Arterial Supply of the H&N 2024 PDF

Arterial supply of the H&N DENT2074 Head & Neck Anatomy Semester 2, 2024 Dr. Sepanta Hosseinpour DDS, MPH, PhD School of Dentistry, The University of Queensland, Brisbane, Australia https://www.pexels.com/ This lecture… By...

Arterial supply of the H&N DENT2074 Head & Neck Anatomy Semester 2, 2024 Dr. Sepanta Hosseinpour DDS, MPH, PhD School of Dentistry, The University of Queensland, Brisbane, Australia https://www.pexels.com/ This lecture… By the end of this lecture, you should be able to: Appreciate course and divisions of the common carotid artery (CCA) Appreciate course and divisions of the internal carotid artery (ICA) Appreciate course and divisions of the external carotid artery (ECA) Suggested additional reading: Head and neck anatomy for dental medicine / edited by Eric W. Baker ; based on the work of Michael Schuenke, Erik Schulte, Udo Schumacher ; illustrations by Markus Voll, Karl Wesker. New York : Thieme, c2010. 2 Overview https://www.smithsonianmag.com/smart-news/blood-vessels-left-imprint-2000-year-old-mummy-180952882/ Structure and functions of arteries Part of the circulatory system Carries oxygenated blood back to the organs Large muscle https://ib.bioninja.com.au/standard-level/topic-6-human-physiology/62-the-blood-system/arteries.html Arterial systems: Subclavian artery https://www.smithsonianmag.com/smart-news/blood-vessels-left-imprint-2000-year-old-mummy-180952882/ The Subclavian Artery It is the chief arterial supply of the upper limb, and the root of the neck contributing branches to the head and the brain. The right artery is a branch of the innominate (brachio-cephalic) artery, whereas the left one is a branch of the arch of the aorta. The Subclavian Artery The 3 parts of the Subclavian Artery as it relates to the Scalenus Anterior Muscle: Medial Part has 3 Branches Vertebral Thyrocervical trunk Internal Thoracic Posterior Part has 2 Branches Costocervical trunk Dorsal Scapula (may also arise form the Costocervical trunk) Lateral Part has 0 Branches The Subclavian Artery Branches Branches of the First/ Medial Part: The Vertebral Artery: It is the first and largest branch, it shares in the formation of the vertebro-basilar system of "the Circle of Willis" supplying the brain. The course of the artery is divided into 4 parts. The First Part/ Segment: From origin to transverse process of C6 vertebra The Second Part/ Segment: Runs through the foramen transversaria of upper 6 cervical vertebrae The Third Part/ Segment: Lies in the suboccipital triangle The Fourth Part/ Segment : Runs in the posterior cranial fossa on the antero-lateral aspect of the medulla oblongata and unites with the other artery to form the Basilar Artery (travels along the ventral aspect of the brainstem). The Basilar Artery Arterial systems: Carotid artery https://www.smithsonianmag.com/smart-news/blood-vessels-left-imprint-2000-year-old-mummy-180952882/ The Common Carotid Artery It is the main arterial supply to the head and neck. The Right artery is a branch of the innominate (brachio-cephalic), and the left one is a branch from the aortic arch. The arteries of the two sides lie deep at the root of the neck where they are separated by a narrow interval. The Internal Carotid Artery Arises at the upper border of the thyroid cartilage, to enter the infratemporal region. It extends along the side of the pharynx until it reaches the base of the skull, where it enters the carotid canal. The beginning of the artery shows the dilatation of the "carotid sinus" in which walls are contained "the baroreceptors" regulating the blood pressure. (Carotid sinus and carotid body are both supplied by the glossopharyngeal nerve). The internal carotid artery is really external (lateral) to the external carotid at its origin, but soon slopes up posteriorly to occupy a medial and deeper level. Branches : no branches in the neck Course of Internal Carotid The internal carotid artery enters the lower opening of the carotid canal in the petrous temporal bone. Within the carotid canal it turns 90 degrees anteromedially to run through the petrous temporal bone. It then turns 90 degrees superiorly to pass across the upper limit of the foramen lacerum into the cranial cavity. Branches of ICA Petrous part Carotico-tympanic arteries Pterygoid branch Cavernous part The hypophyseal branches to the pituitary gland. The meningeal branches Cerebral