You are on page 1of 119

ARTERIAL & VENOUS

SUPPLY OF HEAD & NECK


Dr.Ganesh Kulkarni
PG student

CONTENTS

Introduction
Types of Vessels
Arteries of head and neck region
- External Carotid Artery
- Internal Carotid Artery
Veins of head and neck region
- External Veins
- Dural venous Sinuses
Summary
References
2

INTRODUCTION
THE

CARDIOVASCULAR
SYSTEM
Heart
Blood vessels

Series

of tubes (vessels)
that circulate blood around
the body is the vascular
system

The vascular system is made up of 3 main type of blood


vessels
Arteries
carry blood away from the heart
Capillaries
allow for exchange of materials between the blood and the
cells of the body
Veins
carry blood back to the heart

Types of vessels
1. Aorta (elastic recoil)
Numerous layers of elastin fibers b/w

smooth ms.

Expand when the pressure of the blood rises.

Act as recoil system when ventricles relax.

2. Arteries (muscular, low resistance


vessels)

Less elastic & have a thicker layer of smooth


ms.
Diameter changes slightly as BP raises &
falls.

3. Arterioles (high resistance vessels)


5

Contain highest % smooth muscle.

4. Capillaries (exchange vessels)


Smallest blood vessels.

1 endothelial cell thick.


Provide direct access to cells.
Permits exchange of nutrients & wastes.

5. Venules

Formed when capillaries unite.


Very porous.

6.

Veins
Contain little smooth muscle or elastin.

2/3 of total blood volume is located in


veins ( 70%).

Contain 1-way valves that ensure blood flow to the


heart.

Aorta
is the largest artery in thebody, originating
from theleft ventricleof theheart.
The aorta distributes oxygenated blood to all
parts of the body through thesystemic
circulation

Ascending aorta

5 cm long, begins at the base of the left


ventricle

From 3rd left costal cartilage to 2nd left


costal cartilage

Branches:
Supply the heart Right and Left coronary arteries
8

Arch of Aorta
Origin: Originates slightly to right at the level of

upper border of 2nd right sternocostal joint


Descends left of the 4th thoracic vertebral bodycontinuing as Descending aorta

Branches:

Brachiocephalic trunk

Left common carotid

Left subclavian

Descending Aorta
Its branches

Thoracic aorta- above thediaphragm

Abdominal aorta- below thediaphragm

10

Common Carotid Artery( CCA)

Large bilateral vessel supplying Head and


Neck
Right common
Left common
carotid artery

carotid artery

Origin

Bifurcation of the Arch of aotra in


brachiocephalic thorax in front of
trunk at
trachea.
sternoclavicular
joint

Termination

At the level of upper border of


thyroid cartilage it divides into two.

11

Anterior view

Posterior view

As left carotid artery arises from aortic arch12

thoracic and cervical parts

Relations of thoracic part

Anterior:
Sternothyroid and sternohyoid muscles
Left pleura and lung
Left brachiocephalic vein
Thymic remnants
Posterior
Trachea , left border of oesophagus
Left subclavian artery
Left recurrent laryngeal nerve
Thoracic duct

13

Right

Below- the brachiocephalic trunk

Above-the trachea

inferior thyroid veins

thymic veins

Left

Left vagus nerve

Phrenic nerve

Left pleura and lung

14

Cervical part of common carotid artery

Both right and left have similar course

At the level of upper border of thyroid cartilage


divides

External carotid- exterior of head, face and neck


Internal carotid- cranial and orbital contents

Carotid body and Carotid sinus

15

Carotid sinus

At the termination of
common carotid artery a
slight dilatation is seen
termed as carotid sinus.

Responsive to changes
in the arterial blood
pressure

Its position accountsbaroreceptor-- controls


intra cranial pressure.
16

Carotid body

Small, ellipsoid
reddish-brown
structure.

Acts as
chemoreceptor-

17

Relations of cervical part


Anterolaterally
Tendon of omohyoid

Skin, superficial fascia, platysma, deep cervical


fascia, sternocleidomastoid, sternohyoid and
sternothyroid

Posterior

4th and 6th cervical transverse process --longus colli, longus capitis, scalenus anterior

Sympathetic trunk and ascending cervical artery


18

Medial
Oesophagus
Trachea
Inferior thyroid artery
Recurrent laryngeal nerve
Larynx and pharynx- higher level
Lateral
Internal jugular vein

19

External carotid artery

One of the terminal branches of CCA.


