ARTERIAL SUPPLY OF THE HEAD & NECK
AIM – To know the arterial supply , their anastomoses with other arteries ,various
anatomical deviations and their importance in different kind of surgical aspect in
head & neck region.
The arteries of the oral apparatus and adjacent regions are, with a few
exceptions, branches of the external carotid artery. Only parts of the nasal cavity
and the upper parts of the face receive branches of the internal carotid artery. The
external carotid artery is sometimes termed the facial carotid, supplying superficial
and deep structures of the face, whereas the name cerebral carotid applies to the
internal carotid artery, which sends its blood almost exclusively to the brain.
Common carotid artery –
The common carotid artery arises on the left side from the arch of the
aorta, where it lies in front of the subclavian artery up to the sternoclavicular joint.
Here the two arteries diverge. On the right the bracheocephalic trunk bifurcates
behind the sternoclavicular joint into common carotid and subclavian arteries. The
common carotid gives off no branches proximal to its branches. It lies within
medial part of the carotid sheath, with the internal jugular vein lateral to it and
vagus nerve deeply placed between the two vessels. The sympathetic trunk is
behind the artery and outside the sheath, which is overlapped s superficially by the
infrahyoid muscles and sterocleidomastoid. Medial to the sheath is the trachea and
esophagus and, at a higher level, the larynx and pharynx. The thyroid gland
overlaps the sheath anteromedially.
Site of bifurcation –
The common carotid artery usually bifurcates at the level of the upper
border of the lamina of the thyroid cartilage (upper border of the C4 vertebra) into
the external and internal carotids, it may do so higher near the tip of the greater
horn of the hyoid bone (C3 vertebra).
The terminal portion of the artery is often dilated into the carotid sinus,
which includes the commencement of the internal carotid artery.
The carotid pulse can be felt by pressing backwards between the
trachea and lower larynx medially, and sternomastoid laterally, pressing the artery
against the anterior tubercle of the transverse process of C6 vertebra (carotid
tubercle of chassaignac).
Surface marking –
Surface marking of the common carotid artery is along a vertical line
from the sternoclavicular joint to the level of the upper border of the thyroid
The vessel can be surgically exposed by retracting the lower part of
sterocleidomastoid backwards and incising the carotid sheath.
External Carotid Artery –
The external carotid artery at its commencement lies against the side
wall of the pharynx somewhat medial to the internal carotid artery. It then ascends
in front of the internal carotid deep to the posterior belly of digastrics and
stylohyoid, above which it pierces the deep lamina of the parotid fascia and enters
the gland. It divides within the gland behind the neck of the mandible into the
maxillary and superficial temporal arteries. As the external carotid artery lies in
the parotid gland it is separated from the internal carotid by the deep part of the
gland and its fascia,styloid process and its continuation the stylohyoid ligament,
styloglossus and the” pharyngeal” structures ; stylopharyngeus muscle,
glossopharyngeal nerve and pharyngeal branch of the vagus. At the
commencement of the artery the internal jugular vein lies lateral, but higher up it is
posterior and deep to the artery. The facial vein crosses the artery, with the
hypoglossal nerve lying between. Except at its commencement the vessel lies in
front of the anterior border of sterocleidomastoid.
Surface Marking –
The surface marking of the external carotid is along a line from the
bifurcation of the common carotid passing up behind the angle of the mandible to a
point immediately in front of the ear.
Surgical approach –
The vessel can be exposed in front of the upper part of
sterocleidomastoid before entering the parotid gland by ligating the facial vein.
The hypoglossal nerve which crosses the external and internal carotids
superficially must not be damaged.
Before enters the parotid gland the external carotid artery gives off
Three from in front, otherwise called anterior branches –
a) Superior thyroid artery
b) Lingual artery
c) Facial artery
Two from behind, otherwise called posterior branches –
a) Occipital artery
b) Posterior auricular artery
One deep or medial branch –
- Ascending pharyngeal artery
Two terminal branches –
a) Superficial temporal artery
b) Maxillary artery
1) Anterior branches --
a) Superior thyroid artery –
The superior thyroid artery arises at the commencement of the
external carotid artery. It runs almost vertically downwards, with the vein, to the
upper pole of the thyroid gland, with the external laryngeal nerve close behind it,
alongside the larynx. Before reaching the thyroid gland it gives off branches like –
- Infrahyoid artery
- Sterocleidomastoid artery
- Superior laryngeal artery
- Cricothyroid artery
The superior laryngeal artery pierces the thyrohyoid membrane with
the internal laryngeal nerve. The Cricothyroid artery crosses the upper part of the
Cricothyroid membrane to anastomoses with the contra lateral artery.
