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Transcript
CHPTER 4
THE FACE
Vascular
System of
Head & Neck
Dr. Motaz Shieban , PhD , MD
Surgical Oncologist , Austria
Common Carotid Artery
 The right common carotid artery arises from the
brachiocephalic artery behind the right
sternoclavicular joint
 The left artery arises from the arch of aorta in the
superior mediastenum
 Runs upward through the neck
 Divides into external and internal carotid arteries
Carotid Sinus
At its point of division, the common carotid artery
shows a localized dilatation, called carotid sinus
 It serves as a reflex pressoreceptor mechanism
 A rise in blood pressure causes a slowing of the
heart rate and vasodilatation of the arterioles
Carotid Body
 It is a small structure lies posterior to the point of
bifurcation of the common carotid artery
 It is innervated by glossopharyngeal nerve
 It serves as a chemoreceptor
 Sensitive to excess carbon dioxide and reduced oxygen
tension in the blood
 Stimulus reflexly produces a rise in blood pressure and
heart rate and increase in respiratory movements
Common Carotid Artery
 It is embedded in the carotid sheath throughout its course
 Closely related with the internal jugular vein and vagus nerve
 Apart from the two terminal branches, the common carotid
artery gives off no branch in the neck
 Relations
 Anterolaterally: The skin, fascia, sternocleidomastoid,
sternohyoid, sternothyroid, and posterior belly of omohyoid
 Posteriorly: The transverse processes of lower four cervical
vertebrae, the prevertebral muscles, sympathetic trunk,
vertebral vessels in the lower part of the neck
 Medially: The larynx, pharynx, and below these, the trachea and
esophagus, the lobe of thyroid gland
 Laterally: The internal jugular vein, and posterolaterally, the
vagus nerve
External Carotid Artery
 It is one of the terminal branches of the common carotid artery
 It supplies the structures in the neck, face, scalp, tongue and





maxilla
Begins at the level of the upper border of the thyroid cartilage
Terminates in the substance of the parotid gland by dividing
into superficial temporal and maxillary arteries
At its origin, where its pulsation can be felt, the artery lies
within the carotid triangle
At first, it lies medial to the internal carotid artery
It is crossed by the posterior belly of the digastric and the
stylohyoid
Relations
 Anterolaterally: overlapped by sternocleidomastoid
muscle, fascia and skin, it is crossed by the
hypoglossal nerve the posterior belly of the
digastric muscle and the stylohyoid, crossed by the
facial nerve within the parotid gland
 The internal jugular vein first lie anterior to the
artery then posterior to it
 Medially: the wall of the pharynx, internal carotid
artery
 The stylopharyngeus muscle, the glossopharyngeal
nerve, and pharyngeal branch of the vagus pass
between the external and internal carotid arteries
Branches
1)
2)
3)
4)
5)
6)
7)
8)
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Superficial temporal artery
Maxillary artery
1. Superior Thyroid Artery





Arises from the external carotid artery near its origin
Passes almost vertically downward
Reach the upper pole of thyroid gland
It gives off a branch to the sternocleidomastoid
The superior laryngeal artery pierces the thyrohyoid
membrane with the internal laryngeal nerve
2. Ascending Pharyngeal Artery
 It’s a long slender vessel that ascends on the wall
of the pharynx, which it supplies
3. Lingual Artery
 It arises from the external carotid artery,
opposite the tip of the greater cornu of hyoid
bone
 It loops upward to enter the submandibular
region
 The loop of the artery is crossed superficially
by the hypoglossal nerve
 It supplies the tongue
4. Facial Artery
It arises in the carotid triangle from
the external carotid artery a little
above the lingual artery and,
sheltered by the ramus of the
mandible, passes obliquely up
beneath the digastric and stylohyoid
muscles, over which it arches to enter
a groove on the posterior surface of
the submandibular gland.
It then curves upward over the body
of the mandible at the antero-inferior
angle of the masseter; passes forward
and upward across the cheek to the
angle of the mouth, then ascends
along the side of the nose, and ends
at the medial commissure of the eye,
under the name of the angular artery.
