Head and NeckGreat Vessels of the Head and Neck

Dr. Mohamed El Fiky

Professor of anatomy and Embryology

Brachiocephalic Artery

Left Common

Carotid

RightCommon

Carotid

ExternalCarotid Arteries

Thyroid

Right InternalCarotidArtery

Left InternalCarotidArtery

ThyroidCartilage

Leftsubclavian Artery

Left Common

Carotid

Brachiocephalic Artery

Rightsubclavian

Artery

RightCommon

Carotid

ExternalCarotid Arteries

Right InternalCarotidArtery

Left InternalCarotidArtery

Common Carotid Artery

Mohamed el fiky

Common Carotid ArteryOrigin :Ø The right is the terminal branch of the brachiocephalic, behind the sternoclavicular joint.Ø The left arises in the thorax from the arch of the aorta.

Course in the neck:Ø Runs upwards and backwards within the

carotid sheathØ Ends at the upper border of the thyroid

cartilage (opposite the disc between 3rd and4th cervical vertebrae) by dividing intointernal and external carotid arteries.

Internal carotid artery Origin : one of the two terminal branches of the common carotid arteryBeginning : at the upper border of the thyroid cartilage.

Course : is divided into four parts:1. Cervical part : in the neck.2. Petrous part : within the petrous temporal bone3. Cavernous part : within the cavernous sinus.4. Cerebral part: the terminal portion at the base of the brain after emerging from the cavernous sinus.

Mohamed el fiky

Sympathetic Trunk

Vagus Nerve

Glossopharyngeal Nerve

Carotid Sinus(Baroreceptors)

Carotid Body(Chemoreceptors)

Carotid Branch of Glossopharyngeal Nerve

Communicating Branch (Carotid)of Vagus to Carotid Sinus and Body

In human anatomy, the carotid sinus (or carotid bulb) is a dilated area at the base ofthe internal carotid just superior to the bifurcation of the common carotid at the level of thesuperior border of thyroid cartilage. The carotid sinus is sensitive to pressure changes in thearterial blood at this level. It is the major baroreception site in humans and most mammals.

Carotid sinus

The carotid sinus contains numerous baroreceptors which function as a "sampling area" for many homeostatic mechanisms for maintaining blood pressure. The carotid sinus baroreceptors are innervated by the sinus nerve of Hering, which is a branch of cranial nerve IX (glossopharyngeal nerve)

The carotid body is a small cluster of chemoreceptors and supporting cells located near the fork (bifurcation) of the carotid artery .

Carotid body

The carotid body detects changes in the composition of arterial blood flowing through it, mainly the partial pressure of oxygen, but also of carbon dioxide. Furthermore, it is also sensitive to changes in pH and temperature.

Mohamed el fiky

S- Shaped Course ofInternal Carotid Artery

Internal Carotid ArteryA) Cervical part of the interal carotidq Branches : no branchesB) Intrapetrous part of internal carotid

Branches :1. Caroticotympanic branch : enters the middle ear bypiercing the thin plate of bone separating the carotid canalfrom the middle2. Pterygoid branch : enters the pterygoid canal

C) Cavernous part of internal carotid Branches :u Cavernous branches to the trigeminal ganglion.v Superior and inferior hypophyseal arteries to the pituitary gland. Mohamed el fiky

(D) Cerebral part of internal carotidBranches :1. Ophthalmic artery2. Anterior cerebral artery3. Middle cerbral artery4. Posterior communicating 5. Anterior choroidal

Structures between external and internal carotid :

Internal carotid artery\Anterior cerebral artery

Middlecerebral artery

1-deep part of parotid gland2- styloid process3- styloglossus muscle 4- stylopharyngeus muscle 5- glossopharyngeal nerve 6- pharyngeal branch of the vagus nerve

Mohamed el fiky

superior Thyroid Artery

Lingual Artery

Facial ArteryAscending Pharyngeal Artery

Occipital Artery

Styloglossus

Stylopharyngeus

Glossopharyngeal Nerve

Pharyngeal Branch of Vagus Nerve

Styloid Process

Posterior Auricular Artery

Superficial Temporal ArteryMaxillary Artery

Posterior belly of digasteric

External Carotid Artery

Branches of External Carotid ArteryIt gives eight branches which may be grouped as given below : A. Three anterior 1. Superior thyroid: 2. Lingual: and 3. Facial

B. Two posterior : 1. Occipital ; and 2. Posterior auricular

C. One medial : ascending pharyngeal

D. Two terminal : 1. Maxillary: 2. Superficial temporal Lingual artery Origin : Arises opposite the tip of the greater cornu of the hyoid bone. Course: Is divided into three parts by the hyoglossus muscle. A. First part : Ø Lies in the carotid triangle. Ø Forms characteristic loop or bend which is crossed by the hypologossal nerve.

B. Second part : Lies deep to the hyogossus. C. Third part : Ø Is called arteria profunda linguae or deep lingual artery. Runs upwards along the anterior border of the hyoglossus and then forwards on the under surface of the tongue.

Branches : 1. Suprahyoid artery : arises from the first part passes along the upper border of the hyoid bone. 2. Dorsal lingual arteries : aries from the second part and consist of 3 or 4 branches to supply the tongue, tonsil

and soft palate. 3. Sublingual artery : arises from the third part to the sublingual gland. Mohamed el fiky

Facial artery

Origin : from the external carotid just above the tip of the greater cornu of the hyoid boneCourse in the neck:Ø Ascends vertically upwards deep to the posterior belly of digastric and stylohyoid muscles, lodged in a groove at

the posterior end of the submandibular salivary gland this part of the artery rests on the middle constrictor andthen on the superior constrictor which separares it from the palatine tonsil.

