Blood Supply to the Head and Neck Part 1 PDF

Blood Supply to the Head and Neck – Arterial Supply Josh Hudson Oral and Dental Sciences GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management Intended learning outcomes By the end of this...

Blood Supply to the Head and Neck – Arterial Supply Josh Hudson Oral and Dental Sciences GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management Intended learning outcomes By the end of this session you will be able to.. Name the major arteries in the head and neck Explain what areas these main arteries supply Describe the important relations and branches of the common carotid artery Describe the important relations and branches of the external carotid artery Why do I need to know this? Why do I need to know this? We are working in a very complicated area, often putting sharp things into it! Need to be aware of the blood supply to the different areas we are working Need to know location of important vessels to avoid them Need to know what is considered ‘normal’ to identify deviations from this How is best to learn this? How is best to learn this? Unfortunately, as with a lot of anatomy this is a challenge! If you engage with the content and use resources available to you it should not put you to sleep. Ultimately comes down to three things 1) Take the time to really look at this a memorise 2) Learn pneumonic which are of relevance to you! 3) Use resources Where do I start?  Wikipedia. (2022) Aortic Arch [Photograph]. Available from: https://en.wikipedia.org/wiki/Aortic_arch [Accessed: 17th August 2022] Lets start with the basics.. So to keep things simple, lets start with the basics. Where does the main arterial blood supply to the head and neck originate from? We need to consider the arch of the aorta which gives rise to the brachiocephalic, left common carotid and right subclavian. Lets start with the basics.. This may be confusing but this gives a broad overview of where the blood supply goes from here.. The brachiocephalic gives rise to the right subclavian as well as the right common carotid arteries. The right subclavian gives rise to the right vertebral. The right common carotid forms the internal and external carotid. Lets start with the basics.. The arch of the aorta gives rise to the left subclavian as well as the left common carotid arteries directly. The left subclavian gives rise to the left vertebral. The left common carotid gives rise to the the internal and external carotid, the same as on the right. The right and left vertebral arteries supply blood to the spinal cord and vertebral muscles.  Wikipedia. (2022) Aortic Arch [Photograph]. Available from: https://en.wikipedia.org/wiki/Aortic_arch [Accessed: 17th August 2022] What next? First we will consider the common carotid arteries. The left common carotid comes directly from the arch of the aorta and the right common carotid comes from the brachiocephalic artery.  Kenhub. (2022) Common Carotid [Photograph]. Available from: https://www.kenhub.com/en/library/anatomy/common-carotid-artery [Accessed: 17th August 2022] Where next? These right and left common carotid arteries go on to supply both sides of the head and neck in a mirror image. Both the right and left common carotid arteries split into two main branches Internal carotid artery External carotid artery  Kenhub. (2022) Common Carotid [Photograph]. Available from: https://www.kenhub.com/en/library/anatomy/common-carotid-artery [Accessed: 17th August 2022] Where next? As shown in this diagram, the internal carotid artery goes deep within the face, through the carotid canal in the base of the skull (behind the eyes) and into the cranial cavity. Ultimately this supplies the brain, eyes, forehead and part of the nose with the left and right versions supplying each side.  Kenhub. (2022) Common Carotid [Photograph]. Available from: https://www.kenhub.com/en/library/anatomy/common-carotid-artery [Accessed: 17th August 2022] Where next? As shown in this diagram, the external carotid artery remains more superficial and branches to supply many superficial elements of the head and neck. Ultimately this supplies the neck, face, scalp, tongue and maxilla Where next? Te Su m p p e o r fi ral cial As shown in this diagram, the Po ricu Au ste lar external carotid artery splits rio into 8 main branches. These are r the superior thyroid, ascending pharyngeal, Maxillary lingual, facial, occipital, O cc posterior auricular, l Facia ip ita superficial temporal and l Lingual As aryng maxillary. Ph ce nd eal ior ing p e r These then go on to supply the Su id ro various structures within the head Thy and will be discussed shortly. External Carotid How is best to learn this? How to remember this? The easiest way to learn this is through a pneumonic. The more random the better! (I can still remember mine from university but not suitable to share..) A more sensible option is shown on the next slide How to remember this? S = Superior Thyroid = She A = Ascending Pharyngeal = Always L = Lingual = Likes F = Facial = Friends O = Occipital = Over P = Posterior Auricular = Papa S = Superficial Temporal = Sister M = Maxillary = Mama That’s fine but what do these branches supply? What do these branches supply? These branches supply a whole host of areas in the head and neck. Some of these are more important than others. Detailed on the next few slides are the main