The document provides an overview of the major arteries of the head and neck, including their origins, courses, branches, and clinical significance. It discusses the common carotid artery, external carotid artery, internal carotid artery, and their branches such as the lingual, facial, occipital, and maxillary arteries. The summary highlights the arterial supply of the head and neck originating from branches of the aortic arch and their roles in supplying surrounding structures.

1. GREAT ARTERIES OFTHE HEAD AND NECK
PRESENTED BY: MAHIMA SHANKER
(DEPARTMENTOF ORAL AND MAXILLOFACIAL SURGERY)

2. CONTENTS
• INTRODUCTION
• EMBRYOLOGYAND DEVELOPMENT
• HISTOLOGY OF ARTERIES
• ARCH OF AORTA
• SUBCLAVIANARTERY
i. Origin
ii. Course and termination
iii. Parts and clinical significance
iv. Branches
v. Subclavian steal syndrome
• CAROTID SYSTEM OF ARTERIES
i. Origin and termination
ii. Branches
iii. Surface marking
iv. Ligation
v. Carotid sinus, carotid body and carotid pulse
• EXTERNALCAROTID ARTERY
i. Course
ii. Branches
iii. Relations
iv. Surface marking
v. Ligation
• BRANCHESOF ECA IN DETAIL
• INTERNALCAROTID ARTERY
i. Course and termination
ii. Parts and branches
iii. Clinical significance

3. INTRODUCTION
• BLOOD -The red fluid in the body that contains white and red blood cells,
platelets, proteins, and other elements. (Webster’s New World Medical Dictionary
3rd edition)
• BLOODVESSEL – Part of the circulatory system that transports blood throughout
the body.
• ARTERY - A blood vessel that carries blood, rich in oxygen, away from the heart to
the body.The oxygenated hemoglobin (oxyhemoglobin) in arterial blood makes it
look bright red. (Webster’s NewWorld Medical Dictionary 3rd edition)
• The blood supply of the head and neck consists of an arterial supply and venous
drainage carried out by the arteries and veins, respectively.

5. EMBRYOLOGY AND DEVELOPMENT
• At the beginning of the third week, blood vessel formation begins.
• The early formation of the cardiovascular system is related to the urgent need for
blood vessels to bring oxygen and nourishment to the embryo from the maternal
circulation through the placenta.
• The formation of the embryonic vascular system involves two processes:
vasculogenesis and angiogenesis.
• By the end of the third week, the blood is circulating and the heart begins to beat on
the 21st or 22nd day.

6. Blood vessel formation in the embryo and extraembryonic membranes begins when mesenchymal cells
differentiate into endothelial cell precursors or angioblasts (vessel forming cells)
Angioblasts aggregate to form isolated angiogenic cell clusters or blood islands
Small cavities appear within the blood islands
The angioblasts flatten to form endothelial cells that arrange themselves around the cavities in
the blood islands to form the endothelium
These endothelium-lined cavities soon fuse to form networks of endothelial channels (vasculogenesis)
Additional vessels sprout into adjacent areas by endothelial budding (angiogenesis) and fuse with other vessels
The mesenchymal cells surrounding the primordial endothelial blood vessels differentiate into the muscular and
connective tissue elements of the vessels

8. HISTOLOGY

9. ARTERIAL SUPPLY OFTHE HEAD AND NECK
ARCH OF AORTA
• Arch of aorta - part of the aorta between the
ascending and descending aorta.
• Branches
o Left common carotid artery
o Left subclavian artery
o Brachiocephalic trunk – Right common carotid
artery and right subclavian artery
• The arteries that supply the head and neck -
subclavian and common carotid arteries.

10. SUBCLAVIAN ARTERY
• Subclavian artery - called so because it lies under the clavicle.
• Main source of blood supply to upper limb (called artery of the upper limb)
• Also supplies - part of the thoracic wall, head, neck and brain through its branches.
ORIGIN
• Right subclavian artery - from brachiocephalic trunk.
• Left subclavian artery - from arch of aorta in the thorax.
COURSEANDTERMINATION
• On each side - subclavian artery arches laterally across the anterior surface of the cervical pleura
onto the first rib posterior to the scalenus anterior muscle.
• At the outer border of 1st rib - ends by becoming axillary artery.

