1. ARTERIAL SUPPLY, VENOUS & LYMPHATIC DRAINAGE OF HEAD, NECK AND FACE NetikaTharwani MDS Part 2

2. CARDIOVASCULAR SYSTEM Carries nutrients, oxygen, hormones, etc throughout body. Blood circulates within a fast, high capacity system made up of heart, which is the central pump.

3. ARTERIES: lead away from the heart, carry the blood to the peripheral parts of the body. VEINS: return the blood to the heart.

4. Heart can be thought of as a pair of muscular pumps, 1) feeding a minor loop (PULMONARY) – serves lungs and oxygenates the blood 2) feeding a major loop (SYSTEMIC) – serves the rest of the body

5. Each system is a closed system of tubes, so that blood does not leave the circulation

6. From the center to periphery, the vascular tree shows 3 modifications: The arteries  in number by sending out bifurcations. The arteries  in diameter . Blood flow is faster near the heart than at the periphery.

7. Functionally, 3 main vessels are described: Resistance vessels ( arteries, mainly arterioles) Exchange vessels ( capillaries, sinusoids) Capacitance vessels (veins)

8. RESISTANCE VESSELS Mainly arterioles Provide main source of peripheral resistance to blood flow

9. EXCHANGE VESSELS They allow exchange between blood and the interstitial fluid

10. HISTOLOGY OF BLOOD VESSSELS 3 concentric layers ( tunicae) Tunica intima - innermost layer Tunica media – contains muscle tissue, elastic fibres, collagen. Thickest in arteries and ansent in capillaries, Thin in veins. Tunica adventitia – outer coat of the vessel

12. AV ANASTOMOSES Direct communications between smaller arteries and veins. Notable in the skin of nose lips, ears, nasal mucosae, tongue, etc. In newborn, there are few AV anastomoses but develop rapidly. In old age, they atrophy, sclerose and diminish.

14. ARTERIAL SUPPLY OF HEAD AND NECK

15. AORTA

16. AORTA Ascending aorta begins at the base of left ventricle, continues as aortic arch.

17. BRANCHES FROM THE ARCH 3 Branches arise from convex aspect of arch: Brachiocephalic trunk Left Common Carotid Artery Left Subclavian Artery

18. APPLIED Coarctation of Aorta: Congenital ondition The ductusarterioses remains patent, but rarely compensates.

19. CAROTID SINUS At the point of division, the terminal part of CCA or beginning of ICA shows a localized dilatation. The tunica media of the sinus is thinner, but adventitia is thicker. Serves as a reflex pressure receptor.  in BP causes slowing of heart and vasodilatation of arterioles

21. CAROTID BODY Small structure that lies posterior to the point of bifurcation of CCA. Glossopharyngeal n Chemoreceptor : sensitive to  CO2 and  O2 in blood. Hence, produces a rise in BP and HR.

22. COMMON CAROTID ARTERY

24. Right CCA has only a cervical part while left CCA has cervical and thoracic parts. CCA ascends diverging laterally, where it divides to form EXTERNAL & INTERNAL CAROTID ARTERIES. At the level of upper border of thyroid cartilage. (C3, C4 junction)

25. RELATIONS POSTERIORLY: Transverse processes of the lower four cervical vertebrae Prevertebral muscles ANTEROLATERALLY: Skin Fascia Sternocleidomastoid Sternohyoid Sternothyroid Superior belly of omohyoid

27. Internal jugular vein

28. Vagus nerve (posterolaterally)MEDIALLY: Larynx Pharynx Trachea Oesophagus Lobe of thyroid gland

29. APPLIED The bifurcation of the CCA into the ICA and ECA at the ant border of SCM at the superior border of thyroid cartilage. Carotid pulse

30. EXTERNAL CAROTID A Supplies face, neck and scalp Origin: at the upper border of thyroid cartilage and terminates in parotid gland by dividing into terminal branches superficial temporal and maxillary arteries.

