This document provides an overview of the blood supply to the head and neck region. It begins with an introduction to general principles of the vascular system. It then discusses the major arteries that supply the head and neck region, including the common carotid artery, external carotid artery, internal carotid artery, subclavian artery, and various branches. It provides details on the course, branches, and supply regions for each artery. It concludes with a brief discussion of the venous supply and some clinical implications. The document is presented as part of a lecture on the arterial anatomy of the head and neck.

1. BLOOD SUPPLY OF HEAD
AND NECK
PRESENTED BY: ANUKRATI DONERIA
MDS 1ST YEAR
DEPARTMENT OF PAEDODONTICS
AND PREVENTIVE DENTISTRY

2. Table of content :
• Introduction – general principles
• Overview of arterial supply to head & neck
• Common carotid artery – relations, branches, course of
artery.
• External carotid artery- relations, branches , courses of
artery.
• Internal carotid artery – relations, branches, course of
artery.
• Subclavian artery- relation, branches, course of artery.
• Venous supply of head & neck
• Clinical and dental implications of arteries and veins of
head and neck.
• References

3. INTRODUCTION : GENERAL PRINCIPLES OF VASCULAR
SYSTEM
 Arteries carry blood away from the heart, veins carry deoxygenated blood to the
heart.
 All arteries, carry oxygenated blood except the pulmonary and umbilical arteries,
which carry deoxygenated blood to the lungs (postnatal) and to the placenta
(prenatal) respectively.
 The flow of blood depends on the pumping action of the heart.
 Lumen is narrower in veins than arteries.
 After death arteries gets empty while veins still contains blood.
 Veins have valves to prevent backflow of blood while arteries doesn’t have any
valves.

4. Areas/structures Supplied by arteries
1. Front of the auricle Supratrochlear, supraorbital,
superficial temporal
2. Behind the auricle posterior auricular artery, occipital
artery
3. Face Facial artery, transverse artery.
4. orbit Ophthalmic artery
5. Carotid triangle Common carotid artery, internal
carotid artery, external carotid artery
6. Parotid External carotid artery
7. TMJ Superficial temporal, maxillary artery

5. 8. Tongue Lingual artery
9. Larynx Superior laryngeal artery
10. Nasal septum Anteriosuperior part – anterior ethmoidal artery
Posteroinferior part – sphenopalatine artery
Anterioinferior part – superior labial branch of
facial artery
Posteriosuperior part – greater palatine artery
11. Soft palate Greater palatine branch of maxillary artery,
Ascending palatine branch of facial artery,
Palatine branch of ascending pharyngeal artery
12. Hard palate Greater palatine branch of maxillary artery
13. Sublingual gland Lingual and submental artery
14. Submandibular gland Facial artery
15. Tonsil Tonsillar branch of facial artery

6. Arteries supplying head and neck
region :
 Head and neck region – supplied chiefly by :
a. Common carotid arteries
b. Branches of subclavian artery
 Arteries supplying to the head and neck region
originates from arch of aorta.
 Arch of aorta give rise to :
a. brachiocephalic trunk
b. Left common carotid artery
c. Left subclavian artery

7.  Brachiocephalic trunk gives off two branches
namely:
a. Right common carotid artery
b. Right subclavian artery
 Both left and right common carotid arteries runs
inside carotid sheath on both the sides of neck.
 Both right and left common carotid arteries at the
upper border of the thyroid cartilage divides in
to :
a. External common carotid artery
b. Internal common carotid artery

8. Common carotid artery
Origin
• Left- arch of aorta
• Right- brachiocephalic trunk
Course –
• Enters neck behind sternoclavicular joint.
• Runs within carotid sheath

9. Relations
Anterior :
 Crossed by the superior belly of the omohyoid.
 Below the omohyoid, the artery is covered by :
a. The sternocleidomastoid
b. The anterior jugular vein
c. The sternohyoid
d. The sternothyroid and the middle thyroid vein.

10. Posterior :
1.Transverse process of vertebrae C4-8
2. Vertebral artery
Medial:
1. Thyroid gland
2. Larynx and pharynx, trachea
Lateral :
1. Internal jugular vein

11. External carotid artery
 one of the terminal branches of the common carotid
artery.
 Lies anterior to the internal carotid artery.
Course and relations
 Begins in the carotid triangle at the level of the upper
border of the thyroid cartilage.
 It runs upwards, slightly backwards and laterally, and
terminates behind the neck of the mandible by
dividing into the maxillary and superficial temporal
arteries.