The facial artery is remarkably
tortuous. This is to accommodate
itself to neck movements such as
those of the pharynx in deglutition;
and facial movements such as those
of the mandible, lips, and cheeks.
Branches of
Facial Artery
Cervical
1. Ascending palatine artery
2. Tonsillar branch
3. Submental artery
4. Glandular branches
Facial
1. Inferior labial artery
2. Superior labial artery
3. Lateral nasal branch to
nasalis muscle
4. Angular artery - the
terminal branch
5. Occipital Artery
 It arises from the external
carotid artery, opposite the facial
artery
 It passes upward and reaches
the back of the scalp
 Its terminal part accompanies
branches of the greater occipital
nerve to supply the back of
scalp
 Its path is below the posterior
belly of digastric to the occipital
region.
 This artery supplies blood to the
back of the scalp and sternomastoid muscles, and deep
muscles in the back and neck.
6. Posterior Auricular Artery
 It arises from the external carotid artery, at the level
of the upper border of the posterior belly of the
digastric muscle
 It passes backward to reach the auricle
7. Superficial Temporal Artery
 It is the smaller terminal branch of the external
carotid artery
 Ascends in front of the auricle in company with
auriculotemporal nerve
 It divides into anterior and posterior branches,
which supply the skin over the frontal and temporal
regions
8. Maxillary Artery
It is the larger terminal branch of the external carotid
artery in the parotid gland ,It arises behind the neck of
the mandible .It runs upward and forward, leaves the
infratemporal fossa by entering the pterygopalatine fossa
Branches of Maxillary Artery
First portion
The first or mandibular portion passes horizontally forward,
between the neck of the mandible and the sphenomandibular
ligament, where it lies parallel to and a little below the
auriculotemporal nerve; it crosses the inferior alveolar nerve,
and runs along the lower border of the lateral pterygoid
muscle.
Branches include:
1) Deep auricular artery
2) Anterior tympanic artery
3) Middle meningeal artery
4) Inferior alveolar artery which gives off its mylohyoid branch
just prior to entering the mandibular foramen
5) Accessory meningeal artery
Second portion:
The second or pterygoid portion runs obliquely forward and upward under cover of
the ramus of the mandible and insertion of the temporalis, on the superficial (very
frequently on the deep) surface of the lateral pterygoid muscle; it then passes between
the two heads of origin of this muscle and enters the fossa.
Branches include:
1) Masseteric artery
2) Pterygoid branches
3) Deep temporal arteries (anterior and posterior)
4) Buccal artery
Third portion
The third or pterygomaxillary portion lies in the pterygopalatine fossa in relation with
the pterygopalatine ganglion. This is considered the terminal branch of the maxillary
artery.
Branches include:
1) Sphenopalatine artery (Nasopalatine artery is the terminal branch of the Maxillary
artery)
2) Descending palatine artery
3) Infraorbital artery
4) Posterior superior alveolar artery
5) Artery of pterygoid canal
6) Pharyngeal artery
7) Middle superior alveolar artery (a branch of the infraorbital artery)
8) Anterior superior alveolar arteries (a branch of the infraorbital artery)
Internal Carotid artery
 It is one of the terminal branches of the common
carotid artery
 It supplies the brain, the eye, the forehead, and the
part of nose
 It begins at the level of the upper border of the
thyroid cartilage
 Ascends in the neck to the base of the skull
Internal Carotid artery
 It enters the cranial cavity through the carotid
canal in the petrous part of the temporal bone
 It lies embedded in the carotid sheath with the
internal jugular vein and vagus nerve
 It gives off no branches in the neck
Relations
 Anterolaterally: Below the digastric lie the skin, the
fascia, anterior border of sternocleidomastoid and
the hypoglossal nerve
 Above the digastric lie the stylohyoid and the
stylopharyngeus muscles, the glossopharyngeal
nerve, the pharyngeal branch of vagus nerve, the
parotid gland and the external carotid artery
Relations
 Posteriorly: The sympathetic trunk, longus capitis
muscle, and the transverse processes of the upper
three cervical vertebrae
 Medially: The pharyngeal wall and the superior
laryngeal nerve
 Laterally: The internal jugular vein and the vagus
nerve
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
 The deep cervical lymph nodes
are adjacent to the vein
 Terminate beneath the triangular
interval between the sternal and
the clavicular head of the
sternocleidomastoid muscle joining
the subclavian vein to form the
brachiocephalic vein
 The superior and inferior bulbs:
 are dilatation near the origin and
the termination of the vein.