11. PARTS
On each side, the subclavian artery is divided into three parts by the scalenus anterior muscle
• First part - from origin to medial border of scalenus anterior
• Second part - lies behind scalenus anterior
• Third part - from lateral border of scalenus anterior to outer border of first rib
Third part of the subclavian artery - most superficial, pulsations felt on deep pressure. Located in supraclavicular
triangle. Can be compressed against the first rib by pressing downwards, backwards, and medially in the angle between
clavicle and posterior border of SCM.
Can be ligated here.

12. BRANCHES OF SUBCLAVIAN ARTERY

13. Subclavian steal syndrome

14. CAROTID SYSTEM OF ARTERIES
The common carotid artery is a paired structure that supplies oxygenated blood to the head and neck.
ORIGINANDTERMINATION
• The right common carotid artery - bifurcation of brachiocephalic trunk behind sternoclavicular joint.
• The left common carotid artery - thorax directly from arch of aorta.
• The artery terminates at the level of upper border of thyroid cartilage.
• The left CCA has two parts – a thoracic part and a cervical part
• The right CCA is exclusively cervical.
BRANCHES
• Internal carotid artery
• External carotid artery

15. SURFACE MARKINGOF COMMON CAROTIDARTERY
• First point on sternoclavicular joint
• Second point on anterior border of SCM at the level of upper border of thyroid cartilage

16. LIGATION OF CCA
• Easily accessible in carotid canal
• Covered anteromedially - skin, fascia, platysma and bilaterally by anterior margin of SCM
• Ligation of CCA - at the level of hyoid bone - very few structures pass above it
• Superior thyroid artery, superior thyroid vein and anterior jugular vein - superficial to the artery.
• Opening the carotid sheath more medially - IJV avoided

17. CAROTID SINUS
• Termination of CCA or beginning of ICA - slight dilatation known as carotid sinus.
• Baroreceptor (pressure receptor) and regulates blood pressure.
• Carotid sinus hypersensitivity (CSH) - exaggerated response to stimulation of carotid sinus.
• Dizziness or syncope due to diminished cerebral perfusion.
• Even mild stimulation - bradycardia and drop in BP.

18. CAROTID BODY
• Small, oval, reddish brown structure situated behind the bifurcation of CCA.
• Act as a chemoreceptor and responds to change in the oxygen and carbondioxide content of blood.
CAROTID PULSE
• CCA can be compressed against the prominent anterior tubercle of the sixth cervical vertebrae called carotid
tubercle - pressing medially and posteriorly with the thumb.
• It is located about 4 cm above the sternoclavicular joint at the level of cricoid cartilage.
• Above this level - CCA is superficial, pulsations felt easily
• Most constant pulse in the body.

19. EXTERNAL CAROTID ARTERY
One of the two terminal branches of CCA and supplies the structures external to the head and in front of the neck.
COURSE
• Extends upwards from - level of upper border of lamina of the thyroid cartilage to a point behind the neck of the
mandible - terminates in the substance of the parotid gland by dividing into the superficial temporal and maxillary
arteries.
• Has a slightly curved course so that it is anteromedial to ICA in its lower part and anterolateral in its upper part.

