- Largest artery supplying the dura mater
- Enters foramen spinosum & divides into
two branches:
i) Anterior branch: Supplies occipital
region & dura mater
ii) Posterior branch: Curves backward at
temporal bone & supplies posterior dura
mater
- Gives superficial petrosal, superior
tympanic, orbital and temporal branches
in the cranium

32. FIRST PART
INFERIOR ALVEOLAR ARTERY
- Runs below towards the mandibular foramen on the medial side of the ramus
- Passes through the mandibular canal in the substance of the bone
- Divides into incisor and mental branches near the first premolar
- Incisor branch: Supplies incisors
- Mental branch: Supplies the chin
- Gives a lingual branch at its origin which supplies the mucous membrane of the mouth
- Gives a mylohyoid branch upon entering the mandibular foramen

33. SECOND
PART
DEEP TEMPORAL
- Gives two branches:
Anterior & Posterior
- Anterior branch
communicates with
the lacrimal artery
PTERYGOID
BRANCHES
Supply the
pterygoid muscles
BUCCAL
Runs between
internal pterygoid &
temporalis & supplies
the buccinator.
MASSETERIC
Supplies masseter &
anastomoses with
facial and transverse
facial artery

34. THIRD PART
POSTERIOR SUPERIOR
ALVEOLAR
- Enters
pterygomaxillary fissure
& reaches maxillary
tuberosity
- Divides into branches
that supplies posterior
teeth & maxillary sinus
PHARYNGEAL
Supplies pharynx &
the auditory tube.
ARTERY TO PTERYGOID
CANAL
- Gets distributed to the
upper part of pharynx &
auditory tube
GREATER PALATINE
Supplies palatine glands
& roof of the mouth.
Descends in the
palatine canals &
supplies the soft palate
& palatine tonsils

35. THIRD PART
INFRAORBITAL ARTERY
Runs along infraorbital
groove & canal & emerges on
the face through infraorbital
foramen. Gives 2 branches in
the canal:
Orbital branches: Supplies
rectus inferior & inferior
oblique muscles & the
lacrimal sac
Anterior Superior Alveolar
branches: Supplies upper
incisors & canines and the
maxillary sinus

36. THIRD PART
SPHENOPALATINE ARTERY
(terminal)
Passes through
sphenopalatine foramen
and gives a posterior and
lateral nasal branch
Supplies the frontal,
ethmoidal, maxillary &
sphenoidal sinuses.
Sphenopalatine artery ends
on nasal septum as
posterior septal branch
which anastomose with
ethmoidal, superior labial
& descending palatine
arteries.

37. APPLIED ANATOMY – EXTERNAL CAROTID ARTERY & ITS BRANCHES
ARTERY APPLIED ANATOMY
Superior Thyroid Artery Sup. Laryngeal Nerve & Phonation
Lingual Artery Collateral circulation is affected if ligation of lingual artery is done near
the ECA
Facial Artery Usually sacrificed during excision of Submandibular gland
Occipital Artery Should be ligated in cases of tympanic tumours as it serves as a primary
supply for these tumours.
Maxillary Artery Embolization of maxillary artery can restrict posterior epistaxis.
Serves as a rich source of blood supply for angiofibromas.

38. INTERNAL CAROTID ARTERY

39. INTRODUCTION
• Supplies the brain and the eyes
• Larger than External Carotid Artery in children
• Branches off from the common carotid artery from the
level of C3 or C4 vertebrae

40. CLASSIFICATION OF INTERNAL CAROTID ARTERY
• Eugen Fischer (1938)
5 parts based on Angiographic course, does not include the extracranial course
• Hirohiko Gibo (1981)
4 parts based on Direction of blood flow, does not recognize the clinoid segment
• Pierre Lasajaunias & Alejandro Berenstein (1987)
6 parts based on Embryological Development, not relevant clinically
• Alain Bouthillier (1996)
• Terminologia Anatomica (1998)

41. • Alain Bouthillier (1996)
- Classification based on Anatomy surrounding the ICA
- Most widely used classification in clinical settings
- ICA divided as:
C1: Cervical
C2: Petrous
C3: Lacerum
C4: Cavernous
C5: Clinoid
C6: Ophthalmic
C7: Communicating

