Head and Neck Vasculature Guide

Vasculature of Head and Neck
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Contents
Circulatory system components
• Types of circulation
• Vascular number, size
• Branching patterns
• Anastomosis
• Classification of vessels
• Histology of vessel wall
• Structure of the vessels

Contents
Arteries of head and neck
• Aorta
• Common carotid artery
• External carotid artery
• Internal carotid artery

Contents
Veins of head and neck
• Exterior veins of face
• Veins of neck
• Dural venous sinuses

Vascular system

• Vessel number, size
• Branching patterns
Vascular system

• Anastomosis
• Classification
– Conducting
– Distributing
– Resistance
– Exchange vessels
– Capacitance vessels
Vascular system

Histology of vessel wall
• Tunica intima
• Tunica media
• Tunica adventitia
Vascular system

Structure of blood vessel
• Large elastic arteries
• Muscular arteries
Vascular system

• Arterioles
• Capillaries
Vascular system

Arteriovenous anastomosis
Vascular system
Modified smooth
muscles

• Venules
• Veins
Vascular system

Arterial supply of head and neck

Aorta
• Trunk of the arterial tree conveying oxygenated blood
• Aorta can be divided into

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

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

Descending Aorta
Its branches-
– Thoracic aorta
– Abdominal aorta
Descending Aorta
Aorta

Common Carotid Artery
• Carotid - to put to sleep
• Large bilateral vessel supplying Head and Neck
Common carotid artery
Right Left

Right common
carotid artery
Left common
carotid artery
Origin Bifurcation of the
brachiocephalic
trunk
Arch of aorta
Termination At the level of upper border of
thyroid cartilage

Anterior view
Posterior view
As common carotid artery arises from aortic arch-
thoracic and cervical parts

Relations of thoracic part
Anterior:
• Sternothyroid and
sternohyoid muscles
• Left pleura and lung
• Left brachiocephalic vein
Posterior
• Trachea , left border of
oesophagus
• Left subclavian artery
• Left recurrent laryngeal
nerve
• Thoracic duct

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

Carotid sinus
• At the bifurcation of
common carotid artery
• Responsive to changes
in the arterial blood
pressure
• It acts as baroreceptor-
controls intra cranial
pressure

Carotid body
• Small, ellipsoid reddish-
brown structure
• Acts as chemoreceptor-
• Although the main role is
certain, which component
acts is obscure

Relations of cervical part
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

Medial
• Oesophagus
• Trachea
• Inferior thyroid artery
• Recurrent laryngeal nerve
• Larynx and pharynx- higher level
Lateral
• Internal jugular vein

Applied anatomy
• Carotid pulse
• Surface marking

External carotid artery
• One of the terminal branches

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

Relations of ECA
In the carotid triangle:

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

Branches
• Anterior : Superior thyroid
Lingual
Facial
• Posterior: Occipital
Posterior auricular
• Medial: Ascending pharyngeal
• Terminal: Maxillary
Superficial temporal

Superficial
temporal
Maxillary
Facial
Lingual
Superior thyroid
Posterior
auricular

Superior thyroid arteryExternal carotid artery

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

Branches
Anterior Posterior

Named branches

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.

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 hyoglossus
muscle, finally leaves the muscle in the tongue to
anastomose with the fellow of opposite side
• Three parts
Lingual artery

Lingual artery

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

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

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

Facial 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

Cervical course
Base of the mandible
Facial artery

Facial course
Facial artery

Branches
• Cervical branches
– Ascending palatine artery
– Tonsillar artery
– Glandular branches
– Submental
• Facial branches
– Inferior labial artery
– Superior labial artery
– Lateral nasal artery
Facial artery

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

Branches –
• Sternocleido mastoid branch
• Mastoid branch
• Stylomastoid branch
• Auricular branch
• Muscular branch
• Descending branch
• Meningeal branch
• Occipital branch
Occipital artery

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.