Chief artery of supply in front of neck and in the
face

20

Relations of ECA

21

Above the carotid triangle- lies deep to the


parotid gland
Within the parotid gland

Superficially to retromandibular vein, facial


vein

Deep internal carotid artery

Superior laryngeal nerve; superior cervical


sympathetic ganglion

22

Branches

Anterior :

Superior thyroid
Lingual
Facial

Posterior:

Occipital
Posterior auricular

Medial:

Ascending pharyngeal

Terminal:

23

Maxillary
Superficial temporal

Branches of ECA

24

Superior thyroid artery

25

Relations

Descends forwards in the carotid triangle along


thyrohyoid

Superficially skin, superficial fascia, platysma,


deep cervical fascia

Medial inferior constrictor


external laryngeal

26

Branches

27

Lingual artery

Origin anteromedial part of external


carotid artery at tip of greater cornu of
hyoid bone between superior thyroid and
facial arteries.

Course after short course lies deep to


hyglossus muscle, finally leaves the
muscle in the tongue to anastomose with
the fellow of oposite side

28

Hyoglossus three parts

3 Parts

29

First part of lingual artery:


From origin to posterior border of hyoglossus
Upward loop crossed by hypoglossal N.

Relations:
-skin, superficial fascia,
platysma and deep
fascia
-lies on middle constrictor
30

Second part:

Lies deep to the hyoglossus, runs along


upper border of hyoid bone

Relations:
- covered by hyoglossus, tendon of
digastric, stylohyoid and posterior part of
mylohyoid muscle
31

Third part
Extends from anterior border of hyglossus
to the tip of tongue

Arteria profunda linguae

Relations:
Medial- genioglossus
Lateral longitudinalis linguae inferior
Below lingual mucous membrane
Accompanied by lingual nerve.
32

Facial artery

Origin anterior aspect of external carotid artery

Course runs upwards in neck, then on face;


tortuous in both places.

Two parts

33

Cervical part
Facial part

Tortuous course

34

Cervical branches

Submental

Tonsillar artery

Ascending palatine artery

Glandular branches

Facial branches

35

Inferior labial artery

Superior labial artery

Lateral nasal artery

Occipital artery

Origin posteriorly from the external


carotid, 2 cm from its origin

Course Runs backwards and upwards


deep to lower border of posterior belly of
digastric
ends posteriorly in scalp

36

Branches

Sternocleido mastoid branch

Mastoid branch

Stylomastoid branch

Auricular branch

Muscular branch

Meningeal branch

Occipital branch

37

Posterior auricular artery

Origin- retromandibular fossa above


stylohyoid muscle

Course follows upper border of stylohyoid


muscle, anterior border of styloid process
reaches groove between cartilage of outer
ear and mastoid process.

Distributes branchesto back of auricle, skin


over mastoid and back of scalp.
38

Branches

To digastric, stylohyoid, sternocleido mastoid,


parotid gland

3 named branches-

39

Stylomastoid artery

Auricular artery

Occipital branch

Ascending pharyngeal artery

Origin - Smallest branch of all the


branches

Branches

40

Maxillary artery

Origin larger terminal branch of external carotid,


arises behind and below the mandibular neck,
within substance of parotid gland

Course

41

Mandibular part

Pterygoid part

Pterygopalatine part

42

Mandibular part ( first part)

Passes between the mandibular neck and the


sphenomandibular ligament, below
auriculotemporal nerve

Branches:

43

Deep auricular artery EAM& TMJ.

Anterior tympanic branch Medial part

Middle meningeal artery

Accessory meningeal artery infratemporal fossa

Inferior alveolar artery tooth

mylohyoid

mental

Pterygoid part (Second part)

Ascends obliquely forwards medial to


temporalis and superficial to lower head of
lateral pterygoid

Branches:

Deep temporal branches

Pterygoid branches

Massetric artery

Buccal artery
44

Pterygopalatine part

Passes between the heads of pterygoid and


through pterygomaxillary fissure into the
pterygopalatine fossa

Branches:
Posterior superior alveolar
Infraorbital
Greater palatine
Pharyngeal
Artery of pterygoid canal
Sphenopalatine post.nasal
post septal.

