By

A. Vamsi krishna
II M. D. S
Functional morphology

Embryology

Common carotid artery

External carotid artery

Internal carotid artery

Venous drainage of face

Venous sinuses

Applied anatomy

Conclusion

References
Tight junctions- in brain. Permits smaller molecules

Gap junctions- in skeletal, cardiac & smooth muscle capillaries.

Permits molecules up to 10 nm

Fenestrations- in kidneys, endocrinal glands, intenstinal villi.

Permits molecules up to 20-100 nm.
FEATURES Artery Vein
Tunica Intima-Endothelium Usually rippled due vessel Often smooth
constriction

Internal elastic membrane Present Absent

Tunica media Thick, dominated by smooth Thin, Dominated by smooth

muscle cells and elastic muscle cells and collagen
fibers fibers

External elastic membrane Present Absent

Tunica externa Collagen and elastic fibers Collagen, elastic fibers and
smooth muscle cells
 Aortic arches
Aortic arches are short vessels connecting ventral and dorsal aortae on each side they run
within branchial (pharyngeal) arches are based gradually in the 4th and 5th week, in 6 pairs
in total.
The first, second and fifth pairs soon disappear
The 1st aortic arch – disappears (a small portion persists and forms a piece of the maxillary
artery)
The 2nd aortic arch – disappears (small portion of this arch contributes to the hyoid and
stapedial arteries)

The 3rd aortic arch - has the same development on the right and left side it gives rise to the
initial portion of the internal carotid artery

The external carotid is derived from

the cranial portion of the ventral aorta

The common carotid corresponds to a

portion of the ventral aorta between
exits of the third and fourth arches
The 4th aortic arch - has ultimate fate different on the right and left side

On the left - it forms a part of the arch of the aorta between left common carotid and left
subclavian artery

On the right - it forms the proximal segment of the right subclavian artery

The 5th aortic arch - is transient and soon obliterates

The 6th aortic arch - pulmonary arch - gives off a branch on each side that grows
toward the developing lung bud

On the right side, the proximal part transforms into the right branch of the
pulmonary artery and the distal part disappears

On the left side, the distal part persists as the ductus arteriosus during intrauterine
life and the proximal part gives rise to the left branch of the pulmonary artery
 ECA is one of the terminal branches of the
CCA.

 Chief artery of supply to structures in

front of the neck and in the face.

 Generally arises medial and anterior to

the ICA

 In 15% ECA originates lateral to the ICA,

this variation occurs more frequently on
the right (3:1)
 Anterior
 Superior thyroid
 Lingual
 Facial
 Posterior
 Posterior auricular
 Occipital
 Terminal
 Superficial temporal
 Maxillary
 Medial
Ascending pharyngeal
 First branch

 Arises just below the

level of the greater
cornu of the hyoid bone

 Ends in the thyroid

gland.
 Branches

 Hyoid

 Superior Laryngeal

 Sternocleidomastoid

 Cricothyroid
Origin :
Lingual Artery arises from the ECA
opposite the tip of greater cornu of the
hyoid bone

Course
First part of artery lies in the carotid
triangle

Second part of artery lies deep to

the hyoglossus muscle which separates
it from the hypoglossal nerve

Third Part or deep part : runs

upwards along the anterior margin of
the hyoglossus
 Suprahyoid Br

 Dorsal Lingual Br

 Deep Lingual Artery

 Sublingual Artery
Facial artery is the chief artery of the face
Origin :
 Arises from the ECA just above the greater
cornu of the hyoid bone

 It has two parts, first cervical part in the neck

and facial part.

 It enters the face by winding around the base

of the mandible

 At the anteroinferior angle of the masseter

muscle, it can be palpated here and is called as
an “anaesthetist’s artery”
1. Ascending palatine artery- it supplies to root of tongue &
tonsil.

2. Tonsillar.

3. Submental artery- it is a large artery which accompanies the

mylohyoid nerve, and supplies the submental triangle and sub
lingual salivary gland.

4. Glandular branches that supplies submandibular salivary gland

and submental lymph nodes.
1. Superior labial- supplies to
upper lip & antero-inferior
part of nasal septum.