b) Lingual artery –
The lingual artery arises from the front of the external carotid above the superior
thyroid ,near the tip of the greater horn of the hyoid bone.it forms a short loop,then
passes forwarda along the upper border of the greater horn,deep to hyoglossus.it is
accompanied by the lingual vein.the loop of the artery is crossed laterally by the
hypoglossl nerve and its companion vein,the latter opening into the facial vein.
c) Facial artery-
The facial artery arises from the front of the external carotid above the
lingual artery and runs upwards on the superior constrictor,deep to the
digastrics and stylohyiod muscles,then deep to the submandibular salivary
gland.it grooves the posterosuprior part of the gland.
As the artery lies on the supele it gives off a Tonsillar branch and an
ascending palatine branch .
It Supplies – Tonsil an ssoft palate.
The facial artery then makes an S-bend ,curling over the
submandibular gland and crosses the inferior border of the mandible,where its
pulsation can be felt,at the anterior border of the masseter .
Before passing to the face it gives off the submental artery,which
accompanies the mylohyoid nerve into the submandibular fossa and sends
perforating banches through the mylohyoid to anastomose with a sublingual branch
of the lingual artery.
2) Posterior Branches –
a) Occipital artery –
The artery arises from the back of the external carotid on a level with
the facial artery. It courses backwards deep to the lower border of the
posterior belly of the digastrics. It grooves the base of the skull at the
occipitomastoid suture ,deep to the digastric notch of the mastoid
process,and passes through thae apex of the posterior triangle to supply the
back of the scalp.
The artery gives off two branches to sternoceidomastoid. The upper
branch is a guide to the accessory nerve in front of the upper border of the
At its origin the occipital artery crosses lateral to the hypoglossal
nerve,which hooks around it from behind , the nerve being held down here
by the lower sternocleidomastoid branch of the artery.
b) Posterior Auricular Artery –
The artery arises above the level of the digastrics muscle,within the
substance of the parotid gland. It runs up superficial to he substance of the
styloid process above the posterior belly of digastric and crosses the surface
of the mastoid process to supply the scalp.
Auricular branches supply the pinna of the ear.its stylomastoid branch
enters the stylomastoid foramen and supplies the facial nerve;this branch
may arise from the occipital artery.
3)Medial Branch –
Ascending Pharyngeal Artery –
The ascending pharyngeal artery arises just above the
commencement of the along the side wall of the internal carotid artery.
It supplies the pharyngeal wall and the soft palate and sends
meningeal branches through the foramina nearby.
4)Terminal branches –
a) Superficial Temporal Artery –
- This artery continues the course of the external carotid artery in the
retromandibular fossa and ascending vertically,crosses the posterior root of the
zygomatic arch immediately in front of the outer ear.
- The pulse of this artery can be felt at this place because of the
superficial position of the artery,which,after emerging from the substance of the
- Before the artery leaves the parotid gland, it releases the transverse
facial artery. This originates at the level of the mandibular neck, this branch turns
horizontally forward between the parotid gland and masseter muscle.
- The transverse facial artery is usually found between zygomatic arch
and parotid gland and terminates below the outer corner of the eye,where it may
anastomose with palpebral arteries.
- After sending a few small branches posteriorly to the outer ear and
anteriorly to the joint capsule, the artery divides ontal brarontsmat a variable
distance above the zygomatic arch,into its two main branches, the Parietal and
- The Parietal branch continues almost vertically upward and supplies
a wide lateral area of scalp. The frontal branch runs obliquely upward and
forward and is ,like the parietal branch ,often tortuous. The winding artery is
clearly seen through the skin. In the scalp,the branches of the temporal artery
anastomose with branches of the posterior auricular and occipital arteries
behind,with supraorbital and frontal arteries of the side.