45

Superficial temporal artery

Origin: smaller of the two


terminal branches, begins
in the parotid gland behind
mandibles neck

Course: crosses the


posterior root of zygomatic
process of temporal bone,
divides into anterior and
posterior branches

46

Relations:

In the parotid gland- temporal and


zygomatic branches facial nerve

In the scalp- corresponding veins, posterior


to the auriculotemporal nerve

Branches supply scalp, parotid gland


auricle and facial muscles.and TMJ.

47

Internal carotid artery

Origin - similar to that of ECA at thyroid cartilage


and ends in cranial cavity supplying the brain.

Course- broadest outline

48

Parts
Divided into

Cervical

Petrous

Cavernous

Cerebral

49

Relations: cervical part

Posteriorly -sup cervical


ganglion,sup laryngeal nerve

Medially - ascending
pharyngeal artery
Anterolaterally sternocleidomastoid muscle

Inferiorly-digastric, hypoglossal
nerve

At the level of digastric stylohyoid muscle, posterior


branches of ECA
50No branches in the neck

Petrous part

Relations

Surounded by venous and


sympathetic plexuses

Posterolaterally-middle ear and


cochlea

Anterolaterally- auditory tube


and tensortympani

Superiorlyganglion

51

trigeminal

Branches
Caroticotympanic branch or artery middle
ear
Pterygoid artery- anastomose with Gr.
Palatine artery

52

Cavernous part

Ascends to the posterior clinoid process

Emerges through the dorsal roof of the


cavernous sinus

Branches
Cavernous branches trigeminal Gn.
Hypophyseal branches- pitutary gland.
Meningeal branches

53

Cerebral part

Lies at base of the brain.Divides into


Anterior and Middle cerebral arteries.

Gives off 5 branches:

Ophthalmic artery

Anterior cerebral artery

Middle cerebral artery

Posterior communicating artery

Anterior choroid artery

54

Ophthalmic artery

Artery enters the


orbit through optic
canal.

Terminates near
the medial angle of
the eye, dividing
into supratrochlear
and dorsal nasal
55branches

Branches
Central artery of retina end
Lacrimal branch
Muscular branch
Ciliary arteries- choroid and iris
Supraorbital artery
Posterior ethmoidal artery
Anterior ethmoidal artery
Meningeal artery
Medial palpebral artery
Supratrochlear artery

56

Circle of Willis.

It is site of anastomosis between ICA and


vertebral artery around optic chaisma and the
pituitary stalk.

57

VEINS of HEAD and NECK

58

Veins of exterior
of head and
neck
Cervical veins
Diploic,
meningeal,
intracranial dural
venous sinuses
59

Exterior or External veins of head and neck

Supra trochlear vein

Supra orbital vein

Facial vein

Superficial temporal vein

Pterygoid venous plexus

Maxillary vein

Retromandibular vein

Posterior auricular vein

Occipital vein
60

Superficial veins

61

Deep veins

62

Supra trochlear vein

Supra
trochlear vein

63

Supraorbital vein

64

Facial vein

Origin: largest vein of face, begins as angular vein

Course: downwards and backwards behind facial


artery, but with a straighter course

Joins anterior division of retromandibular vein--common facial vein

Tributaries :

65

Connects with superior ophthalmic vein


Cavernous sinus
On the face
Below mandible

66

Superficial temporal vein

Course: Anterior and posterior unite --- superficial


temporal

Joined by middle temporal vein

Retromandibular vein

Tributaries
Parotid veins
Rami for TMJ
Middle temporal

67

Pterygoid venous plexus

Location partly between


the temporalis and lateral
pterygoid; and partly
between the pterygoids

Tributaries
sphenopalatine vein, buccal vein,
deep temporal vein, dental vein,

pterygoid veins,

massetric veins,
68

greater palatine vein,


middle meningeal vein
branch of ophthalmic vein

Retromandibular vein

Origin-

Branches
Anterior branchPosterior branch-

69

Posterior auricular vein

Occipital Vein

70

Cervical veins or veins of neck

External jugular vein


Posterior external jugular vein
Anterior jugular vein
Internal jugular vein
Lingual vein
Pharyngeal vein
Superior thyroid vein and inferior thyroid vein
Middle thyroid vein
Vertebral vein
Deep cervical vein
71

External jugular vein

Retromandibular (post. div) + Posterior


auricular vein

Drains into subclavian vein.

