Arteries of Head and Neck PDF

Arteries of head and neck  The arch of the aorta (aortic arch), the curved continuation of the ascending aorta begins posterior to the 2nd right sternocostal joint at the level of the sternal angle. The arch descends posterior to the left root of the lung beside the T4 vertebra. T...

Arteries of head and neck  The arch of the aorta (aortic arch), the curved continuation of the ascending aorta begins posterior to the 2nd right sternocostal joint at the level of the sternal angle. The arch descends posterior to the left root of the lung beside the T4 vertebra. The arch ends by becoming the thoracic (descending) aorta posterior to the 2nd left sternocostal joint.  Branches of arch of aorta brachiocephalic trunk left common carotid artery left subclavian artery Brachiocephalic trunk The first and largest branch of the arch of the aorta it divides into the right common carotid and right subclavian arteries. The thyroid ima artery is present in 10-20% and is separated from the brachiocephalic trunk.  The possible presence of this artery must be considered when performing procedures (like tracheostomy) in the midline of the neck inferior to the isthmus because it is a potential source of bleeding  the common carotid artery supplies the head and neck Common carotid arteries The right common carotid artery originates The left common carotid artery begins in from the brachiocephalic trunk the thorax as a direct branch of the arch of immediately posterior to the right the aorta and passes superiorly to enter the sternoclavicular joint and is entirely in the neck near the left sternoclavicular joint. neck throughout its course.  Both right and left common carotid arteries ascend through the neck, just lateral to the trachea and esophagus, within a fascial compartment (the carotid sheath). Carotid sheath Each carotid sheath is a column of fascia that surrounds the common carotid artery, the internal carotid artery, the internal jugular vein, the vagus nerve as these structures pass through the neck  Near the superior edge of the thyroid cartilage (C4 vertebra) each common carotid artery divides into its two terminal branches (carotid bifurcation) the external and internal carotid arteries  The superior part o f each common carotid artery and its division into external and internal carotid arteries occurs in the carotid triangle the superior belly of the omohyoid muscle anteroinferiorly, the stylohyoid muscle and posterior belly of the digastric superiorly, the the sternocleidomastoid muscle posteriorly. carotid pulse The carotid pulse can be palpated by placing the index and 3rd fingers on the thyroid cartilage and pointing them posterolaterally between the trachea and SCM. The pulse is palpable just medial to the SCM. Carotid sinus The internal carotid artery continues the course of the common carotid artery. At the bifurcation, the beginning of the internal carotid artery are dilated. This dilation is the carotid sinus and contains receptors that monitor changes in blood pressure and are innervated by a branch of the glossopharyngeal nerve [IX]. it is a baroreceptor (pressoreceptor) that reacts to changes in arterial blood pressure!  Carotid body Another accumulation of receptors in the area of the bifurcation is responsible for detecting changes in blood chemistry, primarily oxygen content. This is the carotid body and is innervated by branches from the glossopharyngeal [IX] nerve (Fibers of 9 coming from 10 branches)  External carotid arteries The external carotid arteries begin giving off branches as follows: Superior thyroid artery Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Superficial temporal artery Maxillary artery Anterior branches: 1 - Superior thyroid artery 2 – Lingual artery 3 - Facialis artery Post: 4 - Posterior auricular artery 4- 5 – Occipital artery Medial: 5- 6- Ascending pharyngeal artery 6- 3- 2- 1- 1. Superior thyroid artery first branch (the most inferior of the three anterior branches of the external carotid artery) level of the major corn of hyoid bone Runs anteroinferiorly deep to the infrahyoid muscles to reach the thyroid gland. In addition to supplying this gland, it gives off branches to the infrahyoid muscles and the SCM and gives rise to the superior laryngeal artery, supplying the larynx.  the superior thyroid artery) also originate in the carotid triangle.  Superior thyroid artery 1- Infrahyoid branch 2- Sternocleidomastoid branch 3- Superior laryngeal branch 4- Cricothyroid branch 5- Anterior glandular branch 6- Posterior glandular branch 7- Lateral glandular branch Superior laryngeal branch penetrates the membrana thyrohyoidea with the internal branch of the superior laryngeal nerve In the larynx it courses below the mucosa of the Recessus piriformis. Its branches supply the aditus laryngis (laryngeal inlet) and the vestibulum laryngis.  In the larynx it courses below the mucosa of the piriform recess. Its branches supply the aditus laryngis (laryngeal inlet) and the vestibulum laryngis. 