2. Inferior labial- supplies to

lower lip.

3. Lateral nasal- to the ala &

dorsum of nose.
4. Angular – supplies the
lacrimal sac and orbicularis
oculi.
 A small branch arises from
medial side of ECA

 Long, slender vessel, deeply

seated in the neck

 It runs vertically upwards

between the side wall of the
pharynx, the tonsil, the medial
wall of the middle ear and ,
the auditory tube.
 Small and arises above the
posterior belly of digastric

 It runs upwards and backwards

deep to the parotid gland,
crosses the base of the
mastoid process and ascends
behind the auricle.

 Stylomastoid branch
 Occipital Artery

 Arises from the posterior

part of the external carotid,
opposite the facial

 Ends in the posterior part of

the scalp

 May arise from Internal

carotid artery.
 Mastoid
 Meningeal
 Muscular
 Maxillary Artery
 Larger of the two terminal
branches

 Arises behind the neck of the

mandible, and is imbedded in
the substance of the parotid
gland

 It supplies the deep

structures of the face
1st part (mandibular) :
Lies medial to mandible, it runs along the lower border of
lateral pterygoid muscle

 Deep auricular artery

 Ant.tympanic artery

 Middle meningeal artery

 Accessory meningeal artery

 Inferior alveolar artery

Branches Foramen transmitting Distribution

1.Deep auricular Foramen in the floor of External acoustic

external acoustic meatus meatus,outer surface of
tympanic membrane

2.Anterior tympanic Petrotympanic fissure Inner surface of tympanic

membrane

3.Middle meningeal Foramen spinosum 5th and 7th nerve, middle

ear, tensor tympani

4.Accessory meningeal Foramen ovale Meninges, Structures in

the infra temporal fossa

5.Inferior alveolar Mandibular foramen Lower teeth and mylohyoid

muscle
 Middle Meningeal Artery
 Largest artery that supplies
the dura

 It ascends to the foramen

spinosum through which it
enters the cranium

 Divides into two branches,

anterior and posterior.

 It supplies the dura mater

(the outermost meninges)
and the calvaria.
 Runs downword & forward
medial to ramus of mandible
to reach mandibular
foramina

 Before entering mandibular

foramina gives off lingual
and mylohyoid arteries

 In canal gives branches to

mandibular teeth

 After coming out of canal

supply chin via mental artery.
2nd part (pterygoid part) :
 Artery runs forward &upward superficial to the lower head
of the lateral pterygoid muscle
Branches Distribution
1.Deep temporal Temporalis

2.Pterygoid Lateral and

medial
pterygoid

3.Masseteric Masseter

4.Buccal Buccinator
3rd part (pterygopalatine):

 Terminal portion of the artery

passes between the two heads
of the lateral pterygoid muscle
Branches Foramina Distribution
1.Post superior alveolar Alveolar canals in the body of Upper molar and premolar
maxilla teeth ; maxillary sinus

2.Infraorbital Infraorbital fissure Lower orbital muscles,

lacrimal sac ,max sinus

3.Greater palatine Greater palatine canal Soft palate, tonsil, palatine

glands and mucosa,upper
gums

4.Pharyngeal Pharyngeal canal Root of nose , pharynx,

auditory tube,sphenoidal
sinus

4.Artery of pterygoid canal Pterygoid canal Auditory tube, upper

pharynx, middle ear

5.Sphenopalatine(terminal Sphenopalatine foramen Lateral and medial wall of

part) nose and air sinuses.
 Superficial Temporal Artery
 Smaller of the two terminal
branches

 It begins in the substance of

the parotid gland, behind the
neck of the mandible

 Divides into two branches, a

frontal and a parietal
 Branches
 Transverse facial branch

 Anterior auricular branch

 Frontal branch

 Parietal branch

 Zygomatico- orbital branch

 Origin- It is one of the terminal branch of
common carotid artery originates along
with external carotid artery at the upper
border of thyroid cartilage at the disk of
third and fourth cervical vertebra.