 Above the inferior bulb is a bicuspid
valve
 Skin, superficial fascia,
platysma, deep cervical fascia
and parotid lies lateral and
anteriorly
Veins of the Head and neck
 Tributaries:
 Inferior petrosal sinus:
 assist in draining the
cavernous sinus
 leaves through anterior part of
jugular foramen
 join the vein below the
superior bulb
Facial vein:
 is formed by the union
of the supraorbital and
supratrochlear veins the
medial canthus to form
the angular vein
 Communicate with the
cavernous sinus through
the ophthalmic vein via
the supraorbital
Facial vein:
 descend on the face behind
the facial artery to the lower
border of the mandible
 to be joined by the anterior
division of the retomandibular
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
retromadibular 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
artery, 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
Pterygoid plexus:
 Act as peripheral pump, to aid venous
return by the pumping action of the muscle
every time the mouth is opened.
 Yawing, a prolonged and forcible
contraction of the lateral pterygoid to open
the mouth, is accompanied by contraction
of the diaphragm and stretching of limbs, is
a reflex triggered by venous stagnation
Pharyngeal veins:
 drain the pharyngeal
plexus on the outer
surface of the pharynx.
 End in the internal jugular
vein , the facial the lingual
or the superior thyroid
veins
Lingual vein:
 the tip drain into the deep
lingual vein, visible on the
under surface near the
midline
 run back superficial to the
hypoglossus and is joined by
the sublingual vein from the
gland to form vena comtians
 join the internal jugular near
the greater horn of the hyoid
bone
Veins of the Head and neck
 Superior thyroid vein:
 leaves the superior pole of the
thyroid gland and empty in the
facial or the internal jugular
 Middle thyroid vein:
 short and wide, pass from the
middle of the pole directly into
the internal jugular
 Occipital vein:
 join the internal jugular but
more often join the vertebral or
the posterior auricular
Anterior jugular vein:
 start below the chin, pass
beneath the platysma to the
suprasternal notch.
 Pierce the deep fascia and is
connected to the other side
by an anastomosing vein the
jugular arch
 angle laterally to pass deep
to sternocleidomastoid and
open in the external jugular
vein
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
Veins of the Head and neck
 Tributaries:
 Posterior auricular vein
 posterior division of retro mandibular
vein
 Posterior exernal jugular vein
 transverse cervical vein
 suprascapular vein
 anterior jugular vein
External Jugular Vein
 The external jugular vein is 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 sternocleidomastoid muscle
and beneath the platysma muscle
 It drains into the subclavian vein behind the middle
of the clavicle
Anterior Jugular Vein
 The anterior jugular vein 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
sternocleidomastoid muscle
Internal Jugular Vein
 The internal jugular vein is a large vein that
receives blood from the brain, face, and neck
 It starts as a continuation of the sigmoid sinus
and leaves the skull through the jugular foramen
Internal Jugular Vein
 It then descends through the neck in the carotid
sheath lateral to the vagus nerve and the
internal and common carotid arteries
 It ends by joining the subclavian vein behind the
medial end of the clavicle to form the
brachiocephalic vein
Internal Jugular Vein
 Throughout its course, it is closely related to the
deep cervical lymph nodes
 The vein has a dilatation at its upper end called
the superior bulb and another near its
termination called the inferior bulb
 Directly above the inferior bulb is a bicuspid
valve
Tributaries of Internal
Jugular Vein
 Inferior petrosal sinus
 Facial vein
 Pharyngeal veins
 Lingual vein
 Superior thyroid vein
 Middle thyroid vein