31. RELATIONS ANTEROLATERALLY: SCM Hypoglossal nerve Stylohyoid muscle Facial nerve ( parotid) IJV MEDIALLY: Wall of pharynx ICA Glossopharyngeal n

32. BRANCHES Anterior : Superior thyroid Lingual Facial Posterior: Occipital Posterior auricular Medial: Ascending pharyngeal Terminal: Maxillary Superficial temporal

35. SUPERIOR THYROID ARTERY Arises at the level of the greater cornu of hyoid bone. Supplies thyroid gland and some adjacent skin Branches

37. LINGUAL ARTERY Arises anteromedially from ECA opposite to the tip of the greater cornu of hyoid bone. Short course lies deep to hyoglossus muscle, finally leaves the muscle in the tongue to anastomose with the fellow of opposite side. Supplies the floor of the mouth and tongue

38. BRANCHES IN THE FLOOR OF MOUTH: dorsal Lingual arteries Sublingual Deep lingual artery SUPRAHYOID ARTERY: runs along the upper border of hyoid bone

40. FACIAL ARTERY Origin– branch of external carotid artery just above the tip of greater cornu of hyoid bone. Course – runs upwards in neck, then on face; tortuous in both places Two parts- Cervical part Facial part

42. Ascending palatine artery

43. Tonsillar artery

44. Glandular branches

46. Inferior labial artery

47. Superior labial artery

52. Course – follows upper border of stylohyoid muscle, anterior border of styloid process reaches groove between cartilage of outer ear and mastoid process.

54. ASCENDING PHARYNGEAL ARTERY Smallest branch Medially arises from the ECA

56. MAXILLARY ARTERY Varied region of blood supply: External and middle ear, auditory tube Dura mater Upper and lower jaws Muscles of temporal and infratemporal regions Nose and paranasal air sinuses Palate Root of pharynx

58. 3 parts: Mandibular part Pterygoid part Pterygopalatine part

59. Mandibular part Deep auricular Anterior tympanic Middle meningeal Accessory meningeal Inferior alveolar

61. Pterygoid part Supplies the muscles of mastication Deep temporal Pterygoid Masster Buccal

64. Pterygopalatine part Posterior Superior Alveolar Infraorbital Greater palatine Pharyngeal Artery of pterygoid canal Sphenopalatine artery

66. LITTLE’S AREA

69. SUPERFICIAL TEMPORAL ARTERY Arises in the parotid gland behind the neck of the mandible

70. Transverse Facial Auricular artery Zygomatico- orbital artery Middle temporal Frontal Parital

72. INTERNAL CAROTID ARTERY Divided into- Cervical Petrous Cavernous Cerebral

73. CERVICAL part: has no branches

75. PETROUS PART Caroticotympanic branch or artery:- anastomosis with anterior tympanic artery Pterygoid artery :-anastomosis with branch of greater palatine

76. CAVERNOUS PART Within the cavernous sinus Branches: Cavernous branches to the trigeminal ganglion The superior and inferior hypophysealbranches to hypophysiscerebri.

78. CEREBRAL PART Lies at the base of brainafter emerging from cavernous sinus Branches: Ophthalmic Anterior cerebral Middle cerebral Posterior communicating Anterior choroidal

79. Enters through the optic canal dividing into supratrochlear and dorsal nasal branches

82. THANK YOU

83. ARTERIAL SUPPLY, VENOUS & LYMPHATIC DRAINAGE OF HEAD, NECK AND FACE NetikaTharwani MDS Part 2

84. VENOUS DRAINAGE OF SCALP SUPRATROCHLEAR and SUPRAORBITAL veins unite to form ANGULAR vein continues down as FACIAL vein.

85. The SUPERFICIAL TEMPORAL VEIN joins the MANDIBULAR VEIN to form the RETROMANDIBULAR vein unites with FACIAL vein to form COMMON FACIAL vein which drains into IJV.

86. The POST AURICULAR vein and POST DIVISION OF RETROMANDIBULAR vein to form EXT JUGULAR vein and drains into SUBCLAVIAN.