42. • Terminologia Anatomica (1998)
- Terminologia Anatomica is the International
Standard on human anatomic terminology
- Divides the Internal Carotid Artery into 4 parts:
i. Cervical
ii. Petrous
iii. Cavernous
iv. Cerebral

43. • Course:
Begins at bifurcation of
common carotid  Runs
upwards in the petrous
part of temporal bone 
Ends at the carotid canal
• Relations:
Posterior: Longus capitis,
Sup. Cervical ganglion &
Laryngeal N.
Medial: Pharynx,
Ascending Pharyngeal
Artery
Base: Accessory &
Hypoglossal Nerves
Cervical
Portion

44. • Course:
In the petrous portion of
temporal bone  Enters
cavity of skull between
lingula & petrosal
process of sphenoid 
Extends till foramen
lacerum
Three parts: Vertical,
Bend, Horizontal
• Branches:
• Artery of Pterygoid
canal
• Corticotympanic
branches
Petrous
portion

45. COURSE:
Within the cavernous sinus
 Ascends towards posterior
clinoid process  passes by
the side of sphenoid 
Curves on anterior clinoid
process  Perforates dura
mater, forms the roof of
sinus
The curve in the cavernous
segment is known as the
carotid siphon.
Cavernous
Portion

46. • BRANCHES:
Hypophyseal branches:
One or two vessels that supply
the hypophysis
Semilunar branches:
Small vessels that supply the
semilunar ganglion
Anterior meningeal branch:
Supplies dura mater of
anterior cranial fossa
OPHTHALMIC ARTERY

47. OPHTHALMIC ARTERY
• COURSE:
Arises from medial side of anterior clinoid process 
Enters orbital cavity through optic foramen  Reaches
medial wall of orbit  Divides into dorsal nasal and
lacrimal branches
• BRANCHES:
Two groups of branches:
- Orbital
- Ocular

48. • COURSE:
Arises from ophthalmic before entering
the orbit  Supplies eyelids &
conjunctiva
• BRANCHES:
i. Primary branch supplies lacrimal
gland
ii. Zygomaticofrontal &
zygomaticotemporal branches
iii. Lateral palpebral branches
iv. Recurrent meningeal branch
v. Muscular branches
ORBITAL
GROUPLACRIMAL ARTERY

49. SUPRAORBITAL ARTERY
• COURSE:
Passes medially to levator palpebrae &
superior rectus  Divides into superficial
& deep branch as it passes through
supraorbital foramen
Supplies muscles of forehead &
anastomoses with the frontal branch
ORBITAL
GROUP

50. ETHMOIDAL ARTERIES
• COURSE:
Two arteries: Posterior & Anterior
POSTERIOR:
Passes through ethmoidal canal  Supplies
posterior ethmoidal cells  Enters cranium
& gives a meningeal branch to dura mater 
Gives nasal branches in nasal cavity
ANTERIOR:
Passes through ethmoidal canal  Supplies
anterior ethmoidal cells & frontal sinus 
Gives a meningeal branch to dura mater 
Supplies lateral wall & septum of nose
ORBITAL
GROUP

51. MEDIAL PALPEBRAL ARTERIES
• COURSE: Encircles the eyelids
BRANCHES:
Sup. Palpebral: Anastomoses with
zygomaticotemporal artery
Inf. Palpebral: Anastomoses with
lacrimal & transverse facial
artery
Frontal: Anastomoses with
supraorbital artery & supplies
forehead
ORBITAL
GROUP

52. DORSAL NASAL ARTERY
• COURSE:
Passes through lacrimal sac and
divides into two branches:
- One anastomoses with angular
artery
- One runs along the dorsum of
nose & anastomoses with lateral
nasal branch
ORBITAL
GROUP

53. CENTRAL ARTERY OF RETINA
• COURSE:
Pierces dural sheath  Enters the optic nerve  Runs
forward & reaches optic disc  Divides into branches
that supply the retina
OCULAR
GROUP
Occlusion of this
artery results in
blindness

54. CILIARY ARTERIES OCULAR
GROUP
• Short Posterior:
6-12 in number, pierce the sclera & supplies
the choroid & ciliary processes
• Long Posterior:
2 in number, Run between sclera and
choroid, enters ciliary muscle & forms
circulus arteriosus major
• Anterior:
Derived from muscular branch, travels
medial to rectus muscles, becomes a part of
circulus arteriosus major & minor.

