Blood supply of head and

neck & brain

Dr. Narendra Pamidi

Learning objectives
Objectives:
After having attending this lecture and studied the lecture
notes, students should have learned:
the arteries that supply blood to the head and neck
the territories of the external and internal carotids and
their anastomosis
blood supply of the scalp
the major neurovascular bundles in the neck
how the spinal cord is supplied with arterial blood
the venous drainage of the brain and spinal cord

Common carotid artery (CCA)

Origin:
Right CCA: branch
of brachiocephalic
trunk begins in neck
behind right
sternoclavicular joint

Left CCA branch of

aortic arch begins in
thorax & passes
behind left
sternoclavicular joint

Common carotid
artery
Course
Runs in carotid sheath
along with Internal
jugular vein & vagus
nerve
Passes upwards &
backwards in the neck,
From sternoclavicular
joint to upper border of
thyroid cartilage
Ends by dividing into
ECA & ICA arteries

Common carotid artery

Special Features
Carotid sinus localised dilatation at
terminal part of CCA (or beginning
of ICA) innervated by
glossopharyngeal & sympathetic
nerves act as baroreceptor to
regulate blood pressure. carotid sinus
syndrome

Carotid body small reddish-brown

structure situated behind
bifurcation of CCA innervated
mainly by glossopharyngeal n erve
acts as chemoreceptor ie. respond
to changes in concentration of O2
& CO2 in blood

Deep fascia of the

neck
1. Investing fascia
2. Prevertebral
3. Carotid sheath
4.Pretracheal

External carotid artery (ECA)

The ECA is one of the 2
terminal branches of the
CCA
It is the chief artery of
supply to structures in the
neck & face
Origin: begins in carotid
triangle of neck
At level of upper border of
thyroid cartilage ( between
CV3 & 4)

External carotid artery

Course
runs upwards, slightly
backwards & laterally
enters substance of parotid
gland
terminates behind neck of
mandible by dividing into
the maxillary & superficial
temporal arteries
Note: at first it lies medial to
ICA and then passes
backwards & laterally to lie
lateral to ICA

External carotid artery - Branches

There are 8 branches
1. Superior thyroid
2. Ascending pharyngeal
3. Lingual
4. Facial
5. Occipital
6. Posterior auricular
7. Superficial temporal
8. Maxillary
Sister Lilly powdered face
often attracts medical students

Maxillary artery
The maxillary artery
has
an
extensive
distribution
to
the
upper & lower jaws,
muscles of mastication,
the palate & the nose
Origin: It is the larger
terminal branch of
ECA
arises in parotid gland
behind
neck
of
mandible

Infra-temporal fossa

Maxillary artery

1st part:
Deep auricular
Anterior tympanic
Middle meningeal
Accessory meningeal
Inferior alveolar
2nd part: Branches to
muscles of mastication

3rd part:
Posterior superior
alveolar A
Infra orbital A
Greater palatine A
Pharyngeal A
Artery of pterygoid canal
Spheno palatine A

Circle of Willis-Vertebral-basilar system

Each cerebral
artery gives
two types of
branches:
Central
(striate) and
cortical
branches

 Medial
surface
Majority of it
by middle
cerebral
artery

 Medial surface
Most of it anterior
cerebral artery
Occipital lobe posterior
cerebral artery
Temporal pole middle
cerebral artery

 Inferior surface
Lateral part of orbital
surface and temporal pole
middle cerebral artery
Medial part of orbital
surface anterior cerebral
artery
Tentorial surface behind
the temporal pole
posterior cerebral artery

Subclavian artery - Course

Subclavian artery is divided
into 3 parts by the presence
of the scalenus anteior
muscle
1st Part - arches upwards &
laterally from behind
sternoclavicular joint to
medial border of scalenus
anterior
2nd Part - lies behind
scalenus anterior muscle
3rd Part - extends from lateral
border of scalenus anterior to
outer border of 1st rib
where it continues as axillary
artery?

Subclavian artery Branches

1st Part:
1.
2.
3.

Vertebral artery
Internal thoracic artery
Thyrocervical trunk gives off
3 branches
a) inferior thyroid, b) transverse
cervical c) suprascapular

2nd Part:
1. Costocervical trunk gives off 2
branches (Superior intercostal
artery, deep cervical artery)

3rd Part:
Descending (dorsal) scapular
artery

Clinical anatomy of subclavian artery

1.

3rd part may be compressed against

1st rib to stop bleeding in upper arm
2. Aneurysms may form in 3rd part of
artery. Exert pressure on brachial
plexus & results in pain, weakness &
numbness in upper limb
3. Cervical rib artery is kinked as it
passes over rib, causing occlusion
4. Subclavian steal syndrome (SSS):
Occlusion of SA. Blood flow to the
upper limb via vertebral or internal
thoracic. Blood supply from the
brain/thorax
to
the
upper
extremities in SSS is considered to
be stolen

Internal carotid
artery-brain
Enters the brain- carotid
canal
Passes through cavernous
sinus
Branches: Ophthalmic A
Terminal branches: anterior
and posterior cerebral
arteries
Joins with posterior cerebral
arteries to form Circle of
Willis at the base of brain

Venous drainage

Internal jugular veins

The IJV drains the brain, neck

& face
Origin: begins at jugular
foramen at base of skull
it is a continuation of the
sigmoid sinus
Course: descends in carotid
sheath
passes downwards &
anteriorly
ends behind medial end of
clavicle by joining with
subclavian vein to form
brachiocephalic vein

Internal jugular veins - Tributaries

inferior petrosal sinus
facial vein
lingual vein
pharyngeal veins
superior thyroid vein
middle thyroid vein
sometimes, occipital vein
Note: Thoracic duct opens
into angle of union between
left IJV & Left subclavian vein

Internal jugular veins

Clinical Notes
In congestive heart failure or any
disease where venous pressure is
raised, the IJV is markedly
dilated, engorged
Deep cervical lymph nodes lie
along the IJV. In malignancies
involving these nodes, the vein is
usually removed together with
the nodes in a surgical procedure
called block dissection of the
cervical nodes

External jugular vein

Lymphatics
Superficial
Collor &
Deep Column

Superficial
Sub mental (Below chin)
Submandibular
Parotid
Mastoid
Occipital (back of skull)

Deep
I.

Jugulo-digastric

II. Juguloomohyoid

Good day & Thank you

References
Essential Clinical Anatomy: Keith L. More, 4th edition Atlas
of Human Anatomy: Frank H. Netter http:/
Greys anatomy: The anatomical basis of clinical practice