Blood Supply of Head and Neck Corrected Final Part 1

8/10/2019 Blood Supply of Head and Neck Corrected Final Part 1

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GOOD MORNING


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BLOOD SUPPLY OF HEADAND NECK

BY

DR. NILAY SHAH2


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CONTENTSCirculatory System :

Definition Types Of Circulatory Systems

Heart

Histology Of Blood Vesseles

Blood Supply Of Head And Neck :

Aorta

Common Carotid Artery

External Carotid ArteryExternal Carotid Artery :

Superior Thyroid Artery

Lingual Artery

Facial Artery3


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CIRCULATORY SYSTEM

It is a system which supplies nutrients ,

oxygen , hormones etc. throughout bodyand carries away waste , carbon dioxideetc. through blood.

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Circulatory system

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HEART

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HISTOLOGY OF ARTERIES AND VEINS

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COMMON CAROTID ARTERY

RIGHT CCA LEFT CCA

ORIGIN FROM THE

BRACHIOCEPHALICARTERY

DIRECTLY

FROM THEARCH OF

AORTA

TERMINATION AT THE LEVEL OF THE UPPERBORDER OF THYROID CARTILAGE

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Right CCA has only a cervical part while left CCA hascervical and thoracic parts.

CCA ascends diverging laterally, where it divides toform EXTERNAL & INTERNAL CAROTID ARTERIES. At

the level of upper border of thyroid cartilage. (C3, C4junction)

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SURFACE ANATOMY

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RELATIONS

Anterolaterally:

Skin

Fascia

Sternocleidomastoid

Sternohyoid

Sternothyroid

Superior belly ofomohyoid

Posterolaterally:

Transverse processes of the

lower four cervical vertebrae

Prevertebral muscles.

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Medially:

Larynx

Pharynx

Trachea

Esophagus

Lobe of thyroid gland

Laterally:

Internal jugular vein

Vagus nerve

(Posterolaterally)

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APPLIED SCIENCE

Carotid pulse: Thepulse is taken bypalpating the arteryjust deep to theanterior border of theSternocleidomastoidmuscle at the level of

the superior borderof the thyroidcartilage.

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CAROTID SINUS

At the point of division, the terminal part ofCCA or beginning of ICA shows a localizeddilatation.

Serves as a reflex pressure receptor.

in BP causes slowing of heart andvasodilatation of arterioles.

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CAROTID BODY

Small structure that lies posterior to the point

of bifurcation of CCA.

Chemoreceptor: sensitive to

CO2 and

O2in blood.

Hence, produces a rise in BP and HR.

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CAROTID SHEATH (LincolnsHighway)

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EXTERNAL CAROTID ARTERY

Supplies: face, neck andscalp

Origin:at the upperborder of thyroid cartilage.

Terminates :in parotid

gland by dividing intoterminal branchessuperficial temporal andmaxillary arteries.

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BRANCHES

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RELATIONS

ANTEROLATERALLY:

Sternocleidomastoid

Hypoglossal nerve

Stylohyoid muscle

Facial nerve (withinparotid gland)

Internal Jugular Vein

MEDIALLY:

Wall of pharynx

ICA

Glossopharyngeal nerve

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SURFACE ANATOMY

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SUPERIOR THYROIDARTERY

Origin: Arises at the level of thegreater cornu of hyoid bone.

Supplies: Thyroid gland and some

adjacent skin.

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LINGUAL ARTERY

Origin : Arises anteromedially from ECAopposite to the tip of the greater cornu ofhyoid bone.

Short course lies deep to hyoglossus muscle,

finally leaves the muscle in the tongue toanastomose with the fellow of opposite side.

Supplies the floor of the mouth and tongue28


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COURSE AND RELATIONS

First part: in carotid triangle,

sup. To middle constrictor muscle.

forms an Upward loop crossed by hypoglossal n.

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Second part: deep to hyoglossus muscle

Sup. To middle constrictor.

Third part:

Runs upward ,

Then forwards,

Sup. To

genioglossus m.

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FACIAL ARTERY

Originbranch of externalcarotid artery just above thetip of greater cornu of hyoidbone.