2. Ascending pharyngeal artery smallest branch it arises from the posterior aspect of the external carotid artery ascends between the internal carotid artery and the pharynx. Ascending pharyngeal artery sends branches to the pharynx, prevertebral muscles, middle ear, and cranial meninges: Posterior meningeal artery (from jugular foramen to cranial fossa) Pharyngeal branches Inferior tympanic artery 3. Lingual artery arises from the anterior surface of the external carotid artery at the level of the hyoid bone  It arches superoanteriorly and passes deep to the hypoglossal nerve, the stylohyoid muscle, and the posterior belly of the digastric muscle. It disappears deep to the hyoglossus muscle The lingual artery enters the tongue deep to the hyoglossus, between the hyoglossus and genioglossus  Branches of lingual artery: The dorsal lingual arteries provide the blood supply to the root of the tongue and a branch to the palatine tonsil. The deep lingual arteries supply the body of the tongue. The sublingual arteries provide the blood supply to the floor of the mouth, including the sublingual glands. Suprahyoid branch 4. Facial artery 4. Facial artery branches from the anterior surface of the ECA passes deep to the stylohyoid and posterior belly of the digastric muscles, continues deep between the submandibular gland and mandible appears at the lower border of the mandible after passing posterior to the submandibular gland.  continues deep between the submandibular gland and mandible appears at the lower border of the mandible after passing posterior to the submandibular gland.  appears at the lower border of the mandible after passing posterior to the submandibula r gland.  Curving around the inferior border of the mandible just anterior to the masseter, where its pulse can be felt, the facial artery then enters the face. From this point the facial artery runs upward and medially in a tortuous course. It passes along the side of the nose and terminates as the angular artery at the medial corner of the eye.  Along its path the facial artery is deep to the platysma, risorius, and zygomaticus major and minor, superficial to the buccinator and levator anguli oris, and may pass superficially to or through the levator labii superioris.  cervical branches of facial artery Ascending palatine artery: auditory tube, palatine tonsil, soft palate Tonsillar branch: palatine tonsil Submental arter: submental region Glandular branches: submandibular salivary gland facial branches of facial artery Inferior labial artery: lower lip, labial glands Superior labial artery : upper lip, nasal septum, ala of the nose Lateral nasal branch: dorsum of the nose, ala of the nose Angular artery: supplies lacrimal sac, orbicularis oculi muscle. Anastomoses with infraorbital artery and ophtalmic artery (the dorsal nasal branch) circulus arteriosus labiorum The inferior and the superior labial arteries on both sides anastomose with each other and form a vascular ring around the mouth.  Because of the anastomoses between the branches of the facial artery and the other arteries of the face, compression of the facial artery on one side does not stop all bleeding from a lacerated facial artery or one of its branches. In lacerations of the lip, pressure must be applied on both sides of the cut to stop the bleeding.  Facial artery anastomoses sublingual artery (lingual artery) ascending pharyngeal artery (external carotid artery) Neck descending palatine artery ( maxillar) mental artery ( maxillar) transverse facial artery (superficial temporal artery) face infraorbital artery (maxillar) - dorsal nasal artery (ophthalmic artery)  5. Occipital artery originates in the submandibular triangle arises from the posterior aspect of the ECA, superior to the origin of the facial artery. It passes posteriorly, immediately medial and parallel to the attachment of the posterior belly of the digastric muscle in the occipital groove in the temporal bone ends by dividing into numerous branches in the posterior part of the scalp Branches: 1- mastoid branch: Supplies dura mater, enters the posterior cranial fossa via the mastoid foramen 2- auricular branch: Supplies the skin of the posterior aspect of the auricle 3- sternocleidomastoid branch: crosses the hypoglossal nerve 4- occipital ( meningeal) branch: Supplies dura mater, enters from the jugular foramen or condylar canal. 5- descending branches  5- descending branches Anastomoses with the branches of vertebral artery and costocervikal trunk Such as ascending branch of transverse cervical artery this anastomosis allows for compensation when the subclavian artery or carotid communis is occluded  During its course, it passes superficial to the internal carotid artery and CN IX–CN XI.  6. Posterior auricular artery usually the last preterminal branch. It ascends posteriorly between the external acoustic meatus and the mastoid process supply the adjacent muscles; parotid gland; facial nerve; and structures in the temporal bone, auricle, and scalp.  Terminal branches The external carotid artery divides into two terminal branches in the parotid gland The maxillary artery The superficial temporal artery  The maxillary artery passes horizontally, deep to the mandible. The superficial temporal artery continues in a superior direction and emerges from the upper border of the gland after giving off the transverse facial artery.  