- One superficial branch, The zygomatico-orbital artery, arises either
from the main stem of the superficial artery above the zygomatic arch or from its
anterior branch, runs almost horizontally forward toward the outer corner of the
eye, sends branches to the orbicularis oculli muscle,and anastomoses with branches
of the lacrimal artery.
- In addition to the superficial branches, the superficial temporal artery
sends one branch into the depth, the middle temporal artery. Arising slightly above
the zygomatic arch, the middle temporal artery perforates the temporal fascia and
the temporal muscle to continue in the periosteum of the temporal squama , lying
in a vertical groove of the bone. The middle temporal artery ramifies in the
substance of the temporal muscle with branches of the of the posterior deep
temporal artery of the maxillary artery.
Maxillary Artery –
- The maxillary artery arises from the external carotid artery just
below parotid gland. Although the superficial temporal artery
continues the course of the external carotid artery upward,
whereas the maxillary artery arises at a right angle, the
continuation of the external carotid.
- The maxillary artery follows an anterior, slightly upward, and
medial course through the infratemporal fossa. It is deeply
situated on the surface of the mandible and in a varying relation to
the pterygoid muscle.
- In slightly more than 50% of all persons the artery is found on the
outer side of this muscle after passing through the space between
the mandible and sphenomandibular ligament.
- In the remaining individuals the artery lies medial to the lateral
and medial pterygoid muscle. In the latter cases the artery crosses
the lingual and inferior alveolar nerves between the lateral and
medial pterygoid muscles.
- The maxillary artery is, in most persons’, situated lateral to those
two nerves but is sometimes at their medial side.
- In rare cases the artery crosses one of the two nerves on its lateral
side and the other on its medial side. The artery also supplies the
- At the anterosuperior end of infratemporal fossa, the maxillary
artery passes through the pterygopalatine gap, or pterygopalatine
hiatus, into the pterygopalatine fossa, where it splits into its
terminal branches. When the maxillary artery lies on the outer
surface of the lateral part of fossa, where it splits into its terminal
branches. When the maxillary artery lies on the outer surface of
the lateral pterygoid muscle, it reaches the pterygopalatine hiatus
by passing between the two heads of the lateral pterygoid muscle;
it reaches the pterygopalatine hiatus by passing between the two
heads of the lateral pterygoid muscle.
- The maxillary artery may arbitrarily by be divided into four parts.
a) The First (mandibular part) – is the short section which
lies medial to the mandibular neck.
b) The Second (muscular /pterygoid part ) – is the longest
of the four and is in close releation to the lateral
c) The Third ( maxillary part ) - which is here in close
releation to the posterior surface of the maxilla.
d) The Fourth (pterygopalatine /terminal ) – here the artery
divies into its terminal branches in the pterygopalatine
space ,which it enters through pterygopalatine gap.
- The branches of the maxillary artery are numerous and,with the
exception of one ,are destined for the deep structures of the face
,lower and upper jaws and teeth,masticatory muscles ,palate,and
part of the nasal cavity. In addition , the artery sends a branch into
the cranil cavity aas the main supply of the dura mater of the
- Branches from different parts –
a) From mandibular part -
i) Middle meningeal artery – goes to dura mater.
ii)inferior alveolar artery - goes to mandible.
iii)Deep Auricular Artery
iv)Anterior Tympanic .
b) From Muscular/Pterygoid Part –
i) Temporal Artery
c) From Maxillary Part –
i)Posterior Superior Artery
d) Pterygopalatine part –
MANDIBULAR PART –
Middle Meningeal artery –
It runs straight up to enter the foramen spinosum .on its way usually passes
between two roots of the auricular temporal nerve.
Below the cranial base the accessory meningeal artery originates.
It supplies – the Auditory tube & Adjacent muscles.
Here it gives one branch which passes through the foramen ovale to the
After entering to the cranial cavity , the middle menningeal artery sends
several small tympanic branches into the tympanic cavity. These twigs perforate
the roof of the middle ear .
At a variable distance from the foramen spinosum , the middle meningeal
artery splits into—
a) Anterior branch.
b) Posterior branch
The middle meningeal artery and its branches are embedded in deep
branching grooves on the inner surface of the cranial bones .they supply the dura
mater and send branches into the bones over which they pass. The anterior branch
of the middle meningeal artery anastomoses regularly with the lacrimal artery of
the ophthalmic artery of the internal carotid.
