3. AORTA
The aorta is the largest artery
in the body.The aorta begins
at the top of the left ventricle,
the heart's muscular pumping
chamber. The heart pumps
blood from the left ventricle
into the aorta through the
aortic valve
5. EMBRYOLOGY OF ECA
During the fourth and fifth weeks of embryological development,
when the pharyngeal arches form, the aortic sac gives rise to arteries
– the aortic arches.
The aortic sac is the endothelial lined dilation, it is the primordial
vascular channel from which the aortic arches arise.
In the initial stage there are pairs of aortic arches, which are
numbered I, II, III, IV, andVI.
This system becomes altered in further development.
6. Arch 1 - mainly lost, form part of maxillary artery
Arch 2 - stapedial arteries
Arch 3 - common carotid arteries, internal carotid arteries
Arch 4 - left forms part of aortic arch, right forms part right subclavian artery
Arch 6 - left forms part of left pulmonary artery , right forms part of right pulmonary artery
7. ▪ The 3rd Arch forms common carotid artery, first (cervical) part of
internal carotid artery (rest of internal carotid arises from dorsal
aorta), and external carotid artery.
8. COMMON CAROTID ARTERY-COURSE
▪ In the neck, each artery runs upwards within the carotid sheath, under cover of the
anterior border of the sternocleidomastoid muscle.
It begins in the neck behind
the right sternoclavicular
joint.
Right common carotid artery
is a branch of the
brachiocephalic artery.
It begins in the thorax in front
of the trachea opposite a
point a little to the left of the
centre of the manubrium.
Left common carotid
artery is a branch of the
arch of aorta
It ascends to the back of
the left sterno-clavicular
joint and enters the neck.
10. CONTENTS:
common and internal carotid
arteries, internal jugular vein
and the vagus nerve.
In the sheath, common
carotid artery is medially
placed. Vagus nerve lies in
between.
11. RELATIONS:-
The ansa cervicalis lies
embedded in the anterior wall
of the carotid sheath.
The cervical sympathetic
chain lies behind the sheath.
12. BIFURCATION OF COMMON CAROTID ARTERY
▪ Common carotid artery bifurcates into external and internal carotid
arteries at the level of upper border of the thyroid cartilage.
▪ Two structures of importance at the bifurcation are
▪ Carotid sinus
▪ Carotid body
13. CAROTID SINUS
▪ Carotid sinus is the slight dilatation at the termination of the
common carotid artery or the beginning of the internal carotid artery.
▪ It receives a rich innervation from the glossopharyngeal and
sympathetic nerve.
FUNCTION
• Acts as a baroreceptor or pressure receptor and
regulates blood pressure.
14. APPLIED ANATOMY
Carotid sinus syndrome
▪ Loss of consciousness due to simple head movements.
▪ Hypersensitivity of the carotid sinus due to an unknown etiology.
▪ Sudden slight pressure changes, such as that occasioned by
movement of the head, wearing a tight collar may result in
stimulation of the carotid sinus.
15. ▪ Impulses transmitted by the sinus reduce blood pressure and slow
the pumping action of the heart.
▪ Thus decreasing blood supply to the brain and resulting in sudden
loss of consciousness.
▪ While supporting the mandible care should be taken not to apply
pressure on the carotid sinus.
16. CAROTID BODY
▪ Carotid body is a small, oval reddish-brown structure situated behind
the bifurcation.
▪ It receives nerve supply mainly from the glossopharyngeal nerve, but
also from the vagus and sympathetic nerves.
17.
18. External carotid artery
▪ Generally, it lies anterior to the internal carotid artery.
▪ It is the chief artery of supply to structures in the front of the neck
and in the face.
19. COURSE AND RELATIONS
▪ The external carotid artery begins in the carotid triangle at the level
of the upper border of the thyroid cartilage opposite the disc
between the third and fourth cervical vertebrae.
▪ It runs upwards and slightly backwards and laterally, and terminates
behind the neck of the mandible by dividing into the maxillary and
superficial temporal arteries.
▪ The external carotid artery has a slightly curved course, so that it is
anteromedial to the internal carotid artery in its lower part, and
anterolateral to the internal carotid artery in its upper part.
20.
21. ▪ In the carotid triangle, the external carotid artery is comparatively
superficial, and lies under cover of the anterior border of the
sternocleidomastoid.
▪ The artery is crossed superficially by the cervical branch of the facial
nerve, the hypoglossal nerve, and the facial, lingual and superior
thyroid veins. Deep to the artery there are:
(1) The wall of the pharynx;
(2) The superior laryngeal nerve which divides
into the external and internal laryngeal nerves;
(3) The ascending pharyngeal artery
22. ▪ Above the carotid triangle the external carotid artery lies deep in the
substance of the parotid gland.
▪ Within the gland, it is related superficially to the retromandibular
vein and the facial nerve.
23. Deep to the external carotid artery,
there are:
The internal carotid
artery
structures passing
between the external
and internal carotid
arteries
two structures deep
to the internal carotid
artery
styloglossus,
stylopharyngeus
IXth nerve, pharyngeal
branch of Xth
styloid process
superior laryngeal
nerve
superior cervical
sympathetic ganglion.
