Blood supply to head and neck

©M. S. Ramaiah University of Applied Sciences
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BLOOD SUPPLY OF FACE AND NECK
GUIDED BY PRESENTED BY
DR HEMA SESHAN DR RAMYA GANESH

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CONTENTS
• INTRODUCTION
• STRUCTURE OF BLOOD VESSELS
• ARTERIES IN FACE AND NECK
• VENOUS DRAINAGE OF FACE
• BLOOD SUPPLY OF PERIODONTIUM
• APPLIED ANATOMY
• CONCLUSION
• REFERENCES

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INTRODUCTION
Cardiovascular system consists of blood , heart and blood vessels.
Blood is a fluid consisting of RBC , WBC ,platelets and plasma that
carries oxygen and nutrients to and waste materials away from all
body tissues.
Heart is a dual pump that drives the blood in two serial circuits ,the
systemic and the pulmonary circulation pumping 5 L/min
Blood vessels are the part of circulatory system that transports blood
through arteries , capillaries and veins.

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EMBRYOLOGY OF HEART

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STRUCTURE OF BLOOD VESSELS
General structure Functionally

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ARTERIAL SUPPLY OF BODY

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External carotid artery
Internal carotid artery
Subclavian artery
ARTERIAL SUPPLY OF FACE AND NECK

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EXTERNAL CAROTID ARTERY
• COURSE
ECA begins in carotid triangle at level of upper border of thyroid
cartilage.
Runs upwards and laterally terminating behind neck of mandible by
dividing to maxillary and superficial temporal arteries within parotid
gland.
ECA has a slightly curved course so that it is anteromedial to ICA and
lies undercover of SCM.

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RELATIONS
SUPERFICIAL
 Cervical branch of facial nerve
 Hypoglossal nerve
 Lingual nerve
 Superior thyroid veins
DEEP .
 Wall of pharynx
 Superior laryngeal nerves
 Ascending pharyngeal artery
 Parotid gland
superficially to retromandibular vein
deep to ICA , styloglossus , 9 nerve.

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BRANCHES OF ECA

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SUPERIOR THYROID ARTERY
• Supplies upper one third of thyroid gland
• Anastomosis with ascending branch of inferior thyroid artery

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LINGUAL ARTERY

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PARTS OF LINGUAL ARTERY
1
• Lies in carotid triangle
• Characterised by lingual loop permits
free movements of hyoid bone
2
• Lies deep to hyoglossus
• Superficial to middle constrictor of
pharynx
3
• Also called as profunda linguae
• Lies in undersurface of tongue along
anterior border of hyoglossus
4
• Lies between genioglossus and inferior
longitudinal muscle of tongue

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FACIAL ARTERY
Anaesthetists artery
Tortuous course
2 parts –cervical
and facial
3 Branches
Anastomose with
dorsal nasal branch of
ophthalmic artery.

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OCCIPITAL ARTERY
• Arises from ECA opposite to
origin of facial artery.
• Runs deep to mastoid process .
• Supplies
 Sternocleidomastoid muscle
 Posterior belly of digastric
 Splenius capitis
 Longissimus capitis
BRANCHES
• Mastoid
• Meningeal
• muscular

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POSTERIOR AURICULAR ARTERY
• Arises from posterior aspect of ECA.
• Supplies back of auricle , skin over mastoid process and over back of
scalps
• Stylomastoid branch- supplies middle ear , mastoid antrum,
semicircular canals.
•

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ASCENDING PHARYNGEAL ARTERY
Runs vertically upwards between side
wall of pharynx , tonsil , auditory tube
Branches
Pharyngeal branch
-middle constrictor
-Inferior constrictor
-stylopharyngeus
Meningeal branch
-enters through jugular
foramen and
hypoglossal canal to
supply meninges.