Inferior Alveolar Artery –
Its origin varies according to the different relation of the maxillary artery to
the lateral pterygoid muscle.
If the maxillary artery lies superficial to the lateral pterygoid ,the inferior
alveolar artery is a direct branch of the maxillary artery .
If the main artery follows a deep course, the inferior alveolar artery frequently
arises with the posterior deep temporal artery by a common trunk that winds
around the lower border of the lateral pterygoid, whereas the inferior alveolar
artery arises at the lower border of the lateral pterygoid muscle.
From its origin , the inferior alveolar artery turns almost vertically downward
to reach the mandibular canal.
Before entering to the canal ,the inferior alveolar artery releases the mylohyoid
artery, which follows the mylohyoid nerve to the mylohyoid muscle, where is
anastomoses with branches of the submental artery.
In the mandibular canal the inferior alveolar artery sends its terminal
a) Mental artery (larger)
b) Incisive artery (smaller)
a) Mental artery –
Is released through the mental canal, and it supplies soft tissues of the chin and
anastomoses with branches of the inferior alveolar artery.
b) Incisive artery –
It continues the course of the inferior alveolar artery inside the mandible to the
midline, where it anastomoses with the artery of the other side.
The blood vessels that turn from the inferior alveolar artery upward into the
alveolar process are of two distinct types.
set –of branches enters the root canals through the apical foramina and
supplies the dental pulps. They can be termed dental arteries.
set-it is of alveolar or perforating branches enter the interdental and
interradicular septa. The alveolar branches ascend in narrow canals , which often
are visible on radiographs, especiallyin the anterior part of the mandible.
Many small branches arising at right angles, enter the periodontal ligaments of
adjacent teeth or adjacent roots of one tooth.
The interradicular alveolar arteries end in the periodontal ligament at the
bifurcation o the molars. The interdental alveolar arteries perforate the alveolar
crest in the interdental spaces and end in the gingival, supplying the interdental
papilla and the adjacent areas of the buccal and lingual gingiva. In the gingival
these branches anastomoses with superficial branches of arteries, which supply
the oral and vestibular mucosa, for instance , with branches of the lingual ,
buccal, mental,and palatine arteries.
MUSCULAR / PTERYGOID PART –
( this part of the artery supplies the masticatory muscles and the buccinators
a) Anterior & posterior deep temporal artery-
These are the arteries arises from the superior wall of the maxillary artery and
supplies the temporal muscle. They enter the temporal muscle from its deep
The posterior deep temporal artery anastomoses with the middle temporal
If the maxillary artery lies deep to the lateral pterygoid muscle, the posterior
deep temporal artery winds around the lower border and the outer surface of the
lateral pterygiod muscle to reach the temporal muscle, releasing the lower
alveolar artery at the lower border of the lateral pterygoid muscle.
b) Masseteric artery –
It arises from the lateral surface of the maxillary artery and passes through the
mandibular notch following the masseteric nerve.
Between the condylar process of the mandible and the posterior border of the
tendon of the temporal muscle, the masseteric artery reaches the inner, or deep,
surfaceof the masseter muscle, which it supplies.
c) Pterygoid artery –
Lateral and medial pterygoid muscles are supplied by a variable number of
smaller pterygoid branches of the maxillary artery. The number and the location
of these pterygoid branches depend on the relation o the maxillary artery to the
lateral pterygoid muscle.
d) Buccal artery –
It is the last branch of the muscular part of the maxillary artery
If the maxillary artery is situated on the outer surface of the lateral petrygoid
muscle, the buccal artery is given off just before the maxillary artery enters the
slit between the two heads of the lateral pterygoid muscle.
If the maxillary artery follows a deep course,the buccal artery passes laterally
through the slit between the superior and inferior heads of the lateral pterygoid
On the outer surface of this muscle the buccal artery turns downward and
forward between the inferior head of the lateral pterygoid muscle and the
temporal muscle. Crossing the temporal tendons obliquely, the buccal artery
reaches the space between the masseter and buccinator muscle below the buccal
fat pad,which fills this space. At the outer surface of the buccinator muscle, the
buccal artery breaks up into its terminal branches. They supply the buccinator
muscle and the mucous lining of the cheek and anastomoses with branches of
the facial artery and the transverse facial artery.