part 1- The ophthalmic artery 2- The posterior communicating artery 3- The anterior choroidal artery 4- The anterior cerebral artery 5- The middle cerebral artery The External Carotid Artery Course: This artery supplies the extracranial structures. It arises in the carotid triangle as a terminal branch of the common carotid opposite the upper border of the thyroid cartilage (C4). The artery leaves the triangle deep to the digastric muscle, runs upwards and backwards to enter the submandibular and parotid regions where it ends in the parotid gland behind the neck of the mandible by dividing into the superficial temporal and maxillary branches. Arterial systems: Branches of ECA https://www.smithsonianmag.com/smart-news/blood-vessels-left-imprint-2000-year-old-mummy-180952882/ Branches of ECA Mostly arise in the carotid triangle at different levels related to the tip of the greater horn of the hyoid bone. 1. The ascending pharyngeal artery 2. The superior thyroid artery 3. The lingual artery 4. The facial artery 5. The occipital artery 6. The posterior auricular artery 7. The maxillary artery 8. The superficial temporal artery Branches of ECA Anatomically, before the ECA enters the parotid gland the ECA gives off six branches; three from in front, two from behind and one deep (medial). Three in front are: Superior thyroid, lingual, facial Two from behind are: Occipital and posterior auricular One from the medial is: Ascending pharyngeal The Superior Thyroid Artery Course: Arises from the anterior surface of the external carotid (near the commencement) just below the tip of the greater horn of the hyoid bone, descends almost vertically downwards, with the vein, to the upper pole of the thyroid gland. Close behind it is the external laryngeal nerve. Branches: 1. The infra-hyoid artery. 2. The superior laryngeal artery. 3. Sterno-mastoid branches to the sterno- mastoid muscle. 4. The crico-thyroid artery, runs along the cricothyroid muscle and membrane anastomosing with the opposite side. The Lingual Artery It arises from the anterior surface of the external carotid artery opposite the tip of the greater horn of the hyoid bone above the superior thyroid artery. It forms a short upward loop, then passes forwards along the upper border of the greater horn of the hyoid bone, deep to the hyoglossus muscle, before it enters the submandibular region. Its course is divided into three parts, relative to the hyoglossus muscle. The Facial Artery Course: The artery arises in the carotid triangle from the anterior surface of the external carotid, above the lingual artery. It leaves the carotid region, running upwards to enter the sub-mandibular region deep to the submandibular salivary gland. It indents the surface of the gland. It makes an S- bend, curling down over the submandibular gland reaching the lower border of the mandible, it hooks around it. It thus enters the face at the antero-inferior angle of the masseter muscle, where it ascends upwards towards the angles of the mouth, the nose and eye. The course of the artery is tortuous, so that it can accommodate itself to the movements of the pharynx during deglutition and the mandible during opening of the mouth. The Facial Artery Branches of cervical part: 1. The ascending palatine artery 2. The tonsillar artery 3. Glandular branches, to the sub-mandibular salivary gland. 4. The submental artery (largest branch of the cervical portion) The Facial Artery Branches of the facial part: 1. The inferior labial artery: supplies the lower lip anastomosing with the other side to form the inferior labial arch. 2. The superior labial artery: supplies the upper lip 3. Anastomosing with the other side to from the superior labial arch 4. The lateral nasal branches : supply the ala of the nose 5. Angular artery: ends as angular artery which anastomoses with the infraorbital artery 6. Muscular branches: supply adjacent muscle. Posterior belly of digastric, stylohyoid, styloglossus, mylohyoid and the medial pterygoid muscle. The Occipital Artery The Posterior Auricular Artery The Superficial Temporal Artery Branches : 1. The transverse facial artery. 2. The anterior auricular artery. 3. The zygomatico-orbital branch 4. The middle temporal artery: it is the largest branch, arises above the zygomatic arch, pierces the temporal fascia and runs deep to the temporalis muscle supplying it and grooving the bone just above the external acoustic meatus. 