12.  In carotid triangle, ECA lies under the cover of
sternocleidomastoid muscle.
 Above the carotid triangle, it lies deep in the substance
of parotid gland.
Branches :
 The external carotid artery gives off eight branches which
may be grouped as follows.
Anterior
1 Superior thyroid
2 Lingual
3 Facial.

13. Posterior
1 Occipital
2 Posterior auricular.
Medial
1. Ascending pharyngeal
Terminal
1. Maxillary
2. Superficial temporal

14. Maxillary artery
 Largest terminal branch of the external carotid artery, given off
behind the neck of the mandible.
 It has a wide territory of distribution, and supplies:
1. The external and middle ears, and the auditory tube.
2. The Dura mater
3. The upper and lower jaws and teeth.
4. The muscles of the temporal and infra temporal regions.
5. The nose and para nasal air sinuses.
6. The palate
7. The root of the pharynx.

15. COURSE AND RELATIONS
Maxillary artery is divided into three parts :
1. The first (mandibular) part runs forwards , first
between the neck of the mandible and the
spheno-mandibular ligament, below the auriculo-
temporal nerve, and then along the lower border
of the lateral pterygoid.
2. The second (pterygoid) part runs upwards and
forwards superficial to the lower head of the
lateral pterygoid.
3. The third (pterygopalatine) part passes
between the two heads of the lateral pterygoid
and enter the pterygopalatine fossa.

18. Superficial temporal artery :
Course :
 It begins, behind the neck of the mandible under cover
of the parotid gland.
 It runs vertically upwards, it divides into anterior and
posterior branches which supply the temple and scalp.
Branches :
 the superficial temporal artery gives off :
1. transverse facial artery
2. middle temporal artery.

19. Superior thyroid artery
 arises from the external carotid artery just below
the level of the greater horn of the hyoid bone .
 It runs downwards and forwards and just
superficial to the external laryngeal nerve.
 Its relationship to the external laryngeal
nerve, is important to the surgeon during
thyroid surgery. The artery and nerve are
close to each other higher up, but diverge
slightly near the gland. To avoid injury to the
nerve, the superior thyroid artery is ligated as
near the gland as possible.

20. Supplies :
 Thyroid gland
 Tissues of upper part of
larynx
 Infrahyoid muscles
 Sternocleidomastoid muscle
 Cricothyroid muscle

21. Lingual artery
 Arises from the external carotid artery
opposite the tip of the greater horn of
the hyoid bone.
 Its course is divided into 3 parts by the
hyoglossus muscle:
• The first part lies in the carotid triangle.
• second part lies deep to the
hyoglossus along the upper border of
hyoid bone.

22.  The third part is called the arteria profunda
linguae ,or the deep lingual artery. It runs
upwards along the anterior border of the
hyoglossus.
 In its vertical course, it lies between the
genioglossus medially and the inferior
longitudinal muscle of the tongue laterally.
The horizontal part of the artery is
accompanied by the lingual nerve.
Supply :
 Tongue
 Floor of mouth
 During surgical removal of the tongue,
the first part of the artery is ligated before
it gives any branch to the tongue or to the
tonsil.

23. Facial artery :
 Arises from the external carotid artery just above the tip
of the greater horn of the hyoid bone .
 It runs upwards first in the neck as cervical part and then
on the face as facial part.
 The course of the artery in both places is tortuous to
allow the free movements of the pharynx during
deglutition.
 On the face, it allows free movements of the mandible,
the lips and the cheek during mastication and during
various facial expressions.

24. Cervical part
Branches :
1. Ascending palatine
2. tonsillar
3. Submental
4. glandular branches for the submandibular salivary
gland and lymph nodes.
Supply :
Pharynx
Soft palate
Auditory tube
Submandibular gland

25. Facial part
Branches
1. lnferior labial, to the lower lip.
2. Superior labial , to the upper lip and the
anteroinferior part of the nasal septum.
3. Lateral nasal, to the ala and dorsum of the
nose.
4. Supratrochlear artery
5. Supraorbital artery
Supply :
 Muscles and skin of face

26. The ascending pharyngeal artery
It arises near the origin of facial artery.
Course :
It passes upwards between the styloglossus
and the Stylopharyngeus, crosses over the
upper border of the superior constrictor .
Supply :
Tonsil
Soft palate
Root of the tongue.