55. CEREBRAL PORTION
• CIRCULUS ARTERIOSUS / CIRCLE OF
WILLIS
- Attempts to equalize the flow of blood
in different parts of the brain
- Situated in interpeduncular fossa
- Formed by anterior & middle cerebral
arteries of ICA & by the posterior
basilar arteries
- Both anterior cerebral arteries are
connected by anterior communicating
arteries.
- Middle & posterior cerebral arteries are
connected by posterior communicating
artery.

56. CEREBRAL PORTION
• ANTERIOR CEREBRAL ARTERY
- Smallest terminal branch of ICA
- Follows the corpus callosum
- Both arteries are connected by Anterior
Communicating Artery
CORTICAL
Orbital
Frontal
Parietal
CENTRAL
Antero-medial ganglionic
Anterior
Posterior
Middle
Inferior

57. CEREBRAL PORTION
• MIDDLE CEREBRAL ARTERY
- Largest & direct branch of ICA
- Present in the lateral sulcus on the
insula
CORTICAL
Orbital
Frontal
Parietal
Temporal
CENTRAL
Antero-medial ganglionic
Ascending parietal
Inferior Lateral Frontal
Parietotemporal
Ascending frontal
Temporal

58. CEREBRAL PORTION
• POSTERIOR COMMUNICATING ARTERY
- Runs backwards and anastomoses with
posterior cerebral artery
- Frequently larger on one side than the
other
- Gives branches that supply the thalamus
& the third ventricle
• ANTERIOR CHOROIDAL ARTERY
- Supplies hippocampus, fimbria, tela
choroidea, third ventricle & choroid
plexus.

59. APPLIED ANATOMY – INTERNAL CAROTID ARTERY & ITS BRANCHES
ARTERY APPLIED ANATOMY
Middle Cerebral Artery Most common site of cerebrovascular stroke
Internal Carotid Artery &
its branches
Atherosclerotic plaque
Cavernous Portion Arteriovenous fistula leading to exophthalmos

60. VENOUS SUPPLY

61. CONTENTS
•INTRODUCTION
•VEINS OF THE HEAD & FACE
•VEINS IN THE DIPLOE
•VEINS OF THE NECK
•VEINS OF THE BRAIN
•DURAL VENOUS SINUSES

62. INTRODUCTION
• CHIEF VEINS RESPONSIBLE FOR VENOUS DRAINAGE OF HEAD & NECK:
- External Jugular Vein
- Internal Jugular Vein
• MAJOR VEINS OF FACE & SCALP:
- Facial vein  IJV
- Posterior Auricular Vein  EJV

63. VEINS OF THE HEAD AND FACE

64. FRONTAL VEIN
• a.k.a. Supratrochlear vein
• Begins in the forehead in a venous
plexus  Converges with the
superficial temporal vein  Joins
supraorbital vein to make angular
vein

65. SUPRAORBITAL VEIN
• Begins in the forehead & travels 2
paths:
1) Sends a branch which joins the
ophthalmic vein through the
supraorbital notch
2) Runs downwards and joins with
frontal vein to form the angular vein.
• Drains the forehead, eyebrow & upper
eyelid

66. ANGULAR VEIN
Formed by the junction of frontal
and supraorbital vein  Runs
towards the lower margin of orbit
to become facial vein 
Establishes anastomoses between
the anterior facial vein &
cavernous sinus through the
superior ophthalmic vein

67. ANTERIOR FACIAL VEIN
Continuation of the angular vein
Runs below the zygomaticus
Passes superficial to masseter & body
of mandible
Beneath the platysma & cervical
fascia
Unites with retromandibular vein to
form COMMON FACIAL VEIN
Enters internal jugular vein
Ends in the anterior jugular vein

68. BRANCHES OF ANTERIOR FACIAL VEIN
• Deep facial vein
• Sup & Inf Palpebral veins
• Sup & Inf Labial veins
• Buccinator & Masseteric veins
• Submental veins
• Palatine veins
• Submaxillary veins

69. SUPERFICIAL TEMPORAL VEIN
• Begins on side of the skull  Frontal & Parietal veins
arise from this plexus  Unite above the zygomatic arch
 Enters parotid gland  Unites with facial vein to form
POSTERIOR FACIAL VEIN
Branches:
- Transverse facial vein
- Orbital veins
- Parotid veins
- Articular veins from TMJ