72

Anterior jugular vein


Begins in submental region below the chin.
It pierces deep cerevical fascia enters
suprasternal space and is connected to its
felloow on opp. Side by jugular venous arch
Then moves laterally and deep to SCM above
clavicle ends in external jugular vein

73

Internal jugular vein

It is a direct continuation of sigmoid sinus.


Begins at jugular foramen and ends at sternal
end of clavicle by joining the subclavian vein
to form brachicephalic vein.

74

RELATIONS

75

Tributaries

Lingual vein

Pharyngeal vein

Superior and inferior thyroid vein

Middle thyroid vein

Vertebral vein

Deep cervical vein

76

Dural venous sinuses

77

CLASSIFICATION
Paired
Cavernous sinus
Superior petrosal sinus
Inferior petrosal sinus
Transverse sinus
Sigmoid sinus
Sphenoidal sinus
Petrosquamous sinus
Middle meningeal sinus

78

Unpaired
Superior sagittal sinus
Inferior sagittal sinus
Straight sinus
Occipital sinus
Anterior intercavernous
sinus
Posterior intravenous
sinus
Basilar plexus of veins

CAVERNOUS SINUS

Location: Large venous space, in middle


cranial fossa

Anteriorly upto medial end of superior


orbital fissure

Posteriorly apex of petrous temporal


bone

79

RELATIONS

Structures outside sinus

Superiorly- optic chiasma, olfactory tract, internal


carotid artery

Inferiorly foramen lacerum, sphenoid bone

Medially hypophysis cerebri, sphenoidal air sinus

Laterally temporal lobe

Anteriorly superior orbital fissure

Posteriorly petrous temporal bone, midbrain


80

Structures in the lateral wall of sinus

Oculomotor nerve

Trochlear nerve

Ophthalmic nerve

Maxillary nerve

Trigeminal ganglion

81

Structures passing through the centre of the


sinus
Internal carotid artery

Abducent nerve

82

Tributaries incoming channels


From the orbit

Superior and inferior ophthalmic veins

Central vein of retina

From the brain

Superficial middle cerebral vein

Inferior cerebral vein

From the meninges

Sphenoparietal sinus

Frontal trunk of middle meningeal vein


83

Tributaries incoming channels


From the orbit

Superior and inferior ophthalmic veins

Central vein of retina

From the brain

Superficial middle cerebral vein

Inferior cerebral vein

From the meninges

Sphenoparietal sinus

Frontal trunk of middle meningeal vein


84

Anterior view

85

Transverse sinus

Convex upwards, Large sinuses, right is larger than


left

Extends from internal occipital protuberance to


posteroinferior angle of parietal bone

Tributaries
Superior petrosal sinus
Inferior cerebral veins
Inferior cerebellar veins
Diploic vein
Inferior anastomotic vein
86

Straight sinus

Location: Lies in median plane within


junction of falx cerebri and tentorium
cerebelli

Formed by union of inferior sagittal sinus


with great cerebral vein

Terminates at internal occipital


protruberance

87

Superior Sagittal sinus

Location: upper convex attached margin of


falx cerebri

Extends from crista galli to internal


occipital protruberance; usually continues
as right transverse sinus

Confluence of sinuses

88

Tributaries

89

- Superior cerebral veins


- Parietal emmissary veins
- Venous lacunae

Inferior sagittal sinus

Location small channel, posterior 2 /3rds of


falx cerebri

Ends by joining great cerebral vein to form


the straight sinus.

