Anatomy of CVS

4. Blood Vessels of the

Head & Neck
DR. MOHAMAD BAKER ABU-SNAINA
GENERAL SURGEON
 Common Carotid Artery
 The right common carotid artery
arises from the brachiocephalic artery
behind the right sternoclavicular joint.
 The left common carotid artery arises
from the arch of the aorta in the
superior mediastinum.
• The CCA runs upward through the
neck under cover of the anterior
border of the sternocleidomastoid
muscle, from the sternoclavicular joint
to upper border of the thyroid
cartilage where it divides into the
external & internal carotid arteries,
otherwise it gives off no branches
Relations of the Common Carotid Artery
• Anterolaterally: The skin, the fascia,
the sternocleidomastoid, sternohyoid,
sternothyroid, & superior belly of the
omohyoid.
• Posteriorly: The transverse processes
of the lower four cervical vertebrae,
the prevertebral muscles, and the
sympathetic trunk, In the lower part
of the neck are the vertebral vessels.
• Medially: The larynx & pharynx,
below these, the trachea &
esophagus, lobe of the thyroid gland.
• Laterally: The internal jugular vein
posterolaterally, the vagus nerve.
 Carotid Sinus
• Is localized dilatation at the terminal
part of the CCA or the beginning of
the internal carotid artery.
• The tunica media of the sinus is
thinner than elsewhere, but the
adventitia is relatively thick &
contains numerous nerve endings
derived from glossopharyngeal
nerve.
• It serves as a reflex pressoreceptor
mechanism, a rise in blood pressure
causes slowing of heart rate &
vasodilatation of the arterioles.
 Carotid Body
• Is a small structure that lies
posterior to the point of
bifurcation of the common carotid
artery.
• It is innervated by the
glossopharyngeal nerve.
• The carotid body is a
chemoreceptor, being sensitive to
excess carbon dioxide & reduced
oxygen tension in the blood.
• Such a stimulus reflexly produces a
rise in blood pressure & heart rate
& an increase in respiratory
movements.
 External Carotid Artery ECA
• Begins at the level of the upper border
of the thyroid cartilage.
• Terminates in the substance of the
parotid gland behind the neck of the
mandible by dividing into superficial
temporal & maxillary arteries.
• It supplies structures in the neck, face
scalp, tongue & the maxilla.
• Close to its origin, the artery emerges
from undercover of the SCM muscle,
where its pulsations can be felt.
• At first, it lies medial to the internal
carotid artery, but as it ascends in the
neck, it passes backward & lateral.
 Relations of the ECA
 Anterolaterally:
• Overlapped at its beginning by anterior border
of SCM & above this level, it is superficial,
being covered by skin & fascia.
• It is crossed by the hypoglossal nerve, the
posterior belly of the digastric muscle & the
stylohyoid muscles.
• Crossed by facial nerve within parotid gland.
• The internal jugular vein first lies lateral to the
artery & then posterior to it.
 Medially: The wall of pharynx & ICA.
• Stylopharyngeus muscle, the glossopharyngeal
nerve & the pharyngeal branch of the vagus
pass between the ECA & ICA.
 Branches of the ECA
• Superior thyroid artery.
• Ascending pharyngeal artery.
• Lingual artery.
• Facial artery.
• Occipital artery.
• Posterior auricular artery.
• Superficial temporal artery.
• Maxillary artery.
 Branches of the ECA
Superior Thyroid Artery
• Curves downward to the upper pole
of the thyroid gland.
• It is accompanied by the external
laryngeal nerve, which supplies the
cricothyroid muscle.
Ascending Pharyngeal Artery
• Ascends along & supplies the
pharyngeal wall.
Lingual Artery
• loops upward & forward & supplies
the tongue.
 Branches of the ECA
 The facial artery
• loops upward close to the outer surface
of the pharynx & the tonsil.
• It lies deep to the submandibular salivary
gland & bends around the lower border
of the mandible.
• It then ascends over the face close to the
anterior border of the masseter muscle.
• Then ascends around the lateral margin
of the mouth & terminates at the medial
angle of the eye.
• Branches of the facial artery supply the
tonsil, the submandibular salivary gland &
muscles & skin of the face.
 Branches of the ECA
Occipital Artery
• Supplies the back of the scalp.
Posterior Auricular Artery
• Supplies the auricle and the scalp.
Superficial Temporal Artery
• Ascends over the zygomatic arch,
where it may be palpated just in
front of the auricle.
• It is accompanied by the
auriculotemporal nerve & it
supplies the scalp.
 Branches of the ECA
Maxillary Artery: it runs forward
medial to the neck of mandible & enters
the pterygopalatine fossa of the skull.
• It gives off many branches one of them is
the middle meningeal artery.
• Branches supply the upper & the lower
jaws, the muscles of mastication, the
nose, the palate & the meninges.
o Middle Meningeal Artery: Enters the skull
through the foramen spinosum
• It runs laterally within the skull & divides
into anterior & posterior branches.