27. posterior auricular artery
 arises from the posterior aspect of the
external carotid just above the posterior belly
of the digastric .
 It runs upwards and backwards deep to the
parotid gland. It crosses the base of the
mastoid process, and ascends behind the
auricle.
Supply
 the middle ear
 the mastoid antrum and air cells
 Back of the ear

28. Occipital artery :
 Arises form the posterior aspect of external carotid artery and runs upwards along the lower border of
posterior belly of digastric muscle.
 Then it runs deep to mastoid process and the muscles attached to it.
Branches :
 It gives two branches to sternocleidomastoid muscle
 Meningeal branch
 mastoid branch.
Supply :
 Layers of scalp
 Sternocleidomastoid muscle
 Trapezius
 Deep muscles of back
 Dura matter of posterior cranial fossa

29. INTERNAL CAROTID ARTERY
 one of the two terminal branches of the common carotid artery.
 It begins at the level of the upper border of the thyroid cartilage, and
ends inside the cranial cavity by supplying the brain.
 This is the principal artery of the brain and the eye
 The course of the artery is divided into four parts :
a. Cervical part, in the neck
b. Petrous part, within the petrous temporal bone.
c. Cavernous part, within the cavernous sinus
d. Cerebral part in relation to base of the brain.

30. Relations of cervical
part :
Anterior
1. In the carotid triangle :
a. Anterior border of
sternocleidomastoid
b. The external carotid artery
2. Above the carotid triangle
a. Posterior belly of the
digastric
b. Stylohyoid
c. Stylopharyngeus
d. Styloid processes.
e. Parotid gland with
structures within it.

31. Posterior:
1. The glossopharyngeal nerve,
2. vagus, accessory and hypoglossal nerves at the base
of the skull.
Medial :
1. Pharynx
2. The external carotid is anteromedial to it below the
parotid.
Lateral :
1. Internal jugular vein
2. Temporomandibular joint (at the base of the skull).

32. Petrous part
Relations:
1. middle ear and the cochlea
2. the auditory tube and tensor tympani (anterolaterally)
3. the trigeminal ganglion (superiorly)
Branches:
a. Caroticotympanic branches enter the middle ear, and
anastomose with the anterior and posterior tympanic
arteries.
b. The pterygoid branch enters the pterygoid canal with
the nerve of that canal and anastomoses with the
greater palatine artery.

33.  Each internal carotid artery enters the cranial cavity after
traversing the carotid canal.
 It then courses through the cavernous sinus, pierces the
dural roof of sinus and ends immediately lateral to optic
chiasma and divides into middle and anterior cerebral
arteries.
Branches :
1. Posterior communicating artery.
2. Anterior choroidal artery
3. Anterior cerebral artery
4. Middle cerebral artery

34. Cavernous part : With in cavernous sinus the artery gives
off :
a. Cavernous branch to trigeminal ganglion.
b. Superior and inferior hypophyseal branches to
hypophysis cerebri.
Cerebral part : Lies in base of brain after emerging from
cavernous sinus.
Branches :
a. Ophthalmic – supplies structures in the orbit
b. Anterior cerebral
c. Middle cerebral
d. Posterior communicating

35. SUBCLAVIAN ARTERY
 Principle artery continues as axillary artery in the upper
limb.
 It also supplies a considerable part of the neck and brain
through its branches .
 On the right side, it is branch of the brachiocephalic artery. It
arises posterior to the sternoclavicular joint .
 On the left side, it is a branch of the arch of the aorta.

36.  It ascends and enters the neck posterior to the
sternoclavicular joint.
 pursue a similar course in the neck
Course :
1. Each artery arches laterally from the
sternoclavicular joint to the outer border of the first
rib where it ends by becoming continuous with the
axillary artery .
2. The scalenus anterior muscle crosses the artery
anteriorly and divides it into three parts.
3. The first part is medial, the second part posterior,
and the third part lateral to scalenus anterior.

