Anatomy of the Vessels and Nerves of the Head and Neck (Angioneurology) - Chornokulskyi S.T. 2009

Arteries of the Head and Neck. Vessels of the Systemic Circulation
External Carotid Artery

The bifurcation of the common carotid artery (bifurcatio carotidis) into the external and internal carotid Arteries is located at the level of the upper border of the thyroid Cartilage. The dilation at the bifurcation, known as the carotid sinus (sinus caroticus), contains the carotid body (glomus caroticum), which houses specific "glomus" Cells along with numerous chemo- and baroreceptors surrounded by a dense capillary network.

(a. carotis externa) (Fig. 11, 12, 13, 14)

It ascends deep to the posterior belly of the digastric Muscle and the stylohyoid muscle, and within the substance of the parotid gland (at the level of the neck of the Mandible) terminates in its final branches: the superficial temporal and maxillary arteries.

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Fig. 11. Aortic arch, its branches, and topography.

1 - right common carotid artery (a. carotis communis dextra);

2 - right Subclavian Artery (a. subclavia dextra);

3 - brachiocephalic trunk (truncus brachiocephalicus);

4 - internal thoracic artery (a. thoracica interna);

5 - supreme intercostal artery (a. intercostalis suprema);

6 - aortic arch (arcus aortae);

7 - ascending aorta (aorta ascendens);

8 - left main bronchus (bronchus principalis sinister);

9 - Esophagus (oesophagus);

10 - descending aorta (aorta descendens), (Thoracic Aorta) aorta thoracica

Fig. 11a. Topography of the aortic arch relative to the Trachea and esophagus:

1 - brachiocephalic trunk (truncus brachiocephalicus);

2 - left common carotid artery (a. carotis communis sinistra);

3 - left subclavian artery (a. subclavia sinistra);

4 - shadow of the aortic constriction of the esophagus;

5 - tracheal bifurcation (bifurcatio tracheae);

6 - esophagus (oesophagus)

The nine Branches of the external carotid artery can be conveniently divided into three groups: anterior, medial, and posterior.

Anterior branches

1. The superior thyroid artery (a. thyroidea superior) (Figs. 12, 15) courses inferiorly toward The Thyroid Gland, within the substance of which it anastomoses with the inferior thyroid artery. The artery branches into vessels supplying the corresponding anatomical structures:

— superior laryngeal artery (a. laryngea superior);

— infrahyoid branch (r. infrahyoideus);

— sternocleidomastoid branch (r. stemoсleidomastoideus);

— cricothyroid branch (r. cricothyroideus).

2. The lingual artery (a. lingualis) (Fig. 13) is located within the lingual triangle (Pirogov's triangle) and, upon reaching the substance of the Tongue, continues as the deep artery of the tongue (a. profunda linguae), giving off dorsal branches (rr. dorsales linguae) to the dorsum of the tongue. On its course to the tongue, the artery gives off the following branches:

— suprahyoid branch (r. suprahyoideus);

— sublingual artery (a. sublingualis);

supplying the Hyoid bone, sublingual salivary gland, and adjacent Muscles.

3. The facial artery (a. facialis) (Fig. 12), as a anatomical variant, may originate as a common trunk with the lingual artery (truncus linguofacialis). Within the submandibular triangle, the facial artery gives off the following branches:

— ascending palatine artery (a. palatina ascendens);

— tonsillar branch (r. tonsillaris);

— glandular branches (rr. glanduläres) to the sublingual salivary gland;

— submental artery (a. submentalis).

After giving off its cervical branches, the artery curves around the inferior border of the mandible anterior to the masseter muscle (site of digital compression) and branches on the face into:

— inferior and superior labial arteries (aa. labiales inferior et superior);

— lateral nasal branch (r. lateralis nasi);

— branch of the nasal septum (r. septі nasi);

— angular artery (a. angularis), which, near the medial angle of the eye, anastomoses with the dorsal nasal artery (a. dorsalis nasi) from the Internal Carotid Artery, forming an intersystemic anastomosis. These branches supply the Skin, facial muscles, and the mucous membrane of the Oral Cavity.

Fig. 12. Common (23) and external (20) carotid arteries on the right side.

