ARTERIAL SUPPLY AND VENOUS

DRAINAGE OF HEAD, NECK AND

FACE

Presented by-
Dr Sushma Maku
(JR- I)
 Contents-
Introduction
Terminologies
Arterial supply of head , neck and face
-Common carotid artery
-External carotid artery
-Internal carotid artery
-Subclavian artery
 Venous drainage of head, neck and face
-Internal jugular vein and its tributaries
-Facial vein and its tributaries
 - Subclavian vein
Veins of orbit and nose
Ligation of arteries
Common arterial diseases
Conclusion
References
 Introduction-
The blood supply of head and neck region is composed of various arterial supply and
venous drainage.
During surgical procedures these vessels might get damaged so it is important to
understand location of larger blood vessels.
 Terminologies-
 Artery-Large vessel that carries blood from heart to periphery.
 Vein -Large vessel that carries blood from periphery to heart.
 Venule-Small microscopic vein.
 Branch-It is a smaller division of vessel originating from main trunk.
 Anastomosis-Communication between arterial vessels or branches .
 Vessel-The anatomic unit of body that carry, transport or circulate body fluids
such as blood or lymph in tube like structures are called as vasculature or vessel.
-Arteries
-Veins

Textbook of oral anatomy, histology and physiology 2nd edition –K Rajkumar, R Ramya
Arterial supply of head , neck and face-
Common carotid artery
External carotid artery
Internal carotid artery
Subclavian artery

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Arch of aorta

Brachiocephalic trunk Left common carotid

artery Left subclavian artery

Right common carotid

Right subclavian artery
artery

External carotid artery Internal carotid artery

 Common Carotid Artery-

 Course-
-Left-begins in thorax in front of trachea opposite a point little left to manubrium .

-Right-It begins in the thorax in front of the trachea and ascend back of sternoclavicular joint and then enters
into neck.

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
It runs upwards within carotid sheath under anterior border of sternocleidomastoid
muscle up to thyroid cartilage.
Carotid sinus
Carotid body

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
Relations-

Anterior -
-Superior belly of omohyoid
-Sternocleidomastoiid
-Sternohyoid
-Sternothyroid
Posterior -
-Transverse process of
vertebrae c4-8

Medial -
-Thyroid gland
-Larynx
-Pharynx

Lateral -
-Internal jugular vein

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
 External Carotid Artery-
 Course-
- It begins in the carotid triangle at the level of upper
border of thyroid cartilage opposite the disc between
the C3 and C4 cervical vertebrae.

- It runs upward , backward and laterally and terminates

behind the neck of mandible by dividing into maxillary
and superficial temporal arteries.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Relations-
Superficial –
-Covered by skin, superficial fascia , platysma muscle.
-cervical branch of facial nerve and hypoglossal nerve.
-facial, lingual, and superior thyroid vein.
-anterior border of sternocleidomastoid.
Deep-
-Superior laryngeal nerve.
-Ascending pharyngeal artery.
Above the carotid triangle-
-Posterior belly of digastric and stylohyoid.
 Branches-

Anterior-
Superior thyroid Posterior-
Lingual Occipital
Facial Posterior auricular

Terminal-
Medial-
Superficial temporal
Ascending pharyngeal
Maxillary

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
Superior thyroid artery-
Course-
Branches-
Superior laryngeal
Sternomastoid
Cricothyroid

Importance-During surgery of thyroid gland

-to avoid injury to external laryngeal nerve.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Lingual artery-
Course-
1st part- ligual loop crossed by hypoglossal nerve
2nd part-runs along the upper border of hyoid
3rd part- runs along the anterior border of hyoglossus
Branches-
-Dorsal lingual
-Deep lingual
-Sublingual
Importance-During surgical removal of tongue
-before it gives branch to tongue tonsil.

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
Facial artery-
-It arises from ECA above tip of greater cornua of hyoid bone runs
upwards as in neck as cervical part and then on face as facial part.
Course-
-both places is tortuous.

Human anatomy head and neck regional and applied clinical 7 th edition, v3 -B D Chaurasia
Branches-

Part of artery Branch Area perfused

Cervical part Ascending palatine Soft palate

Tonsillar branch Tonsils
Submental Submental triangle,
Sublingual gland
Glandular branch Submandibular gland
Facial part Inferior labial Lower lip
Superior labial Upper lip
Lateral nasal Side of Nose
Anastomoses-
-Terminal branches anastomoses with transverse facial Artery and infraorbital artery.
-At medial angle of eye it communicates with branches of opthalmic artery.
Ascending pharyngeal artery-

Course- It runs vertically upwards between the side wall of

Pharynx, tonsils, middle ear and auditory tube.
-Meningeal branch enters through jugular foramen.
-Pharyngeal branch supplies –
-middle constrictor
-inferior constrictor
-stylopharyngeus