90

Sigmoid sinus

S- shaped; direct contiuation of transverse


sinus

Extends from posteroinferior angle of


parietal bone to bulb of internal jugular
vein

Grooves mastoid process of temporal bone

91

Tributaries:

Mastoid vein and Condylar emissary vein

Cerebellar vein

Internal auditory vein

92

Occipital sinus

Small, attached to
margin of falx cerebri

Begins near foramen


magnum and ends in
confluence of sinus

93

Sphenoparietal
sinus
Lie along posterior
free margin of
lesser wing of
sphenoid
Drain to anteior
cavernous sinus

Superior petrosal
sinus

Anterior part of
tentorium cerebelli

Inferior petrosal sinus


Lie in petro-occipital
fissure
Drain cavernous sinus --internal jugular vein
Tributaries
Labrynthine veins
Veins from medulla, pons,
cerebellum

94

Summary & Conclusion


The blood vessels supplying the head and neck region
by help in carrying out basic functions of blood such
as O2 & CO2 transport, detoxification ,delivery of
hormones, and maintainance of body temperature etc.
However, the vessels are also involved in playing a
crucial role in maintaining intacranial pressure and
also regulate the physical and chemical changes
through receptors and finally provide continuous
supply to nervous tissue of brain which sends
impulses to body to carry out its various functions in
daily life

95

References

Grays anatomy 38th edition


Cunninghams manual of practical

anatomy, volume 3,15th edition

Lasts anatomy

B.D.Chaurasias Human Anatomy, volume


3, 4th edition

B.D.Chaurasias Handbook of General


anatomy 3rd edition

96

THANK
YOU.

97

QUESTION

98

AND ANSWERS

STRUCTURE & HISTOLOGY OF ARTERIES AND


VEINS?

The walls of arteries and veins are composed of three layers


called TUNICS

99

tunica interna (innermost)


tunica media (middle)
tunica externa (outermost)

TUNICA INTIMA / INTERNA:

The innermost layer of the vessel

It consists of three components

i) A single layer of squamous epithelial


cells endothelium
ii)The basal lamina of endothelial cells
iii)The subendothelial layer,
consisting of loose connective tissue

100

TUNICA MEDIA:

The middle layer of the vessel

Consists of circumferentially
arranged layers of smooth muscle

In arteries, it is relatively thick and


extends from internal elastic lamina
to external elastic lamina

External elastic lamina is a layer of


elastin that separates tunica media
from tunica adventitia
101

TUNICA EXTERNA /ADVENTITIA:

The outer most connective tissue layer of the vessel

It is composed primarily of longitudinally arranged


collagenous tissue & few elastic fibres

Prevents undue stretching or distension of the artery

102

Tunica adventitia is relatively thin in most of the arterial


system to quite thick in the venules and veins, where it is the
major component of the vessel wall

103

TUNICA MEDIA (ARTERIES VS VEINS)

A major difference between arteries and veins is the thickness


of the tunica media being much greater in the arteries

This structural difference is necessary because:


The blood pressure in the arteries is much greater than the
veins, whereby the additional smooth muscle in arterial
walls provide reinforcement
The tunica adventitia in veins is thickest coat and consists of
collagen fibres. And few large veins may show bundles of
smooth muscle fibres.

104

ELASTIC VS MUSCULAR ARTERIES

ELASTIC ARTERIES aorta, pulmonary arteries, large


arteries supplying head and neck, limbs

The remaining arteries are MUSCULAR ARTERIES

The main difference in the structure of elastic and muscular


arteries is in the constitution of TUNICA MEDIA

105

ELASTIC VS MUSCULAR ARTERIES


In elastic arteries the media is made up of mainly of elastic
tissue
Elastic tissue is in the form of series of concentric membranes
that are frequently fenestrated.
Eg: aorta, pulmonary arteries, large arteries supplying head
and neck, limbs. Rest are the muscular arteries.

On the contrary in muscular arteries the media is made up of


mainly of smooth muscle.
These muscles are arranged circularly
Between the groups of muscle fibres some connective tisue is
present.
106

ARTERIOLES

When traced distally, muscular


arteries progressively decrease in
calibre till they have a diameter of
about 100m then they become
continuous with arterioles

The larger or muscular arterioles


are 100 to 50 m in diameter

Arterioles less than 50m in


diameter are called terminal
arterioles

107

Arterioles have only one or two layers of smooth muscle in their


tunica media

Arterioles can be distinguished from true arteries


i) by their smaller diameter
ii)do not have internal elastic lamina
iii) few layers of smooth muscle in media

Venules have one or two layers of smooth muscles in tunica media


and surrounding them few pericytes may be seen.