Branches
Cervical part in the neck

Petrous part in the petrous temporal bone

Cavernous part in the cavernous sinus

Cerebral part in relation to base of brain

Cervical part

It ascends vertically in the neck from its origin to the base of

skull to reach the lower end of the carotid canal. This part is
enclosed in carotid sheath along with internal jugular and
vagus nerve. No branches arises from the internal carotid
artery in the neck.
Its initial part shows slight dilation, carotid sinus. Which acts
as a baroreceptor.
 Within the petrous part of
the temporal bone,in the
carotid canal runs upword
forword & medially at rt.
Angle.

Branches

1) Caroticotympanic- enter
middle ear & anastomose
with ant. & post. Tympanic
branches

2) Artery of the Pterygoid Canal-

anastomose with greater
palatine artery
Within the Cavernous Sinus

Branches
1) Artery to trigeminal
ganglion

2)Superior & inferior

Hypophyseal artery
 Lies at the base of the brain
after emerging from the
cavernous sinus
Branches
1.Ophthalmic.
2.Anterior Cerebral.
3.Middle Cerebral.
4. Posterior Communicating.
5. Ant. choroidal

On angiogram internal
carotid show ‘S’ shaped
figure ( carotid siphon )
 Veins of the Head and neck

 Venous drainage from the face is

entirely superficial

 All the venous drainage from the

head and neck terminate in the
internal jugular vein which join the
subclavian vein to form the
brachiocephalic vein behind the
medial end of the clavicle
 Internal jugular vein

 It receive blood from the

brain, face and the neck.

 It emerges through the jugular

foramen, as a continuation of
the sigmoid sinus descend
down in the neck, first behind
then lateral to the internal
carotid artery inside the
carotid sheath
Tributaries
 Facial vein

 Is formed by the union of the

supraorbital and supratrochlear
veins to form the angular vein

 Communicate with the cavernous

sinus through the ophthalmic vein
via the supraorbital
• Runs downwards and backwards
behind the facial artery to the
lower border of the mandible

• To be joined by the anterior

division of the retromandibular
vein

Joins the:
 Pterygoid plexus through deep
facial vein
 Cavernous sinus through
superior ophthalmic vein
 Retromandibular vein

 Formed by the union of superficial

temporal and maxillary vein from
the pterygoid plexus

 Passes downwards in the substance

of the parotid gland emerging from
its lower border & divide into two
divisions
 Retromandibular vein
 Anterior division
 joins the facial vein

 Posterior division:
 pierces the deep fascia and
join the posterior auricular
to form the external jugular.

 It empty into the

subclavian vein
 The maxillary vein
 A short trunk accompany the
first part of the artery.

 Formed by confluence of the

veins of the pterygoid plexus.

 It passes backward between the

sphenomandibular ligament and
the neck of the mandible

 Unite with the superficial

temporal vein to form the
retromandibular vein.
 Pterygoid plexus

 A network of very small veins,

lie around and within the lateral
pterygoid muscle in the
infratemporal region

 Receive some of the veins that

correspond to the maxillary
vein, inferior ophthalmic vein
(internal carotid blood) and the
deep facial vein.
 Pterygoid plexus

 Drain into a pair of large,

short maxillary veins
which join the superficial
temporal vein to form the
retromandibular.

 Deep facial vein drain the

plexus into the facial vein
if the maxillary is
occluded
 External jugular vein
 Begins behind the angle of the
mandible by the union of the
posterior auricular and posterior
division of the retromandibular
veins.

 It descend obliquely, deep to the

platysma, receive the posterior
external jugular vein

 Pierce the deep fascia just above

the clavicle and drain into the
subclavian vein
 Tributaries
 Posterior auricular vein

Posterior division of retro mandibular vein

Posterior external jugular vein

Transverse cervical vein

Suprascapular vein

 Anterior jugular vein

The external jugular vein was formed by the continuation of undivided

retromandibular vein.

The facial vein presented a normal course from its origin up to the base of the

mandible lying posterior to the facial artery at the anterior border of masseter muscle.