The maxillary artery the larger of the two terminal branches of the external carotid artery, gives off several small branches which contribute to the arterial supply to the face maxillary artery The maxillary artery is a major source of blood supply for the nasal cavity, the lateral wall and roof of the oral cavity, all teeth, and the dura mater in the cranial cavity.  The maxillary artery originates within the substance of the parotid gland and then passes forward, between the neck of the mandible and sphenomandibular ligament, into the infratemporal fossa.  It ascends obliquely through the infratemporal fossa to enter the pterygopalatine fossa by passing through the pterygomaxillary fissure. This part of the vessel may pass either lateral or medial to the lower head of the lateral pterygoid.  Maxillary artery passes through and supplies the infratemporal fossa and then enters the pterygopalatine fossa  The first part of the maxillary artery (the part between the neck of the mandible and the sphenomandibular ligament) The second part of the maxillary artery (the part related to the lateral pterygoid muscle) The third part of the maxillary artery is in the pterygopalatine fossa 1st part of the maxillary artery the middle meningeal and inferior alveolar arteries and a number of smaller branches (deep auricular, anterior tympanic, and accessory meningeal) Middle meningeal artery ascends vertically from the maxillary artery and passes through the foramen spinosum to enter the cranial cavity Just inferior to the foramen spinosum, it passes between the two roots of the auriculotemporal nerve at their origin from the mandibular nerve  The middle meningeal artery is the largest of the meningeal vessels supplies much of the dura mater, bone, and related bone marrow of the cranial cavity walls.  As major branches of the middle meningeal artery pass superiorly up the walls of the cranial cavity, they can be damaged by lateral blows to the head.  When the vessels are torn, the leaking blood, slowly separates the dura mater from its attachment to the bone, resulting in an extradural (epidural) hematoma. Inferior alveolar artery descends from the maxillary artery to enter the mandibular foramen and canal with the inferior alveolar nerve It supplies all lower teeth, and contributes to the supply of the buccal gingivae, chin, and lower lip.  Before entering the mandible, the inferior alveolar artery gives origin to a small mylohyoid branch, which accompanies the nerve to the mylohyoid. dental, peridental, mylohyoid, mental branch  The deep auricular - supplies external acoustic meatus anterior tympanic - deep surface of the tympanic membrane accessory meningeal arteries – passes through foramen ovale and supplies cranial dura mater and trigeminal ganglion Branches from the second part the part related to the lateral pterygoid musclegives origin to deep temporal, masseteric, buccal, and pterygoid branches  Deep temporal arteries , usually two in number, travel with the deep temporal nerves to supply the temporalis muscle in the temporal fossa  pterygoid arteries supply the pterygoid muscles. The masseteric artery, accompanies the masseteric nerve laterally through the mandibular notch to supply the masseter muscle. The buccal artery is distributed with the buccal nerve and supplies skin, muscle, and oral mucosa of the cheek. Branches from the third part The part of the maxillary artery in the pterygopalatine fossa Posterior superior alveolar, infraorbital, greater palatine, pharyngeal, sphenopalatine artery of the pterygoid canal The posterior superior alveolar artery originates from the maxillary artery as it passes through the pterygomaxillary fissure. It meets the posterior superior alveolar nerve, accompanies it through the alveolar foramen on the infratemporal surface of the maxilla supplies the molar and premolar teeth, adjacent gingiva, and the maxillary sinus. Infra-orbital artery leaves the pterygopalatine fossa through the inferior orbital fissure. lies in the infra-orbital groove and infra-orbital canal, and emerges through the infra-orbital foramen to supply parts of the face.  Within the infra-orbital canal, the infra-orbital artery gives origin to: branches that contribute to the blood supply of eye muscles and the lacrimal sac; anterior superior alveolar arteries which supply the incisor and canine teeth and the maxillary sinus.  posterior superior alveolar artery (maxillar) Middle superior alveolar artery (infraorbital) anterior superior alveolar artery (infraorbitalis) (rr. dentales rr. peridentales  Greater/ descending palatine artery passes inferiorly with the palatine nerves into the palatine canal It gives origin to a lesser palatine branch then continues through the greater palatine foramen to supply the hard palate  The latter vessel passes forward on the inferior surface of the palate to enter the incisive fossa and pass superiorly through the incisive canal to supply the anterior aspect of the septal wall of the nasal cavity. lesser palatine branch: passes through the lesser palatine foramen supply the soft palate  travels posteriorly and leaves the pterygopalatine fossa through the Pharyngeal palatovaginal canal branch supplies the posterior aspect of the roof of the nasal cavity, the sphenoidal sinus, and the pharyngotympanic tube. Sphenopalatine artery leaves the pterygopalatine fossa medially through the sphenopalatine foramen Sphenopalatine artery posterior lateral nasal