70. MAXILLARY VEIN
Short trunk formed by confluence of
veins of the pterygoid plexus  Passes
between sphenomandibular ligament &
neck of mandible  Unites with
temporal vein to form posterior facial
vein

71. RETROMANDIBULAR VEIN
a.k.a Posterior Facial Vein
Formed by union of superficial
temporal & maxillary vein  Descends
in the parotid and divides into two
divisions:
- Anterior division: Unites with anterior
facial vein to form common facial vein
- Posterior division: Joins posterior
auricular vein to form external jugular
vein

72. POSTERIOR AURICULAR VEIN
Begins in a plexus which communicates
with tributaries of occipital & superficial
temporal veins  Descends behind the
auricula and joins posterior division of
facial vein to form External Jugular vein
 Receives the stylomastoid vein

73. OCCIPITAL VEIN
Begins in back of part of the vertex of
the skull  Pierces the cranial
attachment of trapezius & dips into
suboccipital triangle…
Later, it can follow 3 routes:
- Joins deep cervical & vertebral veins
- Joins posterior auricular vein & ends in
EJV
- Ends in IJV directly

74. VEINS IN THE DIPLOE

75. WHAT IS A DIPLOE?
The spongy cancellous
bone that separates the
inner & outer cortical
layers of the cortical
bone of the skull is
called DIPLOE

76. DIPLOIC VEINS
• Occupy channels in diploe of the cranial
bases
• Large, valveless & exhibit pouch-like
dilatations at irregular intervals
• Increase in size once the sutures unite
• Communicate with meningeal veins &
sinuses of dura mater & with veins of
pericranium

77. DIPLOIC VEINS
- FRONTAL: Opens into
supraorbital vein & superior
sagittal sinus
- POSTERIOR TEMPORAL:
Confined in parietal bone, ends
in transverse sinus
- ANTERIOR TEMPORAL:
Confined in frontal bone, opens
into sphenoparietal sinus
- OCCIPITAL (Largest): Opens
externally into occipital vein &
internally into transverse sinus

78. VEINS OF THE NECK

79. EXTERNAL JUGULAR VEIN
Formed by fusion of Posterior Auricular
Vein & Posterior Facial Vein  Runs along
the posterior border of
sternocleidomastoid  Perforates
subclavian triangle in the deep fascia 
Ends in subclavian vein
BRANCHES:
Occipital v., Post. Ext. Jugular v.,
Transverse cervical v., Suprascapular v.,
Ant. Jugular v.

80. INTERNAL JUGULAR VEIN
Begins in posterior compartment of
jugular foramen  Dilated at its origin,
known as SUPERIOR BULB  Unites with
subclavian vein at the root of the neck to
form brachiocephalic vein  Forms an
INFERIOR BULB before its termination
BRANCHES:
Inferior Petrosal sinus, Lingual veins,
Pharyngeal veins, Sup. & Middle thyroid
veins, Frontal & Occipital veins

81. VERTEBRAL VEIN
Numerous small tributaries from
internal venous plexus join to
form vertebral vein  Enters
foramen in transverse process of
atlas & descends to form a dense
plexus  This plexus ends in a
single trunk near 6th cervical
vertebrae
BRANCHES:
Transverse sinus, Occipital vein,
Anterior & Deep Cervical veins

82. APPLIED ANATOMY – VEINS OF THE HEAD, FACE & NECK
ARTERY APPLIED ANATOMY
Internal Jugular Vein Damage to this vein can send the patient into
a hypovolaemic shock
Retromandibular vein PARROT’S SIGN: Pain caused due to pressure
applied on the retromandibular vein. It is an
indicator of meningitis.
Facial vein Infection spread through facial vein can cause
intracranial meningitis.
Angular vein Any infection spread through angular vein can
spread to the cavernous sinuses, leading to
thrombosis.

