Dr. Mohamed El fiky

1. Head and Neck
Great Vessels of the Head and Neck
Dr. Mohamed El Fiky
Professor of anatomy and Embryology

2. Brachiocephalic
Artery
Left
Common
Carotid
Right
Common
Carotid
External
Carotid Arteries
Thyroid
Right Internal
Carotid
Artery
Left Internal
Carotid
Artery
Thyroid
Cartilage
Left
subclavian Artery
Left
Common
Carotid
Brachiocephalic
Artery
Right
subclavian
Artery
Right
Common
Carotid
External
Carotid Arteries
Right Internal
Carotid
Artery
Left Internal
Carotid
Artery
Common Carotid Artery
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3. Common Carotid Artery
Origin :
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 sheath
Ø Ends at the upper border of the thyroid
cartilage (opposite the disc between 3rd and
4th cervical vertebrae) by dividing into
internal and external carotid arteries.
Internal carotid artery
Origin : one of the two terminal branches of the common carotid artery
Beginning : 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 bone
3. Cavernous part : within the cavernous sinus.
4. Cerebral part: the terminal portion at the base of the brain after emerging from the cavernous sinus.
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4. 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