Ø Passes downwards and forwards between the submandibular gland and the medial pterygoid to appear at thelower border of the mandible

Ø Curves around the lower border of the mandible where it pierces the deep fascia to enter the face at theanteroinferior angle of the masseter.

Branches1. Ascending palatine : ascends on the wall of the pharynx and then winds round the upper border of the superior constrictor muscle to reach the soft palate. 2. Tonsillar artery: is the principal artery of the

tonsil , it pierces the superior constrictormuscle and supplies the tonsil and root of thetongue .

3. Glandular branches : to the submandibulargland

4.Submental artery : accompanies themylohyoid nerve and supplies the sublingualsalivary gland.

Mohamed el fiky

Facial Artery

2- Ascending palatine

1- Tonsilar

3- Glandular

4- Summental

1- Inferior labial

2- Superior labial

3- Lateral nasal

4-Artery to cheeks

5- Angular

A- Cervical branches

B- Branches in the face

Mohamed el fiky

The subclavian artery

Origin :1. On the right side : it takes origin behind the sternoclavicular jointas a terminal branch of the brachiocephalic artery.2. On the left side : arises in the thorax from the arch of the aortaand ascends to enter the neck behind the

sternoclavicualr joint.

Parts : the scalenus anterior corsses anterior to the artery and

divides it into three parts.

Ø The first part : medial to the scalenus anterior

Ø The second part : lies behind the scalenus anteriorØ The third part : lateral to the scalenus anterior

Branches of the subclavian artery(A) First part: gives 3 branches1. Vertebral .2. Thyrocervical trunk.3. Internal thoracic artery.

(B) Second part : give one branch ;costocervical trunk.

( C) Third part : no branches.

Vertebral artery

Origin : from the first part of the subcalvian artery. IT inter the cranial cavity and it supply spinal cord and brain

1- Thyrocervical Trunk

2- Vertebral Artery

3- Internal Mammary

Costocervical Trunk

Ascending Cervical

Superior Intercostal

Suprascapular

Transverse Cervical

Inferior Thyroid Artery

1st Part

3rd

Part

Deep Cervical

Mohamed el fiky

Internal Jugular VeinBeginning : in the jugular foramen as directcontinuation of the sigmoid sinusCourse : descends in the neck within the carotidsheath lateral to the internal and

common carotid arteries.Termination: ends behind the medial end of theclavicle by joining the subclavian vein

to from the brachiocephalic vein.Tributaires:1. Inferior petrosal sinus.2. Common facial vein.3. Lingual vein.4. Pharyngeal veins.5. Superior thyroid vein6. Middle thyroid vein.

Mohamed el fiky

Thyroid gland Site : in the lower part of the front and sides ofthe neck.Shape : It is roughly H-shaped; the vertical limbsrepersent the two lobes and the horizontal limb,the isthmus.Extent:1. Lies opposite 5th, 6th, 7th, cervical and 1st

thoracic vertebrae.2. Each lobe extends from the middle of the

thyroid cartilage to the fourth or fifth trachealrings.

3. The isthmus lies opposite the second, thrid andfourth tracheal rings.

Lobes : Each lobe is conical in shape having :(a) apex ; (b) base ; (c) three surfaces , lateral ,medial and posterior and(d) two borders , anterior and posterior.(a) Apex :Ødirected upwardsØlimited superiorly by the attachment of thesternothyroid muscle to theoblique line of the thryoid cartilage.(B) Base : is on the level with the 4th or 5th trachealrings.(C) lateral (superficial) surface : is convex andis covered by :1. Sternothyroid2. Sternohyoid.3. Superior belly of omohyoid4. Anterior border of the sternomastoid

(D) Medial surface : related to :a. Two tubes : trachea and oesophagusb. The upwards continuation of the two tubes : larynx and pharynx. c. Two muscles : inferior constrictor and cricothyroid.d. Two nerves : external laryngeal and recurrent laryngeal.(E) Posterior surface: is related to the carotid sheath and parathyroid glands.(F) Anterior border : is thin and related to the anterior branch of superior thyroid artery.

(G) Posterior border : is thick and rounded and separates the the medial and posterior branch between the superior and inferior thyroid arteries ; and (c) prathyroid glands.

The IsthmusØ Connects the lower parts to the lobesØ Has (a) two surfaces, anterior and posterior; and (b)two borders superior and inferior.

Anterior surface : is covered by :(a) fascia and skin.(b)strenohyoids;(c) strenothyroids;(d) anterior jugular veinsPosterior surface: related to 2nd , 3rd and 4th trachealrings.Upper border : is related to the anastomosing branches

between the twosuperior thyroid arteries.Lower border :Ø The inferior thyoid veins leave the gland at this border.ØRelated to the anastomosing branches between the twoinferior

thyroid arteries.

Arterial supply1. Superior thyroid artery: is a branch of external carotid artery.

(2) Inferior thyroid artery: Is a branch of the thyrocervical trunk from the subclavian artery

(3) Thyroidea ima artery (in 3% individuals): Arises from the brachiocephalic artery or the aortic arch

(4) Accessory thyroid arteries : come from the tracheal and oesophageal vessels.

Mohamed el fiky

Venous drainage1) Superior thyroid vein: end in the internal jugular vein

2) Middle thyroid vein: ends in the internal jugular vein

3) Inferior thyroid veins:Descend in front of the trachea and drain into the left brachiocephalic vein.

Mohamed el fiky