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Occipital artery-

-It runs backwards and upwards deep into lower border of posterior belly of
digastric ,crossing carotid sheath, hypoglossal nerve then it runs deep to mastoid
process and muscles attached to it.
Branches-
-Mastoid
-Meningeal
-Muscular

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Posterior auricular artery-
Course-
-It runs upwards and backwards deep to parotid
gland but superficial to styloid process.
- It crosses base of mastoid process and ascends
behind the auricle.
- It supplies back of auricle, skin over mastoid
and over the back of scalp.
Branches-
Auricular branches

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Superficial temporal artery-
-It begins behind neck of mandible.
Course-
Branches-
-Transverse facial artery
-Middle temporal artery

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Maxillary artery-

-It arises behind the neck of mandible and is embedded in the substance of parotid gland.
Course-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
BRANCHES-

1st part 2nd part 3rd part

-Infraorbital
-Masseteric -Posterior superior alveolar
-Deep auricular
-Anterior tympanic -Deep temporal - Sphenopalatine
-Middle meningeal -Pterygoid muscle -Greater palatine
-Accessory meningeal -Buccal -Pharyngeal
-Inferior alveolar -Artery to pterygoid canal
Branches Foramen transmitting Distribution
First Deep auricular Skin of external acaustic meatus

l
Part
Anterior tympanic Tympanic membrane
Middle meningeal Foramen spinosm Middle ear and tensor tympani
Accessory meningeal Foramen ovale Pterygoids
Inferior alveolar Mandibular foramen Lower teeth and mylohyoid
Second Masseteric Masseter
Part
Deep temporal Temporalis
Pterygoid Pterygoid muscles
Buccal Cheek
Third PSA Upper molars and premolars
part
Infraorbital Inferior orbital fissure Upper incisors and canine
Greater palatine Greater palatine canal soft palate and gums
Pharyngeal Roof of nose
Sphenopalatine Sphenopalatine foramen Lateral and medial wall of nose
Inferior alveolar artery-
Course- It runs downwards and forwards medial to
ramus of mandible to reach mandibular foramen.

Branches-
-Mylohyoid artery-
-Dental branches-
-Alveolar branches-
-Mental artery-
-Incisive artery-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Internal Carotid Artery-
 - It is the principle artery of brain and eye.
Course – It begins at the level of upper border of thyroid cartilage
opposite to the disc between C3 and C4 cervical vertebrae and ends
in side cranial cavity by supplying to brain.

Parts

Cervical Cerebral

Petrous Cavernous
Branches-
Cervical part- gives no branches.

Petrous part-of temporal bone in carotid

canal.

 Cavernous part-
-trigeminal ganglion.
- hypophyseal branches to hypophysis
cerebri.
Cerebral part-
-Ophthalmic
-Anterior cerebral
-Middle cerebral
-Posterior communicating
-Anterior choroidal
Circle of Willis-
Contents-
-basilar artery
-Posterior cerebral artery
-Posterior communicating artery
-Anterior cerebral artery
-Anterior communicating artery
Relations-
Anterior-
-Anterior border of Posterior-
SCM -Carotid sheath,
-Posterior belly of -Vagus, accessory
digastric and
-Stylohyoid -hypoglossal nerve
-Stylopharyngeus

Lateral-
Medial- -Internal jugular vein
-Pharynx -Temporomandibular
joint
 Subclavian Artery-

 Supplies neck and brain region.

 ORIGIN-
RIGHT SIDE LEFT SIDE

-Branch of -Branch of arch of

brachiocephalic artery aorta , it ascends and
that arise posterior to enters neck posterior
sternoclavicular joint. to left sternoclavicular
joint.
Course-
Scalenous anterior muscle passes anterior to artery on each side
and divides it into 3 parts-
First part-medial
Second part-posterior
Third part-lateral

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Relations-

1st part- 2nd part- 3rd part-

-common carotid artery -Scalenus anterior -Posterior border
-vagus -SCM of SCM
-internal jugular vein -apex of lung -Scalenus medius
-SCM - apex of lung
-Apex of lung
Branches-

1st part
-Vertebral artery
- 2nd part
-Internal thoracic - Costocervical trunk-
artery
-Superior intercostal
-Thyrocervical trunk-
artery
-Inferior thyroid
-Deep cervical
-Transverse cervical

3rd part
-dorsal scapular artery
 VENOUS DRAINAGE OF HEAD, NECK AND
FACE
The veins of head and neck comprises of –
Internal jugular vein and its tributaries
facial vein and its tributaries
Subclavian vein
Veins of orbit ,nose and infratemporal region
Venous Drainage Of Cerebrum-

External cerebral veins-

- Superior cerebral veins
- superficial middle cerebral vein
-Deep middle cerebral vein
- Inferior cerebral veins
-Anterior cerebral vein
Internal cerebral veins-
Terminal veins-
- Great cerebral vein
- Basal vein.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Internal jugular veins and tributaries-
-It receives blood from brain ,face and neck.
Course -Emerges through jugular foramen as a
continuation of sigmoid sinus.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Tributaries-
Inferior petrosal sinus-