It joined with submental vein in submandibular region and ultimately drained into

external jugular vein. JK SCIENCE Vol. 12 No. 4, Oct-December 2010 203-4

Journal of Clinical and Diagnostic Research. 2011 Feb, Vol-5(1):24-27
Of the 35 specimens that were studied, 29 of the common facial veins were found to confirm to the
normal pattern of formation and drainage. 6 specimens showed variations in their terminations.

In one cadaver, there was no division of the retromandibular veins into the anterior and posterior veins
on both sides. The common trunk of the retromandibular veins joined with the anterior facial veins to
form the common facial veins The external jugular veins were absent bilaterally. The common facial vein
terminated directly into subclavian vein of respective side
Undivided retromandibular vein forming external jugular vein and drainage of
common facial vein into internal jugular
 In three specimens, the common facial vein opened into the
external jugular vein.

Journal of Clinical and Diagnostic Research. 2011 Feb, Vol-5(1):24-27

Unpaired sinuses Paired sinuses

Superior sagittal Transeverse

Inferior sagittal Sigmoid

Straight Cavernous

Occipital Superior petrosal

Anterior intercavernous Inferior petrosal

Posterior intercavernous Spheno-parietal

Basilar venous plexus Petro-squamous

Middle meningeal
Superior sagittal sinus
It lies within the convex attached margin of the falx cerebri.
The sinus begins at the crista galli and is continuous with the
right transeverse sinus.
Communications

With the veins of the scalp through the parietal emissary vein.
A vein from the nose through the foramen caecum.
Cavernous sinus through superior anastomotic vein.

Thrombosis of the superior sagittal sinus may take place due

to spread of infection from the nose and scalp.
This will lead to increased intracranial tension resulting in
defective absorption of C. S. F.
Inferior sagittal sinus
It occupies the posterior two thirds of the lower free margin
of the falx cerebri.
It collects blood from the falx ceribri, medial surfase of the
cerebrum and terminates into the straight sinus.
Cavernous sinuses
These paired sinuses are situated on each side of the body of
sphenoid bone
Extend from superior orbital fissure in front to the apex of
petrous temporal behind.
Structures passing through the sinus

Internal carotid artery

Abducent nerve
Occulomotor nerve
Trochlear nerve
Ophthalmic nerve
Maxillary nerve
Septic thrombosis of cavernous sinus may be caused by the
numerous communications from the dangerous area of face,
orbit and pharynx.

If the internal carotid artery is ruptured as a result of fracture

of the base of skull.
Manifested by pulsating exophthalmos, oedema of the eye
lids and loud systolic murmur.
Applied Anatomy
Facial artery -During the surgical removal of the
submandibular salivary gland the incision is made ½ inch
below the lower border of the mandible parallel to
mandibular branch of facial nerve.

Facial artery can be severed during the attempts to open

buccal abscess of the first molar.

An adult female presented with a 22-year history of pain on

the right side of her jaw. Digital palpation over the facial
artery at the inferior border of the mandible elicited and
exacerbated the pain. Surgical exploration revealed a coiled,
tortuous facial artery. Removal of the aberrant artery
provided complete pain relief.
J Craniomandib Disord1992 Fall;6(4):296-9.
Lingual artery- During surgical removal of the tongue, the
first part of artery is ligated in the lingual triangle before it
gives any branch to the tongue or tonsil.

Superior thyroid artery- The artery and External laryngeal

nerve are close to each other above the gland but diverge
slightly near the gland. So the artery is ligated as near to the
gland as possible

Superficial temporal artery- crossing the zygomatic arch

the artery is palpable through the skin and fascia and easily
compressed here to control the temporal hemorrhage.
This vessel is well protected by dense tissue. Its branches
anastomose so freely that a partially detached scalp may be
successfully replaced as long as one vessel is intact.
Middle meningeal artery- It get injured in head injuries
resulting in extradural hemorrhage.
The frontal or anterior branch is commonly involved. The
hematoma presses the motor area, giving rise to hemiplegia
of the opposite side.
The anterior division can be approached surgically by making
hole in the skull over the pterion,4 cm above the zygomatic
arch.
Rarely parietal or posterior branch is implicated, causing
contra lateral deafness. In this case hole is made 4 cm above
and 4 cm below the acoustic meatus.
 Common carotid artery- It can be
compressed against the carotid tubercle,
the anterior tubercle of the transverse
process of vertebra C6 which lies at the
level of cricoid cartilage.