MAXILLARY PART –
This artery runs along the posterior surface of the maxilla near its upper border.
Here it gives off the posterior superior alveolar and infra orbital branches before
entering the pterygomaxillary fissure.
a) Posterior superior alveolar artery.—
This is a fairly large vessel that winds and out around the convexity of the
maxillary tuberosity, where it is closely applied to the periosteum of the bone.
On the way the artery gives off oneor two branches that enter the posterior
superior alveolar nerves.
The terminal, or gingival, extensions of the posterior superior alveolar artery
continue to supply the mucosa covering the buccal surface of the alveolar
process of the molars and premolars up to their gingival margins. Several
branches extend into the cheeks. The posterior superior alveolar artery may
sometimes be a branch of the buccal artery.
b) Infraorbital artery –
It arises from the maxillary artery close to the posterior superior alveolar artery
. often the two arteries arise from the maxillary artery by a common trunk.
The infraorbital artery enters the orbit the orbit through the inferior orbital
fissure and runs anteriorly,first in the infraorbital sulcus and then in the
Emerging through the infraorbital foramen, the infraorbital artery supplies the
anterior part of the cheek and root of the upper lip and anastomoses with
branches of the superior labial artery and the angular artery, which it may
On its way through the orbit, the infraorbital artery sends small branches to the
inferior muscles of the eye ball, the inferior rectus and the inferior oblique
muscles, and participates in supplying the lower lid.
Before leaving the infraorbital canal through the infraorbital foramen, the
anterior superior alveolar artery is given off. The anterior superior alveolar
artery anastomoses with branches of the posterior superior alveolar artery while
passing through the narrow canals in the anterior wall of the maxillary sinus to
the alveolar process. Here anterior superior alveolar artery anastomoses with
branches of the posterior superior alveolar artery and, in neighborhood of the
piriform aperature, with nasal arteries.
The branches of the superior alveolar artery releases are , in principle, arranged
like those in the mandible . The dental arteries enter the apical foramina of the
roots and supply the dental pulps. These arteries send only small twigs to the
periodontal membrane in the apical region of the teeth .
The alveolar, or perforating, arteries descend in the septa between the sockets
of adjacent teeth or roots as interdental or interradicular arteries. The former
end in the gingival papillae, the later in the periodontal membrane at the
function of the roots.
On their way through the interdental and interradicular septa the perforating
arteries send many branches into the periodontal membrane of the adjacent
PTERYGOPALATINE PART –
This part of the artery is short because the artery divides into its terminal branches
immediately after entering the pterygopaltine fossa through the pterygomaxillary
fissure, the gap between the maxilla and the pterygoid process of the sphenoid
a) Descending palatine artery –
It arises in the pterygopalatine fossa. Descending through the pterygopalatine
fossa and then through the pterygopalatine artery reaches the oral cavity
through the major palatine foramen.
In the pterygopalatine canal the descending palatine artery emits inferior
posterior nasal branches, which enter the nasal cavity together with nasal
branches of the palatine nerves. The nasal branches supply the inferior concha
and adjacent region of the lateral wall of the nasal cavity.
The main branch – Major palatine artery as it is emerging through the major
One or two smaller branches, the minor palatine arteries - Arise inside the
pterygopalatine canal and reach cavity through the minor palatine foramina.
They supply the soft palate and the upper part of the palatine tonsil and
anastomoses with branches of the ascending palatine artery.
The major palatine artery turns anteriorly from the major palatine foramen in
the submucousa of the hard palate in a groove between the horizontal palaitine
processof the maxilla and the inner plate of the alveolar process of the maxilla
and the inner plate of the alveolar process. With numerous branches , the major
palatine artery supllies the mucous membrane and the glands of the hard palate
and gingival on the lingual surface of the upper alveolar process.
The gingival branches of the palatine artery anastomoses with gingival branches
of the perforating arteries of the upper alveolar arteries.
The terminal part of the major palatine artery, the nasopalatine branch, reaches
the incisive foramen and, ascending through the incisive canal, enters the the
nasal cavity where it anastomoses with septal branches of the sphenopalatine
of the three terminal branches of the maxillary artery, the artery of the
pterygoid canal, is a small branch that enters the pterygoid canal through its
anterior opening and anastomoses in the canal with a branch of the ascending