Branches –
• To digastric, stylohyoid,
sternocleido mastoid,
parotid gland
• 3 named branches-
• Stylomastoid artery
• Auricular artery
• Occipital branch
Posterior auricular artery

Ascending pharyngeal artery
• Origin - Smallest branch of all the branches
Branches

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

Maxillary artery

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
Frontal & Parietal
– Accessory meningeal artery
– Inferior alveolar artery
Maxillary artery

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

Pterygopalatine part
Passes between the heads of lateral pterygoid, through
pterygomaxillary fissure into the pterygopalatine fossa
Branches:
- PSA Artery
- Infraorbital
- Greater palatine
- Pharyngeal branch
- Artery of pterygoid canal
- Sphenopalatine artery
Maxillary 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

Relations:
• In the parotid gland- temporal and zygomatic branches
facial nerve
• In the scalp- corresponding veins, posterior to the
auriculotemporal nerve

Branches
• Transverse facial artery
• Anterior auricular
branches
• Zygomatico-orbital
branches
• Middle temporal artery
• Frontal branch
• Parietal branch

Applied anatomy
• Anastomose freely; heal with reasonable
hope even if one vessel is intact
• In reduction of zygomatic arch fractures –
Gilli’s approach

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

Divided into-
• Cervical
• Petrous
• Cavernous
• Cerebral

Cervical part
Relations
• Posteriorly
• Medially
• Anteriorly
• Laterally

Petrous part
Relations
• Surounded by venous and
sympathetic plexuses
• Posterolaterally-middle ear and
cochlea
• Anterolaterally- auditory tube
and tensor tympani
• Superiorly- trigeminal ganglion

Branches
• Caroticotympanic branch or
artery
• Pterygoid artery

Cavernous part
• Ascends to the posterior
clinoid process
• Emerges through the dorsal
roof of the cavernous sinus
Branches
• Cavernous branches
• Hypophyseal branches
• Meningeal branches

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

Ophthalmic artery
• Artery enters the orbit
through optic canal.
• Terminates near the
medial angle of the
eye, dividing into
supratrochlear and
dorsal nasal branches

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

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

VEINS of HEAD and NECK

Classification
• Veins of exterior of
head and neck
• Cervical veins
• Diploic, meningeal,
intracranial dural
venous sinuses

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

Superficial veins

Deep veins

Supra trochlear vein
Supra trochlear
vein

Supraorbital vein

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

Facial vein

Applied anatomy
• Has no valves
• Connected to cavernous
sinus
• Danger area of face
Facial vein

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

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

Maxillary vein
• Origin
• Course
• Terminates

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

External jugular vein

Anterior jugular vein

Internal jugular vein

RELATIONS
Internal jugular vein
APPLIED ANATOMY

• Lingual vein
• Pharyngeal vein
• Superior and inferior thyroid vein
• Middle thyroid vein
• Vertebral vein
• Deep cervical vein

Dural venous sinuses

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 intercavernous
sinus
• Basilar plexus of veins

CAVERNOUS SINUS
• Location: Large venous
space, in middle cranial
fossa
• Anteriorly upto – medial
end of superior orbital
fissure
• Posteriorly – apex of
petrous temporal bone

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

Structures in the lateral wall
of sinus
• Oculomotor nerve
• Trochlear nerve
• Ophthalmic nerve
• Maxillary nerve
• Trigeminal ganglion
Cavernous sinus

Structures passing through the centre of the sinus
• Internal carotid artery
• Abducent nerve
Cavernous sinus

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

Lateral view
Cavernous sinus

Anterior view
Cavernous sinus

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

Applied anatomy
• Thrombosis
– Nervous symptoms
– Venous symptoms
• Head injury – pulsating exophthalmos
Cavernous sinus

Transverse sinus
• Convex upwards, Large sinuses, right larger than left
situated in posterior part of attached margin of tentorium
cerebelli
• 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

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

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

Tributaries
- Superior cerebral veins
- Parietal emmissary veins
- Venous lacunae
Superior sagittal sinus

Applied anatomy
• Thrombosis
– Rise in intracranial tension
– Delirium
– Convulsions
– Paraplegia of upper motor neuron type
Superior sagittal sinus

Inferior sagittal sinus
• Location small channel, posterior 2 /3rds
of falx cerebri
• Ends by joining great cerebral vein to form the straight
sinus.

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

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

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 anterior
cavernous sinus

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, cerebellumwww.indiandentalacademy.com

Head and Neck Vasculature Guide

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