dentally relevant supply of each (these lists are not exhaustive). Superior Thyroid = Thyroid gland, some muscles of the neck and larynx Ascending Pharyngeal = Pharynx, soft palate and prevertebral muscles What do these branches supply? Dorsal Lingual Artery Deep Lingual Artery Lingual Artery The lingual artery supplies important structures so we will cover this in a little more detail. It further splits into; 1) Sublingual 2) Dorsal lingual Sublingual Artery Lingual Artery 3) Deep lingual What do these branches supply? Dorsal Dorsal Lingual = This Deep Lingual Artery Lingual supplies the base of the Artery tongue, palatoglossal arch, tonsils, soft palate and epiglottis Sublingual = Supplies the sublingual gland, muscles in the floor of the mouth and Sublingual Artery buccal and gingival mucous Lingual Artery membranes What do these branches supply? Dorsal Deep Lingual = This is the Deep Lingual Artery Lingual terminal part of the lingual Artery artery and gives blood supply to the body of the tongue KEY LEARNING POINTS The lingual artery supplies the tongue, sublingual gland and Sublingual Artery buccal/gingival mucous Lingual Artery membranes What do these branches supply? Facial Artery The facial artery is another vessel that supplies important structures. This branches multiple times to ultimately supply the muscles and skin of the face and the submandibular gland.  Kenhub. (2022) Occipital Artery [Photograph]. Available from: https://www.kenhub.com/en/library/anatomy/occipital-artery [Accessed: 17th August 2022] What do these branches supply? Occipital Artery This artery supplies muscles in the posterior neck, skin of the neck and ear as well as the scalp in the occipital region.  Musculoskeletal Key. (2016) The Posterior Auricular Artery [Photograph]. Available from: https://musculoskeletalkey.com/the-posterior-auricular-artery/ [Accessed: 17th August 2022] What do these branches supply? Posterior Auricular Artery This artery supplies muscles in the posterior neck, skin over and around the ear and the ear structures. Posterior Auricular Artery  Kenhub. (2022) Superficial Temporal [Photograph]. Available from: https://www.kenhub.com/en/library/anatomy/superficial-temporal-artery [Accessed: 17th August 2022] What do these branches supply? Superficial Temporal Artery This artery supplies some of the skin and muscles of the scalp, parotid gland and temporomandibular joint. This is one of the two terminal branches of the external carotid along with the maxillary artery.  Wikipedia. (2022) Accessory Meningeal Artery [Photograph]. Available from: https://commons.wikimedia.org/wiki/File:Assessory_meningeal_artery.png [Accessed: 17th August 2022] What do these branches supply? Maxillary Artery The maxillary artery also supplies important structures so we will cover this in a little more detail. As can be seen from the image, this is a very complex vessel and there is no need to learn all of these branches!  Wikipedia. (2022) Accessory Meningeal Artery [Photograph]. Available from: https://commons.wikimedia.org/wiki/File:Assessory_meningeal_artery.png [Accessed: 17th August 2022] What do these branches supply? Maxillary Artery This ultimately supplies blood to everywhere else. This includes the whole maxillofacial region including; the hard and soft tissues of the maxilla, mandible, nasal cavity and deep facial areas. What do these branches supply? The Teeth Maxillary Artery Superior The maxillary teeth are Alveolar Artery supplied by the maxillary Descending Palatine Artery artery. A branch of this is Inferior Alveolar the superior alveolar Artery artery which splits into posterior, middle and Incisive Branch Internal of Inferior Alveolar anterior branches. These Carotid Artery Artery Dental Branch branches then go on to of Inferior Alveolar Mental Artery supply each of the maxillary Common External Artery teeth depending on their Carotid Artery Carotid Artery position. What do these branches supply? The Teeth Maxillary Artery Superior The mandibular teeth are Alveolar Artery also supplied by the Descending Palatine maxillary artery. A Artery branch of this is the Inferior Alveolar inferior alveolar artery Artery which forms a dental branch, incisive branch Incisive Branch and the mental artery. Internal of Inferior Alveolar These branches then go on Carotid Artery Dental Branch Artery to supply each of the of Inferior Alveolar Mental Artery mandibular teeth Common External Artery depending on their Carotid Artery Carotid Artery position. Summary The arterial supply to the head and neck is complicated Ultimately need to be aware of two main bilateral vessels (internal/external carotid) External carotid gives rise to the blood supply of most of the mouth and face Key branches are; lingual, facial and maxillary branches for the areas we are working Need to have an awareness of other branches Caveat Not everyone is the same and because of this, not all vessels join the same in every case. Due to this, when you undertake further reading you may find some references may have things in a slightly different order as there may be debate on what the most common presentation is. References Image credit; Wikipedia, Kenhub.com, anatomy.tv Resources; Kenhub.com – Invaluable resource for further information Anatomy.tv – You all have access to this interactive anatomy package https://www.youtube.com/watch?v=kJf8wdJPZeQ