arteries , which supply the lateral wall of the nasal cavity and the paranasal sinuses posterior septal branches, which travel medially across the roof to supply the nasal septum (the largest of these branches passes anteriorly down the septum to anastomose with the end of the greater palatine artery) Palatin arteries A. palatina ascendens (a. facialis) ile a. palatina descendens (a. maxillaris) Artery of pterygoid canal passes posteriorly into the pterygoid canal. It supplies surrounding tissues and terminates, after passing inferiorly through cartilage filling the foramen lacerum superficial temporal artery beginning posterior to the neck of the mandible passes anterior to the ear (emerges on the face between the temporomandibular joint (TMJ) and the auricle,) crosses the zygomatic process of the temporal bone enters the temporal fossa, and ends in the scalp by dividing into frontal and parietal branches (or ant and post)  the superficial temporal artery can be palpated anterior to the ear  transverse facial artery arises from the superficial temporal artery within the parotid gland and crosses the face superficial to the masseter It divides into numerous branches that supply the parotid gland and duct, the masseter, and the skin of the face. It anastomoses with branches of the facial artery. Three branches of the external carotid artery supply the largest part of the scalp: the superficial temporal, Posterior auricular occipital arteries supply the lateral and posterior aspects of the scalp.  internal carotid artery separated from cca at the level of c4 at the upper border at thyroid cartilage Arteria carotis interna Pars cerebralis Pars cavernosa Pars petrosa Pars cervicalis  Carotid sinus Carotid body  The internal carotid arteries supply the cerebral hemispheres the eyes and the contents of the orbits, and the forehead.  After its origin, it ascends in front of the transvers proc of the first three cervical vertebrae and enters the carotid canal Petrous part It gives off no branches in the neck and enters the cranial cavity through the carotid canal in the petrous part of the temporal bone. ▪ Caroticotympanic artery ▪ artery of pterygoid canal  After exiting the canal, it enters the middle cranial fossa, where it travels in the sinus cavernosus, makes an s-curve, then passes between cn2-3 and divides into terminal branches.  Cavernous part Branches supply the trigeminal ganglion, the walls of the cavernous and inferior petrosal sinuses, and the nerves contained therein. meningeal branch passes over the lesser wing of the sphenoid to supply the dura mater and bone in the anterior cranial fossa, and also anastomoses with a meningeal branch of the posterior ethmoidal artery. Numerous small hypophysial branches supply the neurohypophysis  Entering the cranial cavity each internal carotid artery gives off the ophthalmic artery, the posterior communicating artery, the middle cerebral artery, and the anterior cerebral artery ophthalmic artery The arterial supply to the structures in the orbit, including the eyeball, is by the ophthalmic artery This vessel is a branch of the internal carotid artery, given off immediately after the internal carotid artery leaves the cavernous sinus. The ophthalmic artery passes into the orbit through the optic canal with the optic nerve ophthalmic artery branches the lacrimal artery, which arises from the ophthalmic artery on the lateral side of the optic nerve, and passes anteriorly on the lateral side of the orbit, supplying the lacrimal gland, muscles, the anterior ciliary branch to the eyeball, and the lateral sides of the eyelid Zygomaticofacial and zygomaticotemporal arteries come from the lacrimal branch, enter the face through the zygomaticofacial and zygomaticotemporal foramina, and supply the area of the face over the zygomatic bone.  the long and short posterior ciliary arteries, which are branches that enter the eyeball posteriorly, piercing the sclera, and supplying structures inside the eyeball; the muscular arteries, which are branches supplying the intrinsic muscles of the eyeball  central retinal artery which enters the optic nerve, proceeds down the center of the nerve to the retina, and is clearly seen when viewing the retina with an ophthalmoscope-occlusion of this vessel or of the parent artery leads to blindness  The supratrochlear (which is one of the two terminal branches of the ophthalmic artery) and supra-orbital arteries branch from the ophthalmic artery while it is in the orbit Continue through the orbit, and exit onto the forehead in association with the supratrochlear and supra-orbital nerves. the arteries ascend across the forehead to supply the scalp as far posteriorly as the vertex of the head.  the posterior ethmoidal artery, which exits the orbit through the posterior ethmoidal foramen to supply the ethmoidal cells and nasal cavity the anterior ethmoidal artery, which exits the orbit through the anterior ethmoidal foramen, enters the cranial cavity giving off the anterior meningeal branch, and continues into the nasal cavity supplying the septum and lateral wall, and ending as the dorsal nasal artery dorsal nasal artery An other terminal branch of the ophthalmic artery, exits the orbit in the medial corner, and supplies the dorsum of the nose. References