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MAXILLARY ARTERY
1st
PART
2nd
PART
3rd
PART
Runs horizontally forwards
between neck of mandible and
sphenomandibular ligament
Runs upwards and forwards
superficial to lateral
pterygoid
Passes between two heads of
lateral pterygoid and enters
ptergopalatine fossa

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FIRST PART OF MAXILLARY ARTERY
Deep auricular artery
• Supplies external acoustic
meatus,tympanic membrane and TMJ.
Anterior tympanic
• Supplies middle ear including medial
surface of tympanic membrane
Middle meningeal artery
• Supplies tensor tympani, 5th and 7th
nerves
Accessory meningeal artery
• Infratemporal region
Inferior alveolar artery
• Lower teeth and mylohyoid muscle

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SECOND PART OF MAXILLARY ARTERY
Deep temporal artery
• temporalis
Pterygoid
• Lateral and medial pterygoids
Masseteric
• Masseter
Buccal
• buccinators

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Third part of maxillary artery
Posterior superior alveolar
• Upper molar and premolar teeth and gums
maxillary sinus
Infraorbital
• Lower orbital muscles ,lacrimal sac , upper
incisor and canine
Greater palatine
• Soft palate , tonsil , palatine glands upper gums
Pharyngeal
• Roof of nose and pharynx, auditory tube ,
sphenoidal sinus
Artery to pterygoid canal
• Auditory tube , upper pharynx
Sphenopalatine
• Lateral and medial walls of nose and air sinuses

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SUPERFICIAL TEMPORAL ARTERY
• Smaller terminal branch of eca
• Behind the neck of mandible undercover of
parotid gland
• Runs vertically upwards,crossing the root of
zygoma or preauricular point
• Supplies temple,scalp,parotid
gland,auricle,and facial muscles
BRANCHES
Transverse facial artery – parotid duct,
masseter.
Middle temporal artery-temporalis muscle

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INTERNAL CAROTID ARTERY
• Terminal branch of CCA
COURSE
• Begins at level of upper border of
thyroid cartilage and ends in cranial
cavity.
• Supplies brain and eye
Cervical part in
neck
cavernous part
cavernous sinus
Petrous part
within petrous
temporal bone
Cerebral part in
base of brain
part

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CERVICAL PART
• Gives no branches.
PETROUS PART
• Lacrimal gland,m glands of nose
CAVERNOUS PART
Branches
• trigeminal ganglion
• superior and inferior hypophyseal
CEREBRAL PART
Branches
• Ophthalmic - structures in orbit
• Anterior cerebral
• Middle cerebral
• Posterior communicating
• Anterior choroidal

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SUBCLAVIAN ARTERY
Principal artery of upper limb which also supplies
considerable part of neck and brain through its branches.
Right
• Branch of brachiocephalic
artery…… arises posterior to
sternoclavicular joint.
Left
• Branch of arch of aorta
…..ascends and enters the neck
posterior to left sternoclavicular
joint.

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VERTEBRAL ARTERY
First and largest
branch of first part
INTERNAL THORACIC
ARTERY
THYROCERVICAL
TRUNK
COSTOCERVICAL
TRUNK
BRANCHES OF SUBCLAVIAN ARTERY

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VERTEBRAL ARTERY
First part extends from origin to foramen
transversarium of sixth cervical vertebrae and runs
backward in to carotid triangle.
Second part pass through foramen
transversaria of upper six vertebrae and
upwards to reach atlas vertebra.
Third part lies in suboccipital triangle.
Fourth part extends from posterior atlanto
occipital membrane to lower border of pons.

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BRANCHES
CERVICAL BRANCHES
-sub occipital muscles
-spinal cord
-vertebra
-meninges
CRANIAL BRANCHES
-posterior cranial fossa
- spinal cord
-cerebrum
-lower border of pons

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INTERNAL THORACIC ARTERY
• Arises from inferior aspect of first part of subclavian
artery .
• Supplies scalenus anterior and cervical pleura.
COSTO CERVICAL ARTERY
• Arises from second part of of subclavian artery
• Supplies posterior vertebral muscles

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THYROCERVICAL TRUNK
Is a short wide vessel which arise from the front of first part of
subclavian artery , close to medial border of scalenus anterior.

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CIRCLE OF WILLIS

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VENOUS SUPPLY
• The venous system is a network of veins which transports
Deoxygenated blood from tissues to the heart.

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VENOUS DRAINAGE OF FACE
• Facial vein
• The Facial vein communicates
with the cavernous sinus
through the common facial
and retromandibular vein.