20. BRANCHES

21. RELATIONS
INTHE CAROTIDTRIANGLE
Superficially - Cervical branch of facial nerve
Hypoglossal nerve
Facial, lingual and superior thyroid veins
Deep to the artery -Wall of pharynx
Superior laryngeal nerve
Ascending pharyngeal artery
ABOVETHE CAROTIDTRIANGLE
Deep in the parotid triangle - within the gland -
Superficially - Retromandibular vein
Facial nerve
Deep to the artery - ICA
Structures passing between ECA and ICA
Styloglossus, Stylopharyngeus, IXth nerve, Pharyngeal branch of Xth nerve, Styloid process

22. SURFACEANATOMYOF ECA
• First point - anterior border of SCM at the level of the upper border of thyroid cartilage.
• Second point - posterior border of the neck of the mandible

23. LIGATION OF EXTERNAL CAROTIDARTERY
• Injuries of upper part of neck or superficial and deep structures of face - ligation of the ECA
• Two points at which ECA can be exposed and tied.
EXPOSURE INTHE CAROTIDTRIANGLE EXPOSURE INTHE RETROMANDIBULAR FOSSA

24. ANTERIOR BRANCHESOF ECA
ORIGIN
Arises from front of ECA below the tip of greater cornua of hyoid bone.
COURSE
• Runs downwards, forwards, parallel and superficial to external laryngeal nerve
• Passes deep to omohyoid, sternohyoid, sternothyroid - reaches the upper pole of lateral lobe of thyroid - divides
into terminal branches.
• Accompanied by superior thyroid vein
BRANCHES
Superior thyroid artery
• Infrahyoid branch
• Sternocleidomastoid branch
• Superior laryngeal artery
• Cricothyroid branch
• Glandular branches to the thyroid gland

25. • Surgical procedures that involve STA - radical neck dissection, cricothyroidotomy, thyroidectomy, reconstruction of
an aneurysm, carotid endarterectomy, treatments for cancer, diagnostic and therapeutic catheterization and
plastic surgery
• Accurate clinical anatomical knowledge of the STA is important to minimizing surgical complications
• Relationship of STA with external laryngeal nerve is important during thyroid surgery
• To avoid injury to the ELN, the STA is ligated and sectioned near the superior pole of thyroid gland where it is not
closely related to the nerve (as it is at the origin)

26. ORIGIN
• Arises - front of ECA opposite the tip of the greater cornu of hyoid bone
• Main artery - supply blood to the tongue
• May arise with the facial artery.
PARTS
Divided into three parts by the hyoglossus muscle
• First part - in the carotid triangle and forms a characteristic loop with convexity upwards - crossed superficially by the
hypoglossal nerve - loop permits free movement of the hyoid bone
• Second part - deep to hyoglossus muscle along upper border of the hyoid bone
• Third part- upwards along anterior border of the hyoglossus muscle, then forwards on the undersurface of tongue
and anastomoses on the opposite side.
Lingual artery
BRANCHES
• From first part –suprahyoid branch
• From second part - dorsal linguae branches (usually two in number)
• From third part - sublingual artery

27. LIGATION OFTHE LINGUALARTERY

28. EXPOSURE OF LINGUAL ARTERY INTHE SUBMANDIBULARTRIANGLE

29. Facial artery
ORIGIN
• Arises from the front of ECA just above the tip of the greater cornu of the hyoid bone
• Divided into two parts - cervical and facial
• Supplies muscles and skin of the face
BRANCHES
From the cervical part (branches in the neck)
• Ascending palatine artery
• Tonsillar artery (main artery of tonsil)
• Glandular branch
• Submental artery
From the facial part (branches on the face)
• Superior labial
• Inferior labial
• Lateral nasal
• Angular

30. • Facial artery - severed accidentally during operative procedures on the lower premolars or molars if an instrument
enters the cheek in this region
• Artery was severed during attempts to open buccal abscess of the first molar
• In a buccal abscess - artery often dislocated and it circles the abscess on inferior and lateral surfaces
• Deep incisions in such a case may endanger the artery - knife should not be allowed to penetrate the lateral or the
inferior wall of the abscess

31. LIGATION OFTHE FACIALARTERY

32. POSTERIOR BRANCHESOFTHE ECA
Occipital artery
• Arises from the posterior aspect of the ECA at the same level as the facial artery.
• Crossed at origin by hypoglossal nerve.
• Supplies posterior part of scalp.
BRANCHES
• Sternocleidomastoid branches (usually two in number)
• Mastoid branch
• Meningeal branches
• Muscular branches
• Auricular branch
• Descending branch
Descending branch of the occipital artery - chief collateral circulation after
ligation of ECA or subclavian artery