5. The terminal frontal and parietal branches. The superficial temporal artery, it is a terminal branch of the external carotid, arises behind the neck of the mandible within the substance of the parotid gland. Arterial systems: The Maxillary Artery https://www.smithsonianmag.com/smart-news/blood-vessels-left-imprint-2000-year-old-mummy-180952882/ The Maxillary Artery Is the larger terminal branch, arises in the parotid region and ends in the pterygo-palatine fossa where it becomes the infra-orbital artery. Course: It arises behind and deep to the neck of the mandible, and runs forwards until it reaches the lower border of the lateral pterygoid muscle (First or Mandibular part). It then crosses the lower head of the lateral pterygoid (Second or Pterygoid part), and finally dips medially between the two heads of the muscle to enter the pterygo-palatine fossa (Third or Pterygo- palatine part). Branches of Maxillary Artery Branches of Maxillary Artery First Part (Mandibular) Branches 1. The deep auricular artery 2. The anterior tympanic artery 3. The middle meningeal artery 4. The accessory meningeal artery 5. The inferior alveolar artery: is the largest branch of the first part, descends downwards and forwards behind its own nerve. The Inferior alveolar artery Branches : 1. The mylohyoid artery: accompanies the mylohyoid nerve in the mylohyoid groove of the mandible. It anastomoses with the submental branch of the facial artery. 2. The incisor/dental branch: arises in the mandibular canal opposite the third molar tooth, supplies branches to the pulps of the teeth and finally anastomoses with the opposite side. 3. The mental artery: leaves the mandible through the mental foramen to supply the chin region and anastomose with the inferior labial and submental branches of the facial artery. Third Part (Pterygo-Palatine) Branches 1.The posterior superior alveolar artery: enters the back of the maxilla and supplies branches to the molar and premolar teeth, accompanying the branches of the maxillary nerve. 2. The greater palatine artery: descends through the greater palatine canal with its nerve to reach the greater palatine foramen on the hard palate. It then runs forward in the groove between the palate and the alveolar part of the maxilla till it reaches the incisive fossa. 2-3 lesser palatine branches are given to supply the tonsil and the soft palate. The Greater Palatine Artery Third Part (Pterygo-Palatine) Branches 3. Pharyngeal branches. 4. The artery to the pterygoid canal. 5. The spheno-palatine artery : is a long slender branch that leaves pterygopalatine fossa, through the spheno-palatine foramen to enter the posterior part of the nasal cavity where it gives nasal branches supplying the nasal and paranasal tissues and the anterior part of the palate. The Infra-Orbital Artery Branches : 1. Zygomatic branch, divides into zygomatico-facial and zygomatico- temporal branches. 2. Middle superior alveolar artery, supplies the sockets of the premolar teeth and their pulp spaces. 3. Orbital branches, to the contents of the orbit. 4. Anterior superior alveolar artery : supplies the socket and pulp spaces of the canine and incisors 5. Terminal palpebral, nasal and labial branches. Summary Structure and functions of arteries. The Subclavian Artery: Medial Part has 3 Branches: Vertebral, Thyrocervical trunk, Internal Thoracic. Posterior Part has 2 Branches, Costocervical trunk, Dorsal Scapula. Lateral Part has 0 Branches. Each CCA divides at the upper border of the thyroid cartilage (C4) into external and internal carotid branches. ECA branches: The ascending pharyngeal artery, The superior thyroid artery, The lingual artery, The facial artery, The occipital artery, The posterior auricular artery, The maxillary artery, and The superficial temporal artery. ICA branches: Petrous part: Carotico-tympanic arteries, and Pterygoid branch Cavernous part: The hypophyseal branches to the pituitary gland and the meningeal branches Cerebral part: The ophthalmic artery, The posterior communicating artery, The anterior choroidal artery, The anterior cerebral artery, and The middle cerebral artery Questions?  Thank you Dr Sepanta Hosseinpour DENT2074 course coordinator School of Dentistry The University of Queensland UQ Oral Health Centre (Rm 7423) 288 Herston Road, Herston Qld 4006 Australia Phone: +61 7 33658160 Email: [email protected] CRICOS code 00025B