37. Relations of the First Part:
Anterior : from medial to lateral side :
1. Common carotid artery
2. Vagus nerve
3. Internal jugular vein
4. The sternothyroid and the sternohyoid
muscles
5. Sternocleidomastoid.
Posterior :
1. Suprapleural membrane
2. Cervical pleura
3. Apex of lung

38. Relations of the second Part:
Anterior
1. Scalenus anterior
2. Right phrenic nerve deep to the paravertebral fascia
3. Sternocleidomastoid.
Posterior
1. Suprapleural membrane
2. Cervical pleura
3. Apex of lung
Superior
1. Upper and middle trunks of brachial plexus

39. Relations of the third part :
Anterior
1. Middle one-third of the clavicle
2. The posterior border of the sternocleidomastoid.
Posterior
1. Scalenus medius
2. Lower trunk of brachial plexus
3. Suprapleural membrane
4. Cervical pleura
5. Apex of lung.
Superior
1. Upper and middle trunks of brachial plexus.
Inferior
1. First rib

40. Branches: The subclavian artery gives off four branches.
1. Vertebral artery
2. Internal thoracic artery.
3. Thyrocervical trunk, which divides into three branches :
a. Inferior thyroid
b. Suprascapular.
c. Transverse cervical arteries.
4. Costocervical trunk, which divides into two branches:
a. Superior intercostal.
b. Deep cervical arteries.
5.Dorsal scapular artery-occasionally.

41. Vertebral artery
 Principle arteries of brain, also supplies spinal cord,
meninges, surrounding muscles and bones.
 Arises from posterosuperior aspect of first part of
subclavian artery and ends in the cranial cavity by
supplying the brain.
 Divided in to 4 parts :
First part :
Extends from it’s origin to the transverse process of 6th
cervical vertebrae.
Artery then runs upwards and backwards in the triangular
space between the scalenus anterior and the longus colli
muscles.

43. Second part : runs through foramen transversaria
of the upper 6th cervical vertebrae.
Third part : Lies in suboccipital triangle.
Fourth part : enters the brain through foramen
magnum under the margins of posterior atlanto-
occipital membrane.

44. Branches :
1. Cervical branches
 Supply the spinal cord, meninges, vertebrae.
2. Cranial branches
Meningeal branch – supplies bone and meninges of posterior
cranial fossa.
Posterior spinal artery – sides of medulla, posterior one third of
spinal cord
Anterior spinal artery – supplies anterior 2/3rd of spinal cord
and medulla.

45. Posterior inferior cerebral artery – largest branch of vertebral
artery. It supplies :
a. posterolateral aspect of medulla.
b. Lower part of pons
c. Cerebellum
Internal thoracic artery
 runs downwards and medially to enter thorax by passing
behind first costal cartilage.
 lt runs vertically 2 cm, on lateral side of sternum till 6th
intercostal space to divide into musculophrenic and
superior epigastric branches.
 Supplies : breast and anterior chest wall

46. Thyrocervical trunk
 It is a short wide vessel which gives :
a. Suprascapular ,
b. transverse cervical
c. inferior thyroid branch.
 lnferiorthyroid artery supplies thyroid and parathyroid glands.
Costocervical trunk
 originates from the posterior surface of the subclavian artery, runs posteriorly
splits into 2 branches:
deep cervical artery,
superior intercostal artery.
 Supplies the first two intercostal spaces and the posterior deep muscles of the
neck.

47. Venous supply
 Head and neck regions are chiefly supplied by jugular veins and subclavian
veins.
 There are main 2 jugular veins : external jugular and internal jugular veins.
External Jugular Vein - formed by the union of two veins:
a. Posterior auricular vein
b. Posterior division of Retromandibular vein
 Retromandibular vein is formed by the union of maxillary vein and superficial
temporal vein.
 Posterior auricular and posterior division of retromandibular veins combine
posterior to the angle of mandible, forming the external jugular vein.
 External jugular vein Supplies the majority of the external face.

48. Course :
 The external jugular vein descends
downwards, runs inside superficial
fascia of the neck and crosses
sternocleidomastoid muscle obliquely.
 It then runs downward and behind the
clavicle it terminates by draining in to
subclavian vein.

49. Internal jugular vein
 Begins in cranial cavity, leaves cranial
cavity from jugular foramen.
 In the neck, the internal jugular
vein descends in the carotid sheath,
deep to the sternocleidomastoid
muscle and runs lateral to the
common carotid artery.
 Posterior to the sternal end of the
clavicle, it combines with the
subclavian vein to form the
brachiocephalic vein.