33. Posterior auricular artery
• Arises from the posterior aspect of the ECA - little above occipital artery
• Crosses superficial to the stylohyoid muscle
• Supplies - auricle, skin over mastoid process and scalp
BRANCHES
• Stylomastoid artery
• Auricular branch
• Occipital branch
Posterior auricular artery is cut in incisions for mastoid operations

34. Ascending pharyngeal artery from the medial aspect of ECA
• Slender artery - arises very close to the lower end of the ECA.
• Runs vertically upwards and supplies - wall of pharynx, tonsil, medial wall of middle ear and auditory tube.
BRANCHES
• Pharyngeal and prevertebral branches
• Meningeal branches
• Inferior tympanic
• Palatine branches

35. TERMINAL BRANCHESOF ECA
Superficial temporal artery
• Smaller, more direct terminal branch of the ECA
• Runs vertically upward crossing the root of zygoma or preauricular point where its pulsations can be felt
BRANCHES
• Transverse facial artery
• Anterior auricular branch
• Zygomatico-orbital artery
• Middle (deep) temporal artery
• Anterior (frontal) and posterior (parietal) terminal branches
• The anterior branch supplies the muscles and skin of the frontal region
• The posterior branch supplies skin and the auricular muscles

36. • Superficial temporal pulse
Pulsations of superficial temporal artery - felt in front of tragus of the ear
Useful to anesthetists when radial pulse not available during surgery - called anesthetist’s artery
• Course of anterior terminal branch of the superficial temporal artery on the forehead clearly seen when person is
angry - more tortuous with increasing age

37. Maxillary artery
• Larger terminal branch of the ECA
• Supplies - upper and lower jaws, muscles of temporal and infratemporal fossae, nose and paranasal sinuses,
palate and roof of pharynx, external and middle ear, pharyngotympanic tube, and dura mater
COURSE ANDTERMINATION
• Arises behind the neck of the mandible
• Runs horizontally forward to the lower head of LP
• Emerges between two heads of LP - enters pterygopalatine fossa and ends by giving terminal branches
PARTS
Divided into three parts by lower head of LP
• First part (mandibular) Beginning to lower border of LP
• Second part (pterygoid) Lower border to the upper border of the lower head
• Third part (pterygopalatine) Upper border of the lower head to pterygopalatine fossa

38. BRANCHES

39. Mandibular part
Deep auricular artery - runs upwards to enter the ear, courses superficially to tympanic membrane passing between the
cartilage and bone (Supplies external acoustic meatus)
Anterior tympanic artery - courses near the tympanic membrane, passes deep to the membrane through
petrotympanic fissure to middle ear and joins circular anastomosis around tympanic membrane
Middle meningeal artery - passes straight upwards through foramen spinosum, joins the two roots of the
auriculotemporal nerve (Supplies bones of skull, dura mater)
Inferior alveolar artery - runs downwards and forwards to IAN at the mandibular foramen, runs further anteriorly in
mandible (Supplies pulps of the mandibular teeth, body of the mandible)
Mental branch emerges from mental foramen (Supplies nearby lip, skin)
Accessory meningeal artery - source of blood supply to the trigeminal ganglion, passes upwards through foramen ovale
(Supplies dura mater of floor of the middle fossa and trigeminal cave)

40. Pterygoid part
(All branches supply only soft tissues)
Masseteric artery - small and passes laterally through mandibular notch to the deep surface of the masseter muscle
which it supplies
Pterygoid artery - supplies the lateral pterygoid muscle and medial pterygoid muscle
Deep temporal artery - bifurcates into two - anterior and posterior - course between temporalis and pericranium
supplying the muscles and anastomose with middle temporal artery
The anterior division communicates with lacrimal artery by small branches which perforate zygomatic bone and great
wing of the sphenoid
Buccal artery - runs obliquely forward between medial pterygoid and temporalis muscle to outer surface of buccinator
muscle (supplies)
Anastomoses with branches of facial artery and infraorbital artery
From infraorbital area, descends bilaterally in superficial face along lateral margin of the nose, running anti-parallel to
the facial artery across the lateral oral region.