83. VEINS OF THE BRAIN

84. INTRODUCTION
• No valves
• Thinner due to lack of musculature in the brain
• Pierce the inner meningeal layer of dura mater
2 types:
- CEREBRAL VEINS:
External: Superior, Inferior & Middle
Internal: Basal, Terminal, Choroid, Great Cerebral
- CEREBELLAR VEINS: Superior & Inferior

85. EXTERNAL CEREBRAL VEINS
SUPERIOR CEREBRAL
- Drains superior, lateral & medial
surfaces of hemispheres
- Opens into superior sagittal sinus
MIDDLE CEREBRAL
- Begins on lateral surface of hemisphere
- Ends in cavernous or sphenopalatine sinus
- Also connected with Sup. Sagital sinus &
Transverse sinus
INFERIOR CEREBRAL
- Begins on under surface of
hemispheres
- On the orbital surface, it opens
into the Sup. Sagital sinus
- On the temporal lobe, it joins
cavernous, sphenoparietal & sup.
Petrosal sinus

86. INTERNAL
CEREBRAL
VEINS
BASAL VEIN
Formed by union of
anterior & middle
cerebral & inferior
striate veins
CHOROID VEIN
Runs along the length
of choroid plexus
Receives veins from
hippocampus, fornix
& corpus callosum
THALAMOSTRIATE VEIN
(terminal)
Commences between corpus
callosum & thalamus, Unites
with choroid vein
GREAL CEREBRAL VEIN
Formed by union of 2
internal cerebral veins,
Ends in the straight
sinus

87. CEREBELLAR VEINS
• SUPERIOR:
Ends in transverse and sup.
Petrosal sinus
• INFERIOR:
Ends in transverse, sup.
Petrosal and occipital sinus

88. SINUSES OF THE DURA MATER

89. INTRODUCTION
• Venous channels in the dura mater which
drain blood from the brain
• Devoid of valves & there is no muscle in
their walls
• Receive blood from brain, meninges & bones
of the skull
• Venous sinuses inside the cranium
communicate with venous sinuses outside
the cranium through emissary veins

90. CLASSIFICATION

91. SUPERIOR SAGITAL SINUS
Occupies the attached margin of falx
cerebri
Begins at crista galli by union of
meningeal veins  Communicates with
veins of nasal and facial cavity  Runs
backwards and grows in size as it ends
near the internal occipital protuberance
 Becomes continuous with transverse
sinus
Branches: Sup. Cerebral veins, Parietal
Emissary veins & Venous Lacunae

92. INFERIOR SAGITAL SINUS
Occupies the posterior 2/3rd of falx
cerebri
Increases in size as it goes backwards
Joins the great cerebral vein to end in
straight sinus.
Branches: Receives veins from Falx
Cerebri and occasionally from medial
surface of hemispheres

93. STRAIGHT SINUS
Formed at the line of junction of falx
cerebri and tentorium cerebelli
Triangular in cross section, formed by
fusion of inferior sagital sinus and the
great cerebral vein
Ends by continuing as transverse sinus
Branches: Receives cerebellar veins

94. TRANSVERSE SINUS
Begins at internal occipital protuberance
Right side: Continuation of sup. Sagital
sinus
Left side: Continuation of Straight sinus
Reaches petrous part of temporal lobe…
2 paths from here:
- Continues as Sigmoid sinus
- Lies at the margin of tentorium
cerebelli
Moves downwards and ends in IJV

95. TRANSVERSE SINUS
Branches: Sup. Petrosal sinus, Inf.
Cerebral veins, Inf. Cerebral veins,
Diploic vein, Inf. Anastomotic vein,
Mastoid & Condylar emissaries,
Cerebellar veins, Internal Auditory vein
The Petrosquamous sinus, when
present, ends in the transverse sinus

96. OCCIPITAL SINUS
- Smallest cranial sinus
Begins at margin of foramen
magnum  Joins the terminal part
of transverse sinus 
Communicates with vertebral
venous plexus  Ends in
confluence of sinuses

97. CENTRE OF THE SINUS: ICA & Abducens N.
CAVERNOUS SINUS
OUTSIDE THE SINUS
Superiorly: Optic tract & Chiasma, ICA
Inferiorly: Foramen lacerum, greater wing
of sphenoid
Medially: Hypophysis cerebri, Sphenoidal
sinus
Laterally: Temporal lobe
Anteriorly: Superior Orbital fissure
Posteriorly: Petrous part of temporal bone
LATERAL WALL OF SINUS: Oculomotor N.,
Trochlear N., Ophthalmic N., Maxillary N.,
Trigeminal Ganglion

98. CAVERNOUS SINUS
Branches:
Sup. & Inferior ophthalmic vein,
Central vein of retina, Middle
cerebral vein, Inferior cerebral
vein, Sphenoparietal sinus, Frontal
trunk of middle meningeal vein