Pharyngeal vein-

Common facial vein-

Lingual vein-

Superior thyroid vein –

Middle thyroid vein-

 Facial vein-
Origin-
-largest vein of the face with no valves.
-begins as angular vein at medial angle of eye,
-forms by supratrochlear and supraorbital veins.
Course-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Deep connections of facial vein-
-communication between supraorbital and superior ophthalmic veins.
-pterygoid plexus through deep facial vein.
 Dangerous area of the face-
The communication between facial vein can lead to
retrograde spread of infections to cavernous sinus.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Lingual vein-
Course-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
  Anterior jugular vein-

-It starts below the chin, pass beneath the platysma to suprasternal
notch and passes laterally deep into sternocleidomastoid and
opens into external jugular vein.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
  External jugular vein-
- It begins behind the angle of mandible runs vertically down neck
along posterior border of SCM .

-It perforates deep neck fascia just above clavicle and drain into
subclavian vein.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Subclavian vein-
It begins at outer border of first rib as continuation of axillary vein.
Tributaries are-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Veins of orbit-
Superior ophthalmic vein
Inferior ophthalmic vein
Central vein of retina

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Veins of nose-
Internal nasal vein join to form sphenopalatine vein that end in
pterygoid plexus.
Superior labial and external nasal vein passes to facial vein.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Ligation of arteries-
Arterial haemorrhages during major operations can often be prevented by ligation of
the respective artery.
Arteries endangered during minor surgical procedures is –
-Facial artery
-Lingual artery
Ligation of facial artery-
-It can be easily exposed at point where it crosses the lower border of mandible to pass
from submandibular region.
-Masseter muscle can be used as landmark to feel pulse.
Procedure-

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
Ligation of Lingual artery-
- During removal of tongue artery dissected back to its origin and
bought under the posterior belly of digastric muscle.
Procedure-
-The submandibular gland is palpated and incision is given posterior part at tip
of mastoid and anterior part towards chin.

Human anatomy head, neck and face vol-3, fifth edition, B D chaursia
 Common Arterial Diseases-
Atherosclerosis-

-It is a result of hyperlipidemia and lipid oxidation in which all

vascular system from aorta to coronary arteries can be
involved and can be characterized by intimal plaques.

Ross R. ,Athrosclerosis –An inflammatory Disease, New England journal of

Medicine-1999;340;115-26
Aneurysm-
-It is a localized abnormal dilation of blood vessel
occurring due to weakening or destruction of vessel
wall.
-It can cause serious ill effects like-
-Thrombosis.
-Alteration in blood flow.
-Rupture of vessel leading to severe hemorrhage.

Neelima Anil Malik- Textbook of Oral and Maxillofacial Surgery-

fifth edition
Arteriovenous malformations-
 It is a congenital malformation due to direct
communication between arterial and venous
system.

 Prevalence-1-100000cases

Neelima Anil Malik- Textbook of Oral and Maxillofacial Surgery-

fifth edition
Hematoma-

- It is a localized collection of blood outside the blood vessel

due to disease or trauma including injury or surgery and may
involve blood continuing to seep from broken capillaries .

-An elevated intra arterial pressure causes effusion of blood

into soft tissue.

Svajhar T,knezevic G,postextraction complication and choices of anaesthesia Acta stomotal

croat1990;24(4)
Temporal arteritis-
-It occurs when one or more arteries are inflamed ,
swollen and tender.

Neelima Anil Malik- Textbook of Oral and Maxillofacial Surgery-

fifth edition
FAY syndrome(TIPIC syndrome)-

- Atypical unilateral pain cause in Face and neck

area.

-Causes intense pain with focal tenderness over

carotid pulse at level of bifurcation of
common carotid artery.
PHACE syndrome-

-Large infantile hemangiomas in head, neck and face

region along with the defects of eyes, heart, major
arteries and brain.

Dissec SC, Zemlin M, Mueeler C, Meyer S , PHACE Syndrome

International Clinical registry and genetic repository , Journal Pediatric 2017
 Conclusion-

-As a dentist we treat diseases of maxillofacial region so it is

important for us to have thorough knowledge of vasculature of this
region to give better treatments.
 References-
Human anatomy head, neck and brain volume 3,fifth edition-
B D Chaurasia
Human anatomy-thirty ninth edition-Henry gray

Neelima Anil Malik- Textbook of Oral and Maxillofacial Surgery- fifth edition

Textbook of oral anatomy, histology and physiology third edition-

K Rajkumar, Ramya

Svajhar T,knezevic G, postextraction complication and choices of

anaesthesia1990;24(4)

Ross R. ,Athrosclerosis –An inflammatory Disease, New England journal of

Medicine-1999;340;115-26
Thank you…