A - diagram of the branching of the external carotid artery:

1 - superficial temporal artery (a. temporalis superficialis);

2 - middle temporal artery (a. temporalis media);

3 - maxillary artery (a. maxillaris);

4 - posterior auricular artery (a. auricularis posterior);

5 - occipital artery (a. occipitalis);

6 - ascending pharyngeal artery (a. pharyngea ascendens);

7 - superior thyroid artery (a. thyroidea superior);

8 - transverse facial artery (a. transversa faciei);

9 - zygomaticoorbital artery (a. zygomaticoorbitalis);

10 - angular artery (a. angularis);

11 - ascending palatine artery (a. palatina ascendens);

12 - tonsillar branch (ramus tonsillaris);

13 - facial artery (a. facialis);

14 - superior and inferior labial arteries (aa. labiales superior et inferior);

15 - superior laryngeal artery (a. laryngea superior);

16 - lingual artery (a. lingualis);

17 - submental artery (a. submentalis);

18 ^- site of noticeable pulsation of the superficial temporal artery (a. temporalis superficialis);

19 - internal carotid artery (a. carotis interna);

20 - external carotid artery (a. carotis externa);

21 - site for Palpation and compression of the facial artery (a. facialis) in case of Hemorrhage;

22 - site for compressing the common carotid artery (a. carotis communis) against the carotid tubercle (tuberculum caroticum) of the sixth cervical vertebra (VI vertebrae cervicalis);

23 - common carotid artery (a. carotis communis)

✵ Middle branches

4. The ascending pharyngeal artery (a. pharyngea ascendens) [Fig. 12A (6)] ascends within the lateral wall of the Pharynx, reaching its vault. It branches into:

— pharyngeal branches (rr. pharyngeales);

— posterior meningeal artery (a. meningea posterior), which passes through the jugular foramen to supply the dura mater of the posterior cranial fossa;

— inferior tympanic artery (a. tympanica inferior), which enters the mucosa of the tympanic cavity through the tympanic canaliculus.

5. The superficial temporal artery (a. temporalis superficialis) (Fig. 12) is a direct continuation of the external carotid artery, giving off its terminal frontal and parietal branches (rr. frontalis et parietalis).

Above the zygomatic arch is the site for its compression to stop hemorrhage. The superficial temporal artery gives off the following branches:

— parotid branches (rr. parotidei);

— transverse facial artery (a. transversa faciei);

— anterior auricular branches (rr. auriculares anteriores);

— zygomaticoorbital artery (a. zygomatico-orbitalis);

— middle temporal artery (a. temporalis media);

supplying the respective HEAD structures.

6. The maxillary artery (a. maxillaris) (Figs. 13, 14).

— the largest branch of the external carotid artery. According to its topography, three parts are distinguished: the mandibular, pterygoid, and pterygopalatine parts.

✵ Branches of the mandibular part (embracing the neck of the mandible):

— Deep auricular artery (a. auricularis profunda) to the external acoustic meatus and tympanic membrane.

— Anterior tympanic artery (a. tympanica anterior) penetrating the mucosa of the tympanic cavity through the petrotympanic fissure of the Temporal bone;

— Inferior alveolar artery (a. alveolaris inferior) running through the mandibular canal to the lower Teeth (rr. dentales), and terminating as the mental branch (r. mentalis) supplying the facial muscles and skin of the chin.

Before entering the mandibular canal, the inferior alveolar artery (a. alveolaris inferior) gives off the mylohyoid branch (r. mylohyoideus) to the muscle of the same name and the anterior belly of the digastric muscle (m. digastricus).

Fig. 13. Ramification of the external and internal carotid arteries and the maxillary artery (sagittal section of the head)

1 - external carotid artery (a. carotis externa);

2 - maxillary artery (a. maxillaris);

3 - middle meningeal artery (a. meningea media);

4 - submental artery (a. submentalis);

5 - nasal septum (septum nasi);

6 - frontal sinus (sinus frontalis);

7 - sphenopalatine artery (a. sphenopalatina);

8 - inferior alveolar artery (a. alveolaris inferior);

9 - sphenoidal sinus (sinus sphenoidalis);

10 - Inferior nasal concha (concha nasalis inferior);

11 - ascending pharyngeal artery (a. pharyngea ascendens);

12 - tonsillar branch (ramus tonsillaris);

13 - facial artery (a. facialis);

14 - lingual artery (a. lingualis);

15 - anterior lateral nasal branch (ramus nasalis anterior lateralis);

16 - anterior meningeal artery (a. meningea anterior);

17 - posterior ethmoidal artery (a. ethmoidalis posterior);

18 - internal carotid artery (a. carotis interna);

19 - anterior septal branch (ramus septalis anterior) from the anterior ethmoidal artery;

20 - posterior septal branch (ramus septalis posterior) from the sphenopalatine artery;

21 - greater palatine artery (a. palatina major);

22 - deep lingual artery (a. profunda linguae);

23 - sublingual artery (a. sublingualis)

— The middle meningeal artery (a. meningea media) enters the middle cranial fossa through the foramen spinosum to supply the dura mater, giving off the superior tympanican artery (a. tympanica superior) to the mucosa of the tympanic cavity. The latter enters the tympanic cavity through the hiatus for the lesser petrosal nerve (hiatus canalis nervi petrosi minoris). An additional branch of the middle meningeal artery, the accessory branch (r. accessorius), passes through the foramen ovale to the dura mater of the middle cranial fossa and the trigeminal ganglion.