50.  During its course, the internal jugular
vein receives blood from
a. Facial vein
b. Lingual vein
c. Occipital vein
d. Superior vein
e. middle thyroid veins.
 These veins drain blood from –
anterior part of face, trachea, trachea, esophagus, larynx,
and muscles of neck.

51. Subclavian vein :
 It is the Continuation of axillary vein. It
originates from the outer border of first rib.
 Joins the internal jugular vein to form
brachiocephalic vein.
 Tributaries are –
a. External jugular vein
b. Dorsal scapular vein
c. Thoracic duct on left side

52. Venous supply of face & scalp :
 Supratrochlear + supraorbital veins = facial
vein.
 Superficial temporal vein – forms
retromandibular vein – in the parotid gland.
 Anterior div of retromandibular vein + facial
vein = common facial vein – drains into
internal jugular vein.
 Post div of retromandibular Vein + posterior
auricular vein = drains in to subclavian vein.

53. Dangerous triangle of face
 The dangerous triangle of the face consists of the area from
the corners of the mouth to the bridge of nose.
 Infections in this region can spread to cavernous sinuses
can lead to it’s thrombosis.
 Presence of emissary veins allows the spread of infections
into cavernous sinus
 Cavernous sinus thrombosis affects
a. cranial nerve III (occulomotor) ,
b. IV (trochlear),
c. VI (Abducent)
d. V (trigeminal)
 if infected for a long period manifest in the loss of function of
the specific muscle and glands.

54. Clinical considerations :
 inferior alveolar artery - Arterial bleeding that comes from
gingivae and dental damage to the lower jaw is usually
from damage to IAA.
 Bleeding that occurs from the dental sockets are from the incisor
branches of the inferior alveolar artery.
 The carotid arteries provides oxygenated blood to the brain. Just
like all arteries, they are susceptible to atherosclerosis, which can
lead to stenosis and embolism .
The common carotid artery
can be used to measure the
pulse. In the setting of
hypovolemic shock, if only the
carotid pulse is palpable.

55.  Hemorrhage from the facial artery can occur
during submandibular gland excision as well.
 Arteries supplying brain are extremely sensitive to
injury, in cases of shaken baby syndrome when
the bone structures have not developed
completely, injury to arteries supplying to brain
may cause seizures, slow heart rate, bleeding in
one or both the eyes.
 Temporal arteritis – occurs when one or more
arteries become inflamed, swollen and tender in
arteries around the temple. Most commonly seen
in old age.

57.  Vertebral artery dissection (VAD)
is an important cause of stroke in
otherwise healthy people with no
known stroke risk factors.
 Central artery of retina is the
arterial supply to most of the
layers of retina of eye. If this
artery is blocked, there will be
sudden blindness.
 Middle meningeal artery get
injured in head injuries resulting
in extradural hemorrhages.
Anaesthetist’s arteries :
superficial temporal artery as it
crosses the front of ear, facial
artery at the anteroinferior
angle of masseter muscle, and
common carotid artery at the
anterior body of
sternocleidomastoid are used.

58.  stapedial artery is a short, small artery supplying the stapedius muscle in the
inner ear.
 In humans, the stapedial artery is normally present in the fetus, where it connects
the future external and internal carotid arteries.
 It originates from the dorsal branch of aortic arch.
 Persistent stapedial artery is a rare congenital vascular anomaly that may present
as a pulsatile middle ear mass.
 Most patients with persistent stapedial artery are asymptomatic.

59. Emissary veins :
 Emissary veins connect the extracranial venous system with the intracranial
venous sinuses.
 Because the emissary veins are valve less, they are an important part in selective
brain cooling through bidirectional flow of cooler blood from the evaporating
surface of the head.
Anesthetics artery :
 If a surgery is going on in any other region of body other then head and neck ,
anesthetist can keep a check on pulse by palpating facial artery at anteroinferior
angle of masseter muscle, staying on head end of operating table and not
interrupting the surgery to feel the radial pulse repeatedly.
 He can also palpate superficial temporal or carotid artery in head and neck

60. References
1. B.D Chaurasia
2. Netter atlas of human anatomy
3. Anatomy, Head and Neck, Carotid Arteries Danielle
Sethi; Ekramul M. Gofur; Abdul Waheed.
4. Anatomy, Head and Neck, Facial Arteries Nuwan
Meegalla; Brian W. Downs.