41. Pterygopalatine part
Sphenopalatine artery - supplies the nasal cavity - passes through sphenopalatine foramen into nasal cavity - gives off
posterior lateral nasal branches
Crossing inferior surface of the sphenoid - ends on the nasal septum as the posterior septal branches
Descending palatine artery - divides to form the greater and lesser palatine arteries to supply hard palate and soft palate
Descends through greater palatine canal with greater and lesser palatine branches of the pterygopalatine ganglion
Emerges from greater palatine foramen - runs forward in a groove on the medial side of alveolar border of hard palate to
incisive canal - terminal branch of the artery passes upward through this canal to anastomose with sphenopalatine artery
Infraorbital artery - passes forwards through inferior orbital fissure along the floor of the orbit and infraorbital canal to
emerge with infraorbital nerve on the face
Posterior superior alveolar artery - supplies maxillary teeth - gives branches that accompany the corresponding nerves
through foramina in posterior wall of the maxilla
Middle superior alveolar artery and anterior superior alveolar artery - branches of the infraorbital artery
Pharyngeal artery - supplies pharynx and roof of the nose
Artery of the pterygoid canal - runs into the pterygoid canal - passes backwards along pterygoid canal with its nerve –
supplies upper part of pharynx
Sends small division into tympanic cavity to anastomose with tympanic arteries

42. • Recent years - extracranial to intracranial bypass using the maxillary artery has gained attention - treatment of
skull base tumors and complex cerebral aneurysms
• Zygomatic osteotomy to allow proper exposure of the vessel - new techniques to reach the maxillary artery without
the need for zygomatic osteotomy - reaching the artery through the deep temporal vessels upon reflection of the
temporalis muscle
• Middle meningeal artery - surgical importance - can be injured in head injuries - source of extradural haemorrhage
• Greater palatine artery - accidently severed during procedures in posterior palatine region
• Pterygopalatine part - important during maxillary orthognathic surgery

43. INTRAORAL LIGATIONOF MAXILLARYARTERY FOR POSTERIOR EPISTAXIS

44. ENDOSCOPIC SPHENOPALATINE ARTERY LIGATION IN POSTERIOR EPISTAXIS
Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis: Retrospective Analysis of 30 Patients
Onur İsmi, Yusuf Vayisoğlu, Cengiz Özcan, Kemal Görür, Murat Ünal
Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey

45. INTERNAL CAROTID ARTERY
• One of the two terminal branches of the CCA and is more direct
• Upward continuation of the CCA
• Supplies structures inside the skull and orbit
COURSE ANDTERMINATION
• Begins at upper border of the lamina of thyroid cartilage at the level between C3 and C4 vertebrae
• Runs upwards to reach the base of the skull and enters carotid canal
• Enters cranial cavity through foramen lacerum
• In the cranial cavity – enters cavernous sinus and has a tortuous course
• Ends - anterior perforated substance of the brain by dividing into anterior and middle cerebral arteries

47. Infarction and cerebrovascular accidents
Hypoperfusion - decrease in oxygen, nutrient supply to organs - remain hypoperfused for a prolonged period they will
die - a process known as infarction
In the brain - manifests as a stroke – in anterior circulation, middle cerebral artery affected in about 90% of these cases
Atherosclerotic plaques - earlier course of the ICA and terminal branches - surgically accessed for the plaque removal -
this procedure is called carotid endarterectomy
Basal skull fractures - ICA enters the skull through carotid canal - fractures of the base of the skull can tear the ICA
resulting in an AV fistula inside the cavernous sinus

48. REFERENCES
• The Developing Human: ClinicallyOriented Embryology by Keith L Moore
• Snell’s ClinicalAnatomy
• Oral Anatomy by Sicher
• Atlas of Human Anatomy by Netter