99. INTERCAVERNOUS SINUS
Connects both the cavernous sinuses at the hypophysis cerebri and
forms the circular sinus

100. SUPERIOR PETROSAL SINUS
• Lies in the attached part of tentorium
cerebelli
• Connects the cavernous & transverse
sinus
• Receives some cerebral & cerebellar
veins and veins from the tympanic
cavity

101. INFERIOR PETROSAL SINUS
• Lies in the junction formed by petrous
part of temporal bone with the basilar
part of occipital bone
• Begins in posteroinferior part of
cavernous sinus, passes through the
jugular foramen and ends in the
superior bulb of IJV
• Receives the internal auditory veins &
veins from the pons, medulla
oblongata & the cerebellum

102. BASILAR PLEXUS
• Consists of several venous
channels
• Connects both the inferior
petrosal sinuses
• Communicates with the
anterior vertebral venous
plexus

103. EMISSARY VEINS

104. VEIN FORAMEN/CANAL FUNCTION
Mastoid Emissary Vein Mastoid foramen Unites transverse sinus with occipital or posterior
auricular vein
Parietal Emissary Vein Parietal foramen Unites inferior sagital sinus with veins of the scalp
Rete Canalis Hypoglossus Hypoglossal Canal Unites transverse sinus with vertebral vein & deep
veins of the neck
Condyloid vein Condyloid canal Unites transverse sinus with deep veins of the neck
2 to 3 small veins (unnamed) Foramen lacerum
Unites cavernous sinus with pterygoid plexus
Rete foraminis ovalis Foramen ovale
Veins of Vesalius Foramen Vesalius
Internal Carotid plexus of veins Carotid canal Unites cavernous sinus with Internal Jugular vein
One small vein (unnamed) Foramen Cecum Unites superior sagital sinus with veins of nasal
cavity
EMISSARY
VEINS
Emissary veins
establish
communication
between
sinuses inside
the skull & the
veins external
to it.

105. CLINICAL RELEVANCE FOR DENTISTS

106. HEMATOMA DUE TO PSA NERVE BLOCK
- Can arise due to unintentional nicking
of blood vessels while giving posterior
superior alveolar nerve block. Blood
accumulates in the infratemporal fossa.
- Visible swelling.
- External ice should be applied.
- Swelling disperses after 7-14 days.
Most commonly encountered blood
vessels:
- Pterygoid plexus of veins
- Maxillary artery

107. EPISTAXIS: Etiology in children & adults
CHILDREN
• Repeated nose picking
• Mucosal irritation
• Dry weather, Cold climate
• Infants with GERD
• Migraine
• Upper Respiratory Tract
infections
ADULTS
• Septal abnormality
• Dry weather, Cold climate
• Blood dyscrasias
• Tumours
• Cocaine abuse
• Nasal polyps
• Hepatic diseases

108. EPISTAXIS
Management
Source: ReliasMedia

109. DANGER ZONES OF THE FACE

110. SINUSES OF THE FACE
FUNCTION:
- Air filtration
- Reduces weight of the skull
- Voice resonation
- Providing a buffer against
facial trauma

111. FRONTAL
SINUS
ARTERIAL SUPPLY:
- Sphenopalatine artery
- Anterior Ethmoidal artery
- Anastomotic vein between
supraorbital & superficial
ophthalmic vein
APPLIED ANATOMY:
- Sinusitis that can later give
complications like Orbital cellulitis,
subdural abscess and meningitis
- Osteomyelitis secondary to sinusitis can
be metastatic due to rich vasculature

112. ETHMOIDAL
SINUS
ARTERIAL SUPPLY:
- Sphenopalatine artery
- Anterior and posterior
ethmoidal arteries
- Supraorbital artery
APPLIED ANATOMY:
- Sinusitis
- Anterior Ethmoidal Artery rupture
can cause significant bleeding in
the ethmoidal fovea
- CSF leakage

113. SPHENOIDAL
SINUS
ARTERIAL SUPPLY:
- Sphenopalatine artery
- Posterior Ethmoidal artery
- Venous plexus
APPLIED ANATOMY:
- Sinusitis that can later give
complications like meningitis,
Abducens nerve palsy and
Cavernous Sinus Thrombosis