27. INTERNAL CAROTID ARTERY
▪ Origin
▪ It is one of the terminal branch of common carotid artery originates
along with external carotid artery at the upper border of thyroid
cartilage at the disk of third and fourth cervical vertebra.
28. BRANCHES
▪ Cervical part in the neck
▪ Petrous part in the petrous temporal bone
▪ Cavernous part in the cavernous sinus
▪ Cerebral part in relation to base of brain
30. Origin :
▪ Arises from the ECA just above the greater cornu of the hyoid bone
▪ It has two parts, first cervical part in the neck and facial part.
▪ It enters the face by winding around the base of the mandible by
piercing deep cervical facia.
▪ At the antero-inferior angle of the masseter muscle, it can be
palpated here and is called as “anaesthetist’s artery”
31. COURSE:
▪ Runs upwards in -- neck as cervical part ; face -- facial part.
▪ Tortuous course—In neck allows free movements of pharynx
during deglutition,
▪ on face -- free movements of mandible , lips, & cheek during
mastication & facial expressions, escapes traction & pressure during
movements.
32. Cervical part
▪ Cervical part Runs upwards on superior constrictor of pharynx deep
to the posterior belly of digastric.
▪ It grooves the posterior border of sub-mandibular gland, makes S-
bend [2 loops] 1st winding down over sub-mandibular gland & then
up over the base of mandible.
33. Facial part
▪ The vessel enters the face by winding around the base of the
mandible, and by piercing the deep cervical fascia at the antero-
inferior angle of the masseter muscle.
▪ It runs upwards and forwards deep to the risorus, to a point 1.25cm
lateral to the angle of the mouth.
▪ Then it ascends by the side of the nose upto the medial angle of the
eye where it terminates by anastomosing with the dorsal nasal
branch of the ophthalmic artery.
35. BRANCHES OF FACIAL ARTERY-facial
Inferior labial artery
Superior labial artery
Lateral nasal branch to nasalis
muscle
Angular artery - the terminal
branch
36. ▪ The facial artery normally arises from the external carotid artery,
just above the lingual artery, at the level of greater cornu of hyoid
bone in the carotid triangle.
▪ It then passes upwards and forwards medial to the ramus of the
mandible.
▪ It passes deep to the superficial part of the submandibular salivary
gland making a characteristic loop, winds around the base of the
mandible to enter the face at anteroinferior angle of the masseter
muscle.
▪ In the face, it runs upwards and forward, laterals to angle of the
mouth, and terminates as angular artery at medial angle of eye.
▪ Its branches in the face include: inferior labial artery, to the lower
lip; superior labial artery, to the upper lip; lateral nasal artery, to
supply the ala and dorsum of the nose
(STANDRING, 2008).
37. ANASTOMOSES
▪ 1.The large anterior branches anastomose with similar branches of
the opposite side and with the mental artery. In the lips,
anastomoses are large, so that cut arteries spurt from both ends.
▪ 2.Small posterior branches anastomose with the transverse facial
and infraorbital arteries.
▪ 3.At the medial angle of the eye, terminal branches of the facial
artery anastomose with branches of the ophthalmic artery.This is,
therefore, a site for anastomosis between the branches of the
external and internal carotid arteries.
39. SURFACE MARKING OF FACIAL PART
1)A point on the
base of the
mandible at the
anterio-inferior
border of the
masseter muscle
2)A second point
1.2cm lateral to
the angle of the
mouth.
3)A point at the
medial angle of
the eye.More
tortuous b/n first
two points.
41. ASCENDING PALATINE ARTERY:
▪ Originates near the origin of facial artery.
▪ It passes upwards between the
stylopharyngeus and styloglossus
muscles, to supply the levator veli
palatini, superior pharyngeal constrictor
and neighbouring muscles, soft palate,
tonsils, and auditory tube
42. TONSILLAR ARTERY:
▪ Passes between the styloglossus and medial pterygoid muscles and
pierces the superior pharyngeal constrictor muscle to supply the
palatine tonsil and the posterior tongue.
43. SUB MENTAL ARTERY:
▪ Arises from the facial artery near the anterior border of the masseter muscle.
▪ It follows the base of the mandible in an anterior direction and turns onto the chin at
the anterior border of the depressor anguli oris muscle and accompanies with the
mylohyiod nerve.
It supplies the sub-mental triangle and
sublingual salivary gland and forms anastomoses
with several arteries in its vicinity,
including the mental and sublingual arteries.
44. GLANDULAR ARTERIES:
▪ Distribute as three or four vessels to the submandibular gland to
supply it and the adjacent area.
▪ Glandular branches supply submandibular gland and submandibular
lymph glands
46. INFERIOR LABIAL ARTERY:
▪ Originates near the corner of the
mouth, passes deep to the
depressor anguli oris muscle, and
pierces the orbicularis oris muscle.
▪ -The artery courses superficial to
that muscle, supplying it as well as
the substance of the lower lip.
▪ -It forms an anastomosis with its
counterpart of the other side and
with branches of the mental and
sub-mental arteries.
