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Blood supply of Head and Neck
- 1. 1
- 2. 2 Blood supply of Head and Neck Ravi GR Post graduate student
- 3. 3 Contents Circulatory system components • Types of circulation • Vascular number, size • Branching patterns • Anastomosis • Classification of vessels • Histology of vessel wall • Structure of the vessels
- 4. 4 Contents Arteries of head and neck • Aorta • Common carotid artery • External carotid artery • Internal carotid artery
- 5. 5 Contents Veins of head and neck • Exterior veins of face • Veins of neck • Dural venous sinuses
- 8. 8 • Vessel number, size • Branching patterns Vascular system
- 9. 9 • Anastomosis • Classification – Conducting – Distributing – Resistance – Exchange vessels – Capacitance vessels Vascular system
- 10. 10 Histology of vessel wall • Tunica intima • Tunica media • Tunica adventitia Vascular system
- 11. 11 Structure of blood vessel • Large elastic arteries • Muscular arteries Vascular system
- 12. 12 Structure of blood vessel • Arterioles • Capillaries Vascular system
- 13. 13 Structure of blood vessel Arteriovenous anastomosis Vascular system Modified smooth muscles
- 14. 14 Structure of blood vessel • Venules • Veins Vascular system
- 15. 15 Arterial supply of head and neck
- 16. 16 Aorta • Trunk of the arterial tree conveying oxygenated blood • Aorta can be divided into
- 17. 17 Ascending aorta • 5 cm long, begins at the base of the left ventricle • From 3rd left costal cartilage to 2nd left costal cartilage Branches: – Supply the heart- • Right and Left coronary arteries Ascending Aorta Aorta
- 18. 18 Arch of Aorta • Origin: Originates slightly to right at the level of upper border of 2nd right sternocostal joint • Descends left of the 4th thoracic vertebral body- continuing as Descending aorta Branches: – Brachiocephalic trunk – Left common carotid – Left subclavian Arch of Aorta
- 19. 19 Descending Aorta Its branches- – Thoracic aorta – Abdominal aorta Descending Aorta Aorta
- 20. 20 Common Carotid Artery • Carotid - to put to sleep • Large bilateral vessel supplying Head and Neck Common carotid artery Right Left
- 21. 21 Right common carotid artery Left common carotid artery Origin Bifurcation of the brachiocephalic trunk Arch of aotra Termination At the level of upper border of thyroid cartilage Common carotid artery
- 22. 22 Anterior view Posterior view As left carotid artery arises from aortic arch- thoracic and cervical parts Common carotid artery
- 23. 23 Relations of thoracic part Anterior: • Sternothyroid and sternohyoid muscles • Left pleura and lung • Left brachiocephalic vein • Thymic remnants Posterior • Trachea , left border of oesophagus • Left subclavian artery • Left recurrent laryngeal nerve • Thoracic duct Common carotid artery
- 24. 24 Relations of thoracic part Right • Below- the brachiocephalic trunk • Above-the trachea inferior thyroid veins thymic veins Left • Left vagus nerve • Phrenic nerve • Left pleura and lung Common carotid artery
- 25. 25 Cervical part of common carotid artery • Both right and left have similar course • At the level of upper border of thyroid cartilage divides- – External carotid- exterior of head, face and neck – Internal carotid- cranial and orbital contents • Carotid body and Carotid sinus Common carotid artery
- 26. 26 Carotid sinus • At the bifurcation of common carotid artery • Responsive to changes in the arterial blood pressure • Its position accounts- baroreceptor-- controls intra cranial pressure Common carotid artery
- 27. 27 Carotid body • Small, ellipsoid reddish- brown structure • Acts as chemoreceptor- • Although the main role is certain, which component acts is obscure Common carotid artery
- 28. 28 Relations of cervical part Common carotid artery Anterolaterally • Tendon of omohyoid • Skin, superficial fascia, platysma, deep cervical fascia, sternocleidomastoid, sternohyoid and sternothyroid Posterior • 4th and 6th cervical transverse process --- longus colli, longus capitis, scalenus anterior • Sympathetic trunk and ascending cervical artery
- 30. 30 Medial • Oesophagus • Trachea • Inferior thyroid artery • Recurrent laryngeal nerve • Larynx and pharynx- higher level Lateral • Internal jugular vein Common carotid artery
- 31. 31 Applied anatomy • Carotid pulse • Carotid palpation Common carotid artery
- 32. 32 External carotid artery • One of the terminal branches
- 33. 33 Course:ECA Superficial temporal artery Maxillary artery • In the substance of parotid gland • Ascends slightly forwards and inclines backwards--- midway between mastoid tip and angle of the mandible External carotid artery
- 35. 35 Relations of ECA In the carotid triangle: External carotid artery