Courseruns upwards inneck, then on face; tortuousin both places.

Two parts- Cervical part

Facial part

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Cervical branches:

Ascending palatine

artery

Tonsillar artery

Glandular branches

Submental

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Blood supply of palate

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Facial

branches :

Inferior

labial artery

Superiorlabial artery

Lateral nasal

artery

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Blood supply of lateral nasal wall

Kisselbachsplexus

Littles area

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Surface Anatomy

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Palpation

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APPLIED

It is known as aneshtetist artery as it is easy to findand large enough in size.

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Anastomosis

The superior and inferiorlabial branches have largeanastomoses with theircounterparts of the otherside. So, in case of an injuryto that region, the cutarteries spurt from bothends.

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Third Molar Impaction

Incision extended too high

May cause profuse bleeding

Because of anastomosingbranches between facialand lingual branches.

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Submandibular incision

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GOOD MORNING


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Contents

External Carotid Artery (cont.)

Occipital Artery

Ascending Pharyngeal artery

Maxillary Artery

Superficial Temporal Artery

Internal Carotid Artery

Ophthalmic Artery

Circle of willis46


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OCCIPITAL ARTERY Originposteriorly from the external carotid, 2

cm after from its origin.

CourseRuns backwards and upwards deep tolower border of posterior belly of digastric and

ends posteriorly in scalp.

Supplies- The occipital belly of occipitofrontalisand skin and pericranium associated with the scalp ,sternomastoid , stylomastoid and some parts of

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BRANCHES

1. Sternomastoid branch

2. Stylomastoid branch

3. Auricular barnch

4. Mastoid branch

5. Meningeal branch

6. Occipital branch

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POSTERIOR AURICULAR

Origin: From the external carotid artery abovethe Digastric muscle and Stylohyoid muscle ,opposite the apex of the styloid process .

Course : It ascends posteriorly beneaththe parotid gland , along the styloid process ofthe temporal bone , between the cartilage of theear and the mastoid process of the temporal bone.

Supplies : to the scalp posterior to the auricleand to the auricle itself.

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ASCENDING PHARYNGEAL


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ASCENDING PHARYNGEALARTERY

Origin: posterior part of the externalcarotid.

Course:ascends vertically betweenthe internal carotid and the side ofthe pharynx , to the under surface of the

base of the skull, lying on the longuscapitis .

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MAXILLARY ARTERY

Varied region of blood supply:

1) External and middle ear, auditory tube

2) Dura mater

3) Upper and lower jaws

4) Muscles of temporal and infratemporal regions

5) Nose and paranasal air sinuses

6) Palate

7) Root of pharynx

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3 parts:

1) Mandibular part

2) Pterygoid part

3) Pterygopalatine part

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Mandibular part

The first or mandibularportionpasses horizontally forward,between the neck of the mandible andthe sphenomandibular ligament,

where it lies parallel to and a littlebelow the auriculotemporal nerve ;

it crosses the inferior alveolar nerve ,and runs along the lower border ofthe lateral pterygoid muscle.

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1) Deep auricular

2) Anteriortympanic

3) Middle meningeal

4) Accessory

meningeal

5)Inferior alveolar

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INFERIOR ALVEOLAR ARTERY

Origin:It descends with the inferior alveolarnerve to the mandibular foramen on themedial surface of the ramus of the mandible.

Course : It runs along the mandibularcanal in the substance of the bone,accompanied by the nerve, and opposite the

first premolar tooth divides into two branches,incisor and mental.

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M l h id b h


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Mylohyoid branch: As the inferior alveolarartery enters the foramen, it gives off a mylohyoidbranch which runs in the mylohyoid groove , and

supplies the mylohyoid muscle

Molar branches: to each root of he molars.

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Incisor branch : during course gives branches to


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Incisor branch : during course gives branches tocancellous bone .

A series of branches which correspond in number to the roots

of the teeth : these enter the minute apertures at theextremities of the roots, and supply the pulp of the teeth.

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Mental branch: The mental branchescapeswith the nerve at the mental foramen , supplies

the chin, and anastomoses withthe submental and inferior labial arteries .