Carotidynia is a syndrome characterized

by unilateral (one-sided) tenderness of
the carotid artery, near the bifurcation.

Carotid Sinus
 Present at the termination of CCA. (or
beginning of ICA.)
 Tunica media is thin, tunica adventia is
thick
 Acts as BARORECEPTOR/PRESSURE
RECEPTOR.
 Carotid sinus hypersensitivity (CSH) is an exaggerated
response to carotid sinus baroreceptor stimulation. It results
in dizziness or syncope from transient diminished cerebral
perfusion.
For these individuals, even mild stimulation to the neck
results in marked bradycardia and a drop in blood pressure.

Carotid Siphon of Angiogram

 Siphon region is the most common site for atherosclerotic

plaque formation in carotid artery
 Carotid Body
 Carotid body situated behind the bifurcation of CCA
 Act as a chemoreceptor & respond to change in the O2, CO2 and pH
content of the blood

 Carotid body paragangliomas are vascular lesions, and this is

reflected in their imaging appearance. These lesions splay apart the
internal (ICA) and external carotid arteries (ECA), and as it enlarges, it
will encase, but not narrow the ICA and ECA.
Head Neck Pathol. Dec 2009; 3(4): 303–306.
 Danger Area of Face
 The facial vein is devoid of valves
and rests directly on the facial
muscle.

 The movement of facial muscles

might facilitate the spread of septic
emboli from the infected area of
upper lip and lower part of the nose
in retrograde direction.

 Cause thrombosis of cavernous sinus

with serious complication.
Occlusive disease

It is the obstruction or blockage of the body's blood vessels,

including arteries in the head and neck.
Occlusive disease is caused by atherosclerosis
The most common symptom of occlusive disease affecting the
brain is a transient ischemic attack (TIA), or "mini stroke."
Temporal arteritis

Temporal arteritis occur when one or more arteries become

inflammed, swollen, and tender.
Temporal arteritis commonly occurs in the the arteries
around the temples (temporal arteries).
These vessels branch off from the carotid artery in the neck.
PHACE syndrome

Patients can have abnormalities of the

arteries that carry blood to the brain either in
the head (cerebral) or neck (cervical).
These blood vessels can have abnormal
shapes, sizes or paths through the neck and
head.
Dysgenesis
Narrowing
Non-visualization
Abnormal course or origin
Persistent fetal arteries
Shaken baby syndrome (SBS)

It is a form of child abuse. It refers to

brain injury that happens to the child.
It occurs when someone shakes a baby
or slams or throws a baby against an
object. A child could be shaken by the
arms, legs, chest, or shoulders.

What causes the brain injury?

Shaking or throwing a child, or
slamming a child against an object,
causes uncontrollable forward,
backward, and twisting head
movement.
Brain tissue, blood vessels, and nerves
tear. The child's skull can hit the brain
with force, causing brain tissue to bleed
and swell.
Mild injuries may cause subtle symptoms. A child may vomit or
be fussy or grouchy, sluggish, or not very hungry. More severe
injuries may cause seizures, a slow heartbeat, trouble hearing,
or bleeding inside one or both eyes
 References
 Human Anatomy Vol 3 Head,Neck & Brain
- BD Chaurasia’s 4th Edition
 Textbook of Anatomy Vol3
- Inderbir Singh 3rd Edition
 Anatomy of the Head & Neck
- M J. Fehrenbach, S W. Herring 3rd Edition
 Operative maxillofacial Surgery
- Jhon. D.Langdon & Mohan F. Patel
 Textbook of Anatomy
- A. W. Rogers
 Deaver JB Surgical Anatomy of Human body
- Blakiston, Philadelphia
 www.wikipedia.org