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DANGEROUS AREA OF FACE
• The danger triangle of the face
consists of the area from the
corners of the mouth to the bridge
of the nose
• Due to the special nature of the
blood supply to the nose and
surrounding area, it is possible for
retrograde infections from the
nasal area to spread to the brain
causing cavernous sinus
thrombosis, Meningitis or brain
abscess.

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BLOOD SUPPLY OF PERIODONTIUM
• Microcirculatory tracts , blood vessels and lymphatic vessels play an
important role in drainage of tissue fluid and in spread of inflammation.
Study of blood vessels done by:
Doppler flow measurement is a non invasive means to observe blood flow
modifications related to disease[ambrosini et al in 2002]
Histoenzymatic reactions for alkaline phosphatase and adenosine
triphosphatase[Carranza et al in 1996]
Injection of india ink was done in animals in which perfusion of peroxidase
allowed for blood vessel identification and permeability index.
[schwint et al in 1984]

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ARTERIAL
Supra
periosteal
Vessels of
PDL
Arterioles
VENOUS
Accompanies
arterial supply
LYMPH
Submaxillary
Lymph
nodes
GINGIVA

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BLOOD SUPPLY OF SUPPORTING STRUCTURES
• Inferior and superior alveolar arteries
• Reaches pdl from 3 sources
1. apical vessels
2. Penetrating vessels from alveolar bone
3. Anastomosing vessels from gingiva
• Venous drainage accompanies arterial
supply
• Arteriovenous anastomosis which is
seen in apical region

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CLINICAL ANATOMY
1.Atherosclerosis:
• It is the hardening and narrowing of the arteries in which an
artery wall thickens as a result of invasion and accumulation
of WBCs and proliferation of intimal-smooth-muscle cell
creating a fibro fatty plaque. E.g. Atherosclerosis of Carotid
Arteries.
• Atherosclerotic thickening of the tunica intima of the Carotid
arteries will reduce blood flow to the brain, resulting in the
variety of neurological symptoms; headache, dizziness,
muscular weakness.
• If blood flow is completely occluded, a cerebral ischemia
results.

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Atherosclerosis of Carotid Arteries

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ANEURYSM
• An Aneurysm is a localized, blood-
filled balloon-like bulge in the wall
of a blood vessel.
• As an aneurysm increases in size,
the risk of rupture increases. A
ruptured aneurysm can lead
to bleeding and subsequent
hypovolemic shock, leading to
death.
• Aneurysms are a result of a
weakened blood vessel wall, and
can be a result of a hereditary
condition or an acquired disease.

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ARTERIOVENOUS MALFORMATION
 Arteriovenous
malformation (AVM) is an
abnormal connection
between arteries and veins,
bypassing the capillary system.
 This vascular anomaly is widely
known because of its occurrence
in the central nervous system, but
can appear in any location.
Although many AVMs are
asymptomatic, they can cause
intense pain or bleeding or lead
to other serious medical
problems.

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HEMORRHAGE
• Hemorrhage is blood escaping from
the circulatory system.
• Bleeding can occur internally, where
blood leaks from blood
vessels inside the body, or externally,
through a natural opening.
• Hypovolemia is a massive decrease
in blood volume, and death by
excessive loss of blood is referred to
as exsanguination.
• The stopping or controlling of
bleeding is called hemostasis and is
an important part of both first
aid and surgery.

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HEMORRHAGE
• Hemorrhage is blood escaping from
the circulatory system.
• Bleeding can occur internally, where
blood leaks from blood
vessels inside the body, or externally,
through a natural opening.
• Hypovolemia is a massive decrease
in blood volume, and death by
excessive loss of blood is referred to
as exsanguination.
• The stopping or controlling of
bleeding is called hemostasis and is
an important part of both first
aid and surgery.

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CONCLUSION
Clinicians have to know the structures which are present at the
operating site & vessels we have to preserve during the surgeries...
Some infections from the face can spread in the retrograde direction
because venous channels of face have interconnections with the
cavernous sinus…. so for proper diagnosis and management, we have
to know the facial anatomy and blood supply to face.

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REFERENCE
• Textbook of anatomy by BD chaurasia 4th edition
• Textbook of human anatomy by Grays 38th edition
• Textbook of periodontology by Carranza 11th edition
• Textbook of human anatomy by inderbir singh 2nd edition
• Online sources for pictures

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Blood supply to head and neck

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