47. SUPERIOR LABIAL ARTERY
▪ Arises just above the inferior labial artery. It passes superficial to the
orbicularis oris muscle in the upper lip to serve that muscle as well as
the substance of the upper lip.
▪ - It sends a small twig, the SEPTAL BRANCH to supply antero-
inferior part of the nasal septum and another one, the ALAR
BRANCH, into the wing of the nose.
▪ -The terminus of the vessel will anastomose with its counterpart of
the opposite side.
48. LATERAL NASAL ARTERY:
▪ Small branch arising at and passing into the wing and bridge of the
nose.
▪ This supplies ala and dorsum of the nose.This vessel will anastomose
with various other arteries in its vicinity.
49. ANGULAR ARTERY:
▪ Is the terminal continuation of the facial artery, supplying the tissues
in the vicinity of the medial corner of the eye and anastomosing with
dorsal nasal branch of the ophthalmic artery.
51. A STUDY ON FACIAL ARTERY VARIATION AND ITS
CLINICAL IMPLICATION FOR FACIAL SURGERIES
▪ Results:The variations in the facial artery were grouped under three
categories following the classification of Bayramet.al, 2010.
▪ Type I category – Facial artery terminated as angular artery ;
▪ Type II category – facial artery terminated as superior labial ;
▪ Type III – Facial artery terminated as inferior labial .
▪ In present study (type-II) is seen. Premasseteric branch was
observed.
Md Khaleel Ahmed 1, Pradeep K. Murudkar 2, Md.Kafeel Ahmed 3. International Journal of Anatomy
and Research,IntJ Anat Res 2015,Vol 3(1):966-69
52. ▪ Discussion: Niranjan NS (1988) observed the variations of facial
artery in 50 hemi-faces. According to him, facial artery terminated as
angular artery in 68 % of hemi-faces, lateral nasal artery in 26% of
hemi-faces,
▪ Superior labial artery in 4% of hemi-faces and 2% terminated at the
alar base 12. In present study facial artery terminates as superior
labial artery. A study conducted by Magden et.al (2009) , on the
premasseteric branch, suggested that in 3% cases the diameter of
premasseteric branch was larger than the facial artery.
▪ Conclusion:This study shows that the variation in the branching
pattern of facial artery variations, which help in avoiding the mishaps
during certain surgical procedures.
54. Facial Artery Compression:
▪ Applying pressure to the facial artery as it passes
over the inferior border of the mandible just
anterior to the angle will diminish blood flow to
that side.
▪ Can be injured during operative procedures on
lower premolars & molars, if instrument enters the
cheek at inferior vestibular fornix., also while
attempt to open a buccal abscess or mucocoele.
55. ▪ In mandibular 1st molar region care must be taken not to injure the
facial artery while extending the vertical incision down the vestibule
during surgical extraction of mandibular impaction.
▪ So it is recommended that start vertical incision from the vestibule in
upward direction.
56. ▪ While excising the submandibular gland,the facial artery should be
ligated at two points and should be secured before dividing it,
otherwise it may retract through stylomandibular ligament causing
serious bleeding.
▪ During the surgical removal of the submandibular salivary gland the
incision is made ½ inch below the lower border of the mandible
parallel to mandibular branch of facial nerve.
▪ Facial artery can be severed during the attempts to open buccal
abscess of the first molar.
57. LIGATION OF FACIAL ARTERY
▪ Exposed -at the point crossing the lower border of mandible .
▪ Using contracted masseter as a landmark, pulse of facial artery felt at
point situated anterior to the attachment of masseter.
58. ▪ Incision - at least half inch below the border of mandible & parallel to it.
59.
60.
61. APPLIED ANATOMY-COMPLICATIONS
▪ During injury of the face bleeding from the facial artery can be stopped by
compressing the artery against the lower border of mandible.
▪ The pulsation of the artery can be felt along the lower border of the
mandible near the anteroinferior angle of masseter muscle.
▪ In the lips branches of the facial artery are found nearer to the mucous
membrane than to the skin.
▪ Hence injuries caused by the teeth on the mucous membrane of the mouth
may develop hidden haematomas.
62. Calcified facial artery
▪ Facial artery calcification was first demonstrated on intraoral
radiographs in 1942 by Ennis and BurIcet.
63.
64. A report of the panoramic radiographic incidence and appearance
Dale A. Miles and Robert M. Craig
65.
66. REFERENCES
▪ B.D.Chaurasia Human Anatomy for Dental Students,5th edition
▪ Textbook of Oral and Maxillofacial surgery,S.M.Balaji,1st edition
▪ Cunningham’s ManualOf PracticalAnatomy,G.J. Romanes
▪ Ram’sTextbook of Human Anatomy, MV Ramasamy
▪ Anatomy For Dental Students , A S Moni
▪ Surgical complications in oral implantology,LouieAl-Faraje
▪ A report of the panoramic radiographic incidence and appearance Dale A. Miles
and Robert M. Craig
▪ Md Khaleel Ahmed 1, Pradeep K. Murudkar 2, Md.Kafeel Ahmed 3. International
Journal of Anatomy and Research,Int J Anat Res 2015,Vol 3(1):966-69