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Inferior Alveolar Nerve Block

Positive aspirationsduring IANB is around10%.

To Prevent :

1. Depth of penetration ofneedle should not be

more than 8-10 mm inchildren.

2. Always achieve bonecontact before youinject.

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1) Deep temporal

2) Pterygoid

3) Masster

4) Buccal

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Pterygopalatine part

The third or pterygopalatine portionliesin the pterygopalatine fossa in relation withthe pterygopalatine ganglion .

This is considered the terminal branch of themaxillary artery.

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POSTERIOR SUPERIOR ALVEOLARARTERY

Origin : Descending upon the tuberosity ofthe maxilla .

Supplies : divides into numerous branches,some of which enter the alveolar canals , tosupply the molar and premolar teeth and thelining of the maxillary sinus , while others arecontinued forward on the alveolar process tosupply the gingiva .

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Posterior Superior Alveolar Nerve Block

Very high chances ofpositive aspirations andinjecting into pterygoidplexus of veins or if needleis inserted too deep then

Maxillary Artery ,also.

Prevention :

1. Depth of the penetration

should not be more than10-14 mm.

2. Always aspirate in Twodifferent planes.

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Infra Orbital Artery

Origin:The infraorbital artery appears, fromits direction, to be the continuation of thetrunk of the Maxillary artery.

Course : It runs along the inferior orbitalgroove and canal , and emerges on the facethrough the infraorbital foramen..

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Branches

1. Orbital Branches:supply the rectusinferior and inferioroblique andthe lacrimal sac

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2. Anterior Superior

Alveolar Artery-

Descend through theanterior alveolar canalsto supply the

upper incisor and canineteeth and the mucousmembrane ofthe maxillary sinus.

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Infra Orbital Nerve Block

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Blood supply of palate ( Palatineartery )

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Blood supply of lateral nasal wall

Kisselbachsplexus

Littles area

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SUPERFICIAL TEMPORAL


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SUPERFICIAL TEMPORALARTERY

Arises in the parotid gland behind the neck ofthe mandible

1) Transverse Facial

2) Auricular artery

3) Zygomatico- orbital artery

4) Middle temporal

5) Frontal (Anterior branch)

6) Parietal (Posterior branch)80


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Palpation

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INTERNAL CAROTID


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INTERNAL CAROTIDARTERY

Divided into-

Cervical (has no branches)

Petrous

Cavernous

Cerebral

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PETROUS PART

Caroticotympanic branch or artery:-

anastomosis with

anterior tympanic artery

Pterygoid artery :-anastomosis with branch

of greater palatine

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CEREBRAL PART

Lies at the base of brain after emerging fromcavernous sinus

Branches:

1) Ophthalmic

2) Anterior cerebral

3) Middle cerebral

4) Posterior communicating

5) Anterior choroidal

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OphthalmicA


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Artery

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Circulus arteriosus

(circle of willis)

Lies at base of brain

Branch Of Internal Carotid

Artery

Vertebral Arteries

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APPLIED


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APPLIED

Stroke: A stroke is the acute development of afocal neurological deficit as a result of localizedor diffuse cerebral hypoperfusion.

causes : most commonly, cerebral embolus andcerebral thrombosis, cerebral hemorrhage,subarachnoid hemorrhage.

Within fiveminutes the tissue in the region of theobstruction is dead

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Transient ischemic attacks (TIAs) in tia


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Transient ischemic attacks (TIAs)- in tiarecovery is usually complete within 24 hours. They serveas a warning that treatment may be necessary.

lifestyle, control of hypertension (if present), and

drug treatment to inhibit platelet aggregation (e.g.,aspirin), to decrease the chance of clots forming and

embolizing into the cerebral circulation.

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Intracerebral aneurysms

Cerebral aneurysms arise from the vessels in andaround the cerebral arterial circle (of Willis).

They typically occur in and around the anterior

communicating artery, the posterior communicatingartery, the branches of the middle cerebral artery, thedistal end of the basilar artery , and the posteriorinferior cerebellar artery.

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THANK YOU

Blood Supply of Head and Neck Corrected Final Part 1

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