• The anterior branch is important because
it lies close to the motor area of the
cerebral cortex of the brain.
 Internal Carotid Artery ICA
• It begins at the bifurcation of the
common carotid artery at the level of
the upper border of the thyroid
cartilage.
• It supplies the brain, the eye, the
forehead & part of the nose.
• The artery ascends in the neck
embedded in the carotid sheath with
the internal jugular vein & vagus
nerve.
• At first it lies superficially; it then
passes deep to the parotid salivary
gland.
 Internal Carotid Artery ICA
• leaves the neck by passing into
the cranial cavity through the
carotid canal in the petrous part
of the temporal bone.
• It then passes upward & forward
in the cavernous venous sinus.
• Then passes upward again medial
to the anterior clinoid process of
the sphenoid bone.
• Then inclines backward, lateral to
the optic chiasma.
• Terminates by dividing into the
anterior & the middle cerebral
arteries.
 Relations of the ICA in the Neck
 Anterolaterally
• Below the digastric: skin, fascia, anterior
border of the SCM & hypoglossal nerve.
• Above the digastric: the stylohyoid & the
stylopharyngeus muscle, glossopharyngeal
nerve, the pharyngeal branch of the vagus,
the parotid gland & the ECA.
 Posteriorly:
• The sympathetic trunk, the longus capitis
muscle, & the transverse processes of the
upper three cervical vertebrae.
 Medially:
• Pharyngeal wall & superior laryngeal nerve
 Laterally:
• The internal jugular vein & the vagus nerve
 Branches of ICA
 No branches in the neck.
 Ophthalmic Artery
• It arises from the internal carotid
artery as it emerges from the
cavernous sinus.
• Passes forward into the orbital
cavity through the optic canal, & it
gives off the central artery of the
retina which is an end artery & the
only blood supply to the retina.
 Posterior Communicating Artery
• Runs backward to join the
posterior cerebral artery.
 Branches of the ICA
 Anterior Cerebral Artery
• This is a terminal branch of the
internal carotid artery.
• It passes forward between the
cerebral hemispheres.
• Supply the medial & the
superolateral surfaces of the
cerebral hemisphere.
• It is joined to the artery of the
opposite side by the anterior
communicating artery.
 Branches of the ICA
 Middle Cerebral Artery
• The largest terminal branch of the internal carotid artery.
• Supplies the entire lateral surface of the cerebral
hemisphere except:
 The narrow strip along the superolateral margin (which is
supplied by the anterior cerebral artery)
 The occipital pole & inferolateral surface of the
hemisphere (both of which are supplied by the posterior
cerebral artery).
• Thus it supplies all the motor area except the leg area.
• It also gives off central branches that supply central
masses of gray matter & the internal capsule of the brain.
 Circle of Willis
• lies in the subarachnoid space at the
base of the brain.
• Formed by the anastomosis
between the branches of:
 The two internal carotid arteries.
 The two vertebral arteries. (branch
of subclavian)
• The anterior communicating,
posterior cerebral & basilar (formed
by the junction of the two vertebral
arteries) are all arteries that
contribute to the circle.
• Cortical & central branches arise
from the circle & supply the brain.
 Subclavian Arteries
 Right Subclavian Artery: arises from
the brachiocephalic artery, behind the
right sternoclavicular joint then arches
upward & laterally over the pleura.
• At the outer border of 1st rib, it
becomes the axillary artery.
 Left Subclavian Artery
• Arises from the arch of aorta.
• Ascends to the root of the neck &
arches laterally similar to right
subclavian artery.
• The scalenus anterior muscle passes
anterior to the artery divides it into
three parts, 1st ,2nd & 3rd parts.
First Part of the Subclavian Artery
• Extends from the origin of the
subclavian artery to the medial
border of the scalenus anterior
muscle.
• This part gives off:
“Branches of 1ST Part of
Subclavian Artery”
 Vertebral artery.
 Thyrocervical trunk.
 Internal thoracic artery
 The vertebral artery
• Ascends in the neck through the
foramina in the transverse processes
of the upper six cervical vertebrae.
• Passes medially above the posterior
arch of the atlas & ascends through
the foramen magnum into the skull.
• On reaching the anterior surface of
the medulla oblongata it joins the
vessel of the opposite side to form
the basilar artery.
• Branches in the neck: Spinal &
muscular arteries.
• Branches in the skull: Meningeal,
ant. & post. spinal, posterior inferior
cerebellar & medullary arteries.
 The thyrocervical trunk
• A short trunk that gives off three
terminal branches.
 The inferior thyroid artery
ascends to the posterior surface
of the thyroid gland, It supplies
the thyroid & the inferior
parathyroid glands.
 The superficial cervical artery is
a small branch that crosses the
brachial plexus.
 The suprascapular artery runs
laterally over the brachial plexus
to reach the back of the scapula.
 The internal thoracic artery
• The internal thoracic artery
descends into the thorax behind
the 1st costal cartilage & in
front of the pleura.