✵ Branches of the pterygoid part (in the infratemporal fossa)

— Masseteric artery (a. masseterica)

— Deep temporal arteries (aa. temporales profundae) supplying the temporalis muscle (m. temporalis);

— Pterygoid branches (rr. pterygoidei) supplying the pterygoid muscles;

— Buccal artery (a. buccalis).

These arteries supply all the Muscles of Mastication and the buccinator muscle.

— Posterior superior alveolar artery (a. alveolaris superior posterior) enters through the alveolar foramina of the maxillary tuberosity to supply the mucosa of the maxillary sinus, and further extends to the upper molars and maxillary gingiva (rr. dentales et peridentales).

✵ Branches of the pterygopalatine part (Fig. 13) (in the pterygopalatine fossa)

— Infraorbital artery (a. infraorbitalis) passes through the inferior orbital fissure, infraorbital canal, and infraorbital foramen to reach the facial muscles and skin, anastomosing with branches of the facial artery (a. facialis) and superficial temporal artery (a. temporalis superficialis). Within the infraorbital groove and canal, the infraorbital artery gives off the following branches:

— of the inferior rectus and inferior oblique Muscles of the eye.

— the descending palatine artery (a. palatina descendens), which, in turn, gives rise to the artery of the pterygoid canal (a. canalis pterygoidei), and subsequently to the greater and lesser palatine arteries (aa. palatini major et minores) after passing through the corresponding canals.

— The sphenopalatine artery (a. sphenopalatina) [Fig. 13 (7)] enters the Nasal cavity through the foramen of the same name to supply the nasal mucosa, branching into the posterior lateral nasal and posterior septal branches (aa. nasales posteriores laterales et septales). It forms numerous intersystemic anastomoses with branches of the anterior and posterior ethmoidal arteries (aa. ethmoidalis anterior et posterior) and intrasystemic anastomoses with the greater palatine and superior labial arteries.

Posterior branches

7. The occipital artery (a. occipitalis) [Fig. 12 (5)] branches off at the level of the facial artery, courses posteriorly, and lies within the occipital groove of the temporal bone. It divides into the following branches:

— mastoid branch (r. mastoideus) with a meningeal branch (r. meningeus);

— auricular branch (r. auricularis);

— sternocleidomastoid branches (rr. sternocleidomastoidei);

— occipital branches (rr. occipitales);

— descending branch (r. descendens) supplying the muscles of the posterior neck region.

Fig. 14. Maxillary artery (a. maxillaris)

A — branching pattern of the maxillary artery:

1 - external carotid artery (a. carotis externa); 2 - maxillary artery (a. maxillaris); 2a - deep auricular artery (a. auricularis profunda); 2b - anterior tympanic artery (a. tympanica anterior); 3 - middle meningeal artery (a. meningea media); 4 - posterior deep temporal artery (a. temporalis profunda posterior); 5 - anterior deep temporal artery (a. temporalis profunda anterior); 6 - descending palatine artery (a. palatina descendens); 7 - sphenopalatine artery (a. sphenopalatina); 8 - inferior alveolar artery (a. alveolaris inferior); 9 - masseteric and pterygoid arteries (aa. masseterica et pterygoidei); 10 - buccal artery (a. buccalis); 11 - posterior superior alveolar artery (a. alveolaris superior posterior); 12 - infraorbital artery (a. infraorbitalis); 13 - mental artery (a. mentalis); 14 - auriculotemporal nerve (n. auriculotemporalis) encircling the middle meningeal artery (a. meningea media); 15 - posterior auricular artery (a. auricularis posterior);

B — anatomical variations in the course of the trunk of the maxillary artery (a. maxillaris):

B1 - superficial to the lateral pterygoid muscle (m. pterygoideus lateralis); B2 - between its heads; B3 - between the branches of the mandibular nerve (n. mandibularis)

Anatomy of the Vessels and NERVES OF THE Head and Neck

The occipital artery anastomoses with branches of the vertebral and deep cervical arteries (subclavian artery system), as shown in Fig. 19 a.

8. The posterior auricular artery (a. auricularis posterior) (Fig. 12 c) branches off superior to the occipital artery and gives off the following branches:

— auricular branch (r. auricularis);

— occipital branch (r. occipitalis);

— stylomastoid artery (a. stylomastoidea).

The stylomastoid artery enters the facial canal through the stylomastoid foramen, where it gives rise to the posterior tympanic artery (a. tympanica posterior). The latter travels to the mucosa of the tympanic cavity via the canaliculus of the chorda tympani and also supplies the stapedius muscle (r. stapedius) and mastoid air cells (rr. mastoidei).

9. The sternocleidomastoid artery (a. sternocleidomastoidea). Alongside the external carotid artery, it frequently originates from the occipital artery as well. It supplies the muscle of the same name, penetrating its substance at the border between the middle and upper thirds.