- 36. 36 Above the carotid triangle- lies deep to the parotid gland Within the parotid gland- • Superficially to retromandibular vein, facial vein • Deep – internal carotid artery • Superior laryngeal nerve; superior cervical sympathetic ganglion External carotid artery
- 37. 37 Branches • Anterior : Superior thyroid Lingual Facial • Posterior: Occipital Posterior auricular • Medial: Ascending pharyngeal • Terminal: Maxillary Superficial temporal External carotid artery
- 39. 39 External carotid artery Superficial temporal Maxillary Facial Lingual Superior thyroid Posterior auricular
- 40. 40 Superior thyroid artery External carotid artery
- 41. 41 Relations • Descends forwards in the carotid triangle along thyrohyoid • Superficially– skin, superficial fascia, platysma, deep cervical fascia • Medial – inferior constrictor external laryngeal Superior thyroid artery
- 43. 43 Named branches Superior thyroid artery
- 44. 44 Applied anatomy • Its relationship to the external laryngeal nerve is important during thyroid surgeries. • The artery and the nerve very close to each other higher up but diverge near the gland. Superior thyroid artery
- 45. 45 Lingual artery • Origin – anteromedial part of external carotid artery at tip of greater cornu of hyoid bone between superior thyroid and facial arteries. • Course – after short course lies deep to hyglossus muscle, finally leaves the muscle in the tongue to anastomose with the fellow of oposite side • Hyoglossus – three parts Lingual artery
- 47. 47 First part of lingual artery: • From origin to posterior border of hyoglossus Relations: -skin, superficial fascia, platysma and deep fascia -lies on middle constrictor - loop of artery is crossed by hypoglossal nerve. Lingual artery
- 48. 48 Second part: • Lies deep to the hyoglossus, runs along upper border of hyoid bone Relations: - covered by hyoglossus, tendon of digastric, stylohyoid and posterior part of mylohyoid muscle Lingual artery
- 49. 49 Third part • Extends from anterior border of hyglossus to the tip of tongue • Arteria profunda linguae Relations: • Medial- genioglossus • Lateral – longitudinalis linguae inferior • Below – lingual mucous membrane Lingual artery Branches
- 50. 50 Facial artery • External maxillary artery • Origin – anterior aspect of external carotid artery • Course – runs upwards in neck, then on face; tortuous in both places • Two parts- – Cervical part – Facial part Facial artery
- 51. 51 Cervical course Base of the mandible Facial artery
- 53. 53 Branches • Cervical branches – Ascending palatine artery – Tonsillar artery – Glandular branches – Submental • Facial branches – Inferior labial artery – Superior labial artery – Lateral nasal artery Facial artery
- 54. 54 Occipital artery • Origin – posteriorly from the external carotid, 2 cm from its origin • Course – Runs backwards and upwards deep to lower border of posterior belly of digastric ends posteriorly in scalp Occipital artery
- 55. 55 Branches – • Sternocleido mastoid branch • Mastoid branch • Stylomastoid branch • Auricular branch • Muscular branch • Descending branch • Meningeal branch • Occipital branch Occipital artery
- 56. 56 Posterior auricular artery • Origin- retromandibular fossa above stylohyoid muscle • Course – follows upper border of stylohyoid muscle, anterior border of styloid process reaches groove between cartilage of outer ear and mastoid process. • Distributes branches partly to ear and partly to the scalp.
- 57. 57 Branches – • To digastric, stylohyoid, sternocleido mastoid, parotid gland • 3 named branches- • Stylomastoid artery • Auricular artery • Occipital branch Posterior auricular artery
- 58. 58 Ascending pharyngeal artery • Origin - Smallest branch of all the branches Branches
- 59. 59
- 60. 60 Maxillary artery • Origin – larger terminal branch of external carotid, arises behind and below the mandibular neck, in substance of parotid gland • Course – – Mandibular part – Pterygoid part – Pterygopalatine part
- 62. 62 Mandibular part ( first part) • Passes between the mandibular neck and the sphenomandibular ligament, below auriculotemporal nerve Branches: – Deep auricular artery – Anterior tympanic branch – Middle meningeal artery – Accessory meningeal artery – Inferior alveolar artery Maxillary artery
- 63. 63 Pterygoid part (Second part) • Ascends obliquely forwards medial to temporalis and superficial to lower head of lateral pterygoid Branches: • Deep temporal branches • Pterygoid branches • Massetric artery • Buccal artery Maxillary artery
- 64. 64 Pterygopalatine part Passes between the heads of lateral pterygomaxillary fissure into the pterygopalatine fossa Branches: Maxillary artery