• It descends vertically one
fingerbreadth lateral to the
sternum; in the sixth intercostal
space, it divides into the
superior epigastric & the
musculophrenic arteries.
 Second Part of the Subclavian Artery
• The second part of the
subclavian artery lies behind
the scalenus anterior muscle.
 Branches
• The costocervical trunk runs
backward over the dome of the
pleura & divides into the:
 Superior intercostal artery,
which supplies the 1st & the 2nd
intercostal spaces.
 Deep cervical artery, which
supplies the deep muscles of
the neck.
Third Part of the Subclavian Artery
• Extends from the lateral border of
the scalenus anterior muscle across
the posterior triangle of the neck to
the lateral border of the 1st rib, to
become the axillary artery.
• In the root of the neck, it is closely
related to the brachial plexus.
 Branches
• Usually has no branches.
• Occasionally, the superficial cervical
arteries, the suprascapular arteries,
or both arise from this part.
 Veins of the Head & Neck
• They may be divided into:
The veins of the brain,
venous sinuses, diploic
veins & emissary veins.
The veins of scalp, face &
neck.
 Veins of the Head
 Veins of the Brain
• The veins of the brain are thin
walled & have no valves.
• They consist of the cerebral veins,
the cerebellar veins, & the veins
of the brainstem, all of which
drain into the neighboring venous
sinuses.
 Venous Sinuses
• Situated between the periosteal
& the meningeal layer of the dura
mater.
• They have thick, fibrous walls, but
they possess no valves.
 Veins of the Head
 Diploic Veins
• The diploic veins occupy
channels within the bones of
the vault of the skull
 Emissary Veins
• They are valveless veins that
pass through the skull bones.
• They connect the veins of the
scalp to the venous sinuses
(& are an important route for
the spread of infection).
 Veins of the Face & the Neck
Facial Vein
Maxillary Vein
Superficial Temporal Vein
Retromandibular Vein
Anterior Jugular Vein
External Jugular Vein
Internal Jugular Vein
Subclavian Vein
 Veins of the Face & the Neck
 Facial Vein
• Formed at the medial angle of the
eye by the union of the supraorbital
& supratrochlear veins.
• Connected through the ophthalmic
veins with the cavernous sinus.
• Descends down the face with the
facial artery & passes around the
lateral side of the mouth & crosses
the mandible.
• Joined by the anterior division of the
retromandibular vein & drains into
the internal jugular vein.
 Veins of the Face & the Neck
 Maxillary Vein
• Formed in the infratemporal fossa
from the pterygoid venous plexus.
• Joins the superficial temporal vein to
form the retromandibular vein.
 Superficial Temporal Vein
• Formed on the side of the scalp.
• It follows the superficial temporal
artery & the auriculotemporal nerve &
then enters the parotid salivary gland,
where it joins the maxillary vein to
form the retromandibular vein.
 Veins of the Face & the Neck
 Retromandibular Vein
• Formed by the union of superficial
temporal & maxillary veins.
• On leaving the parotid salivary gland, it
divides into an anterior branch, which
joins the facial vein & posterior branch,
which joins the posterior auricular vein
to form the external jugular vein.
 Anterior Jugular Vein
• It descends in the front of the neck
close to the midline.
• Just above the sternum, it is joined to
the opposite vein by the jugular arch.
• It joins the external jugular vein deep
to the SCM muscle.
 Veins of the Face & the Neck
 External Jugular Vein
• Formed behind the angle of the jaw by
the union of the posterior auricular vein
with the posterior division of the
retromandibular vein.
• It descends across the SCM muscle &
beneath the platysma muscle & drains
into the subclavian vein behind the
middle of the clavicle.
• Tributaries
 Posterior external jugular vein
 Transverse cervical vein
 Suprascapular vein Anterior jugular vein.
 Veins of the Face & the Neck
 Internal Jugular Vein
• A large vein that receives blood from
the brain, face & neck.
• It starts as a continuation of the
sigmoid sinus & leaves the skull
through the jugular foramen.
• Descends in the carotid sheath Tributaries of Internal
lateral to the vagus nerve & the Jugular
internal & common carotid arteries. • Inferior petrosal sinus.
• It ends by joining the subclavian vein • Facial vein.
behind the medial end of the clavicle • Pharyngeal veins.
to form the brachiocephalic vein. • Lingual vein.
• It is closely related to the deep • Superior thyroid vein.
cervical lymph nodes. • Middle thyroid vein.
 Veins of the Face & the Neck
Subclavian Vein
• Is a continuation of the axillary vein at
the outer border of 1st rib.
• It joins the internal jugular vein to form
the brachiocephalic vein & it receives
the external jugular vein.
• In addition, it often receives the thoracic
duct on the left side & the right
lymphatic duct on the right.
o Relations
• Anteriorly: The clavicle
• Posteriorly: The scalenus anterior muscle
& the phrenic nerve
• Inferiorly: The upper surface of the 1st rib