108

CAPILLARIES

Capillaries are the smallest diameter blood vessels

Terminal arterioles continued into a capillary plexus

Exchange of gases, metabolites, waste products between blood


and tissues takes place through the walls of capillaries

Average diameter of capillary is 8m

109

The capillary is made up of


single layer of endothelial cells
and their basal lamina.

Overlying the basal lamina there


may be isolated perivascular
cells (pericytes)

110

Special Staining techniques for Blood


Vessels.

Per iodic Acid Schiff


For elastic component
A) Verhoeffs iron haematoxylin
B)Gomori aldehyde fuchsin
Trichromes
Massons trichrome
Mallory- Azan
Van giesons stain for collagen component.

111

Immunohistochemistry

Markers of blood vessel endothelium used


commonly are CD31, CD34, and factor VIIIrelated antigen (von Willebrand factor or vWF.)

CD 105(endoglin), Vascular Endothelial Growth


factor(VEGF) also used.

Proliferating Cell Nuclear Antigen (PCNA ) and


ki 67 for proliferating endothelial cells.
112

Lincolns highway?

Carotid sheath is also known as Lincolns


highway. It was named Lincolns Highway by
Mosher in 1929 b/c it is formed by all three
layers of deep fascia but anatomically
separate from all layers

Travels through pharyngomaxillary space &


extends from skull base to thorax

113

Reasons for cavernous sinus thrombosis?

The cavernous sinuses receive venous blood from


the facial veins (via the superior and inferior
ophthalmic veins) This complex web of veins
contains no valves;Since the cavernous sinuses
receive blood via this distribution, infections of the
face including the nose, tonsils, and orbits can
spread easily in retrograde route.

The intimate juxtaposition of veins(emissary veins),


arteries(ICA), nerves(3rd .4th & 6th nerve), meninges,
and paranasal sinuses accounts for the characteristic
etiology and presentation of cavernous sinus
thrombosis (CST). CST is more commonly seen with
sphenoid and ethmoid and to a lesser degree with
frontal
114
sinusitis.

Canals of Zuckerkandl?
Perforating canals of Zuckerkandl & Hirschfeld
are the nutrient canals in interdental and
interradicular septa which house the
interdental and interradicular arteries , veins,
lymph vessels and nerves.

115

Diploic veins?
Diploe or diploic space is found in
thebonesof the vault of the skull, and is
themarrow-containing area ofcancellous
bonebetween the inner and outer layers
ofcompact bone.

Thediploic veinsare found in theskull, and


drain the diploic space. The diploic veins drain
this area into thedural venous sinuses.

116

Littles area?

Kiesselbach's plexus orLittle's area, is a


region in the anteroinferior part of thenasal
septum, where four arteriesanastomoseto
form a vascular plexus called Kiesselbach's
plexus. The arteries are
anterior ethmoid artery
great palatine artery
sphenopalatine artery
superior labial artery
Little's area is a usual site for epistaxis as it is
exposed to drying effect of inspiratory current.

117

Other names of ECA and ICA?

External carotid Artery is also known as arteria carotis


externa

Internal Carotid Artery is also known as arteria carotis


interna

118

If ECA is ligated on one side ,how does the ECA on other side
compensate for it?

In a study for evaluation of the homodynamic of the


collateral circulation, the main collateral pathway to the
ligated ECA region was the ipsilateral occipital artery
through Richter's anastomosis from the vertebral artery
in the case of unilateral ECA ligation.
This collateral flow can be maintained through ECA
anastomotic branches such as superior and inferior
thyroidal arteries, deep cervical artery, descending
branch of occipital artery , superior and inferior labial
arteries or an aberrant ICA branch .
(Hemodynamic changes in the head and neck after
ligation of the unilateral carotid arteries: a study
using color Doppler imaging. Ann Otol Rhinol
119
Laryngol.1994
Jan;103(1):41-5.)