- 65. 65 Superficial temporal artery • Origin: smaller of the two terminal branches, begins in the parotid gland behind mandible’s neck • Course: crosses the posterior root of zygomatic process of temporal bone, divides into anterior and posterior branches
- 66. 66 Relations: • In the parotid gland- temporal and zygomatic branches facial nerve • In the scalp- corresponding veins, posterior to the auriculotemporal nerve Superficial temporal artery
- 67. 67 Branches • Transverse facial artery • Anterior auricular branches • Zygomatico-orbital branches • Middle temporal artery • Frontal branch • Parietal branch Superficial temporal artery
- 68. 68 Applied anatomy • Control of temporal haemorrhage • Anastomose freely; partially detached with scalp also heal with reasonable hope even if one vessel is intact • Placement of incisions in craniotomy • In reduction of zygomatic arch fractures – Gilli’s approach Superficial temporal artery
- 69. 69 Internal carotid artery • Origin - similar to that of ECA • Course- broadest outline – Vertically upwards – neck – Horizontally forwards and medially- petrous carotid canal – Upwards – foramen lacerum – Horizontally forwards – cavernous sinus – Vertically upwards medial- anterior clinoid process – Backwards and upwards – to its terminal branches
- 70. 70 Divided into- • Cervical • Petrous • Cavernous • Cerebral Internal carotid artery
- 71. 71 Cervical part Relations • Posteriorly • Medially • Anterolaterally • Inferiorly • At the level of digastric • Above the digastric Internal carotid artery
- 72. 72 Petrous part Relations • Surounded by venous and sympathetic plexuses • Posterolaterally-middle ear and cochlea • Anterolaterally- auditory tube and tensor tympani • Superiorly- trigeminal ganglion Internal carotid artery
- 73. 73 Branches • Caroticotympanic branch or artery • Pterygoid artery Internal carotid artery
- 74. 74 Cavernous part • Ascends to the posterior clinoid process • Emerges through the dorsal roof of the cavernous sinus Branches • Cavernous branches • Hypophyseal branches • Meningeal branches Internal carotid artery
- 75. 75 Cerebral part Lies at base of the brain.Divides into Anterior and Middle cerebral arteries. • Gives off 5 branches: • Ophthalmic artery • Anterior cerebral artery • Middle cerebral artery • Posterior communicating artery • Anterior choroid artery Internal carotid artery
- 76. 76 Ophthalmic artery • Artery enters the orbit through optic canal. • Terminates near the medial angle of the eye, dividing into supratrochlear and dorsal nasal branches Internal carotid artery
- 77. 77 Branches • Central artery of retina • Lacrimal branch • Muscular branch • Ciliary arteries • Supraorbital artery • Posterior ethmoidal artery • Anterior ethmoidal artery • Meningeal artery • Medial palpebral artery • Supratrochlear artery Ophthalmic artery
- 78. 78 Circle of Willis • Circulus arteriosus – polygonal • Anterior cerebral arteries through anterior communicating arteries Basilar artery Posterior cerebral arteries each joins the ipsilateral internal carotid artery by a posterior communicating artery
- 80. 80 VEINS of HEAD and NECK
- 81. 81 Classification • Veins of exterior of head and neck • Cervical veins • Diploic, meningeal, intracranial dural venous sinuses
- 82. 82 Exterior or External veins of head and neck • Supra trochlear vein • Supra orbital vein • Facial vein • Superficial temporal vein • Pterygoid venous plexus • Maxillary vein • Retromandibular vein • Posterior auricular vein • Occipital vein
- 84. 84 Deep veins
- 85. 85 Supra trochlear vein Supra trochlear vein
- 87. 87 Facial vein • Origin: largest vein of face, begins as angular vein • Course: downwards and backwards behind facial artery, but with a straighter course • Joins anterior division of retromandibular vein--- common facial vein Tributaries : – Connects with superior ophthalmic vein – Cavernous sinus – On the face – Below mandible
- 88. 88 Facial vein
- 89. 89 Applied anatomy • Has no valves • Connected to cavernous sinus • Danger area of face Facial vein
- 90. 90 Superficial temporal vein • Course: Anterior and posterior unite --- superficial temporal • Joined by middle temporal vein • Retromandibular vein • Tributaries – Parotid veins – Rami for TMJ – Middle temporal
- 91. 91 Pterygoid venous plexus • Location – partly between the temporalis and lateral pterygoid; and partly between the pterygoids Tributaries – • sphenopalatine vein, • deep temporal vein, • pterygoid veins, • massetric veins, • buccal vein, • dental vein, • greater palatine vein, • middle meningeal vein • branch of ophthalmic vein
- 92. 92 Maxillary vein • Origin • Course • Terminates
- 93. 93 Retromandibular vein • Origin- • Branches Anterior branch- Posterior branch-
- 94. 94 • Posterior auricular vein – Origin – Terminates – Tributaries • Occipital Vein
- 95. 95 Cervical veins or veins of neck • External jugular vein • Posterior external jugular vein • Anterior jugular vein • Internal jugular vein • Lingual vein • Pharyngeal vein • Superior thyroid vein and inferior thyroid vein • Middle thyroid vein • Vertebral vein • Deep cervical vein
- 96. 96 External jugular vein APPLIED ANATOMY
- 97. 97 Anterior jugular vein APPLIED ANATOMY
- 100. 100 • Lingual vein • Pharyngeal vein • Superior and inferior thyroid vein • Middle thyroid vein • Vertebral vein • Deep cervical vein
- 102. 102 CLASSIFICATION Paired • Cavernous sinus • Superior petrosal sinus • Inferior petrosal sinus • Transverse sinus • Sigmoid sinus • Sphenoidal sinus • Petrosquamous sinus • Middle meningeal sinus Unpaired • Superior sagittal sinus • Inferior sagittal sinus • Straight sinus • Occipital sinus • Anterior intercavernous sinus • Posterior intravenous sinus • Basilar plexus of veins
- 103. 103
- 104. 104 CAVERNOUS SINUS • Location: Large venous space, in middle cranial fossa • Anteriorly upto – medial end of superior orbital fissure • Posteriorly – apex of petrous temporal bone
- 105. 105 RELATIONS Structures outside sinus • Superiorly- optic chiasma, olfactory tract, internal carotid artery • Inferiorly – foramen lacerum, sphenoid bone • Medially – hypophysis cerebri, sphenoidal air sinus • Laterally – temporal lobe • Anteriorly – superior orbital fissure • Posteriorly – petrous temporal bone, midbrain Cavernous sinus
- 106. 106 Structures in the lateral wall of sinus • Oculomotor nerve • Trochlear nerve • Ophthalmic nerve • Maxillary nerve • Trigeminal ganglion Cavernous sinus
- 107. 107 Structures passing through the centre of the sinus • Internal carotid artery • Abducent nerve Cavernous sinus
- 108. 108 Tributaries – incoming channels From the orbit • Superior and inferior ophthalmic veins • Central vein of retina From the brain • Superficial middle cerebral vein • Inferior cerebral vein From the meninges • Sphenoparietal sinus • Frontal trunk of middle meningeal vein Cavernous sinus
- 111. 111 Communications – Draining channels THROUGH INTO Superior petrosal sinus Transverse sinus Inferior petrosal sinus Internal jugular vein Emissary veins Pterygoid plexus of veins Superior ophthalmic vein Facial vein Anterior and posterior intercavernous sinuses Communicates with the opposite side Cavernous sinus
- 112. 112 Applied anatomy • Thrombosis – Nervous symptoms – Venous symptoms • Head injury – pulsating exophthalmos Cavernous sinus
- 113. 113 Transverse sinus • Convex upwards, above Reid’s base line; Large sinuses, right larger than left • Extends from internal occipital protuberance to posteroinferior angle of parietal bone Tributaries • Superior petrosal sinus • Inferior cerebral veins • Inferior cerebellar veins • Diploic vein • Inferior anastomotic vein
- 114. 114 Straight sinus • Location: Lies in median plane within junction of falx cerebri and tentorium cerebelli • Formed by union of inferior sagittal sinus with great cerebral vein • Terminates at internal occipital protruberance Applied anatomy- ball valve mechanism
- 115. 115 Superior Sagittal sinus • Location: upper convex attached margin of falx cerebri • Extends from crista galli to internal occipital protruberance; usually continues as right transverse sinus • Confluence of sinuses
- 116. 116 Tributaries - Superior cerebral veins - Parietal emmissary veins - Venous lacunae Superior sagittal sinus
- 117. 117 Applied anatomy • Thrombosis – Rise in intracranial tension – Delirium – Convulsions – Paraplegia of upper motor neuron type Superior sagittal sinus
- 118. 118 Inferior sagittal sinus • Location small channel, posterior 2 /3rds of falx cerebri • Ends by joining great cerebral vein to form the straight sinus.
- 119. 119 Sigmoid sinus • S- shaped; direct contiuation of transverse sinus • Extends from posteroinferior angle of parietal bone to bulb of internal jugular vein • Grooves mastoid process of temporal bone
- 120. 120 Tributaries: • Mastoid vein and Condylar emissary vein • Cerebellar vein • Internal auditory vein Applied anatomy • During mastoid operations • Thrombosis of sigmoid sinus • Otitic hydrocephalus Sigmoid sinus
- 121. 121 Occipital sinus • Small, attached to margin of falx cerebri • Begins near foramen magnum and ends in confluence of sinus Sphenoparietal sinus • Lie along posterior free margin of lesser wing of sphenoid • Drain to anteior cavernous sinus
- 122. 122 Superior petrosal sinus • Anterior part of tentorium cerebelli Inferior petrosal sinus • Lie in petro-occipital fissure • Drain cavernous sinus --- internal jugular vein Tributaries • Labrynthine veins • Veins from medulla, pons, cerebellum
- 123. 123