114. MAXILLARY
SINUS
ARTERIAL SUPPLY:
- Posterior Superior Alveolar artery
- Infraorbital artery
- Anterior Superior Alveolar artery
- Superior artery of inferior concha
APPLIED ANATOMY:
- Maxillary sinusitis
- Oroantral fistula
- Cavernous sinus infection
- Carcinoma of maxillary sinus

115. APPLIED ANATOMY OF
DURAL VENOUS SINUSES

116. ASEPTIC
Infection of membrane of Cavernous sinus
Pool of pus
Venous involvement
Tunica intima releases sticky exudate with the pus
Aseptic Thrombus
Bacteraemia
Septicaemia
CAVERNOUS SINUS THROMBOSIS
SEPTIC
• Caused as a late complication of
an infection of dangerous area of
face or the paranasal sinuses.
• Retrograde spread of infection.
• 70% of infection caused due to
Staphylococcus Aureus

117. COMPLICATIONS OF CAVERNOUS SINUS THROMBOSIS
• Periorbital oedema
• Chemosis (swelling of conjunctiva)
• Exophthalmos
• Increased intraocular pressure
• Hypoesthesia (reduced touch)
• Meningism: Neck stiffness, Photophobia, Headache
• Lateral gaze palsy (due to Abducens nerve)
• Ptosis ( due to Optic nerve)
• Ophthalmoplegia (paralysis of more than one extraocular muscle)
• Reduction of corneal reflex ( due to Ophthalmic nerve)

118. EXTRADURAL & SUBDURAL HEMORRHAGES
EXTRADURAL HEMORRHAGE SUBDURAL HEMORRHAGE
- Between outer layer of skull
and dura mater
- Due to arterial involvement
(MMA)
- Late symptoms of cerebral
compression (Lucid
interval)
- Paralysis occurs first in face
then spreads to other parts
of the body
- No blood in CSF
- Between arachnoid and
dura mater
- Early symptoms of cerebral
compression
- Paralysis is haphazard
- Blood present in CSF

119. OTHER COMPLICATIONS OF DURAL VENOUS SINUSES
SUPERIOR SAGITAL SINUS THROMBOSIS
• Infection spreads to the superior
sagital sinus via veins, diploe and nose.
- Leads to high intracranial tension
- Delirium
- Paraplegia of lower limbs
SIGMOID SINUS THROMBOSIS
- Secondary to otitis media & mastoiditis
OTITIC HYDROCEPHALUS
Spread of infection from sigmoid and
transverse sinus to superior sagital sinus
can cause impaired CSF drainage leading
to OTITIC HYDROCEPHALUS.

120. CONCLUSION

121. REFERENCES
• Gray, Henry. Anatomy of the Human Body. London, England: Bounty,
2012.
• Chaurasia, B. D. B D Chaurasia’s Handbook of General Anatomy. Vol. 4.
Delhi, India: CBS, 2009.
• Cunningham, Daniel John, and George John Romanes. Head and Neck and
Brain. Oxford: Oxford Univ., Pr., 1986.

122. REFERENCES
• GARG, KRISHNA. Bd Chaurasia’s Human Anatomy for Dental Students. Vol. 2. Place of
publication not identified: CBS Publishers & Distributors, 2012.
• Bouthillier, A., van Loveren, H. R., & Keller, J. T. (1996). Segments of the Internal
Carotid Artery: A New Classification. Neurosurgery, 38(3), 425–433
• Janfaza P. Surgical Anatomy of Head and Neck. Cambridge: Harvard University Press;
2011.
• Netter, Frank H. Atlas of Human Anatomy. Vol. 6. Philadelphia: Saunders/Elsevier,
2014.

123. REFERENCES
• Ahmad, T. (2018). New easy improved and safe methods of posterior superior alveolar
nerve block. International Journal of Biomedical and Advance Research, 9(7), 255-
258
• Scheuer JF, 3rd, Sieber DA, Pezeshk RA, et al. Anatomy of the facial danger zones:
maximizing safety during soft-tissue filler injections. Plast Reconstr
Surg. 2017;139:50e–58e
• Janfaza P. Surgical Anatomy of Head and Neck. Cambridge: Harvard University Press;
2011.
• Chaurasia, B. D. B D Chaurasia’s Handbook of General Anatomy. Vol. 4. Delhi, India:
CBS, 2009.
• Das S., A concise textbook of surgery, 8th edition., Kolkata, India: S. Das publication,
2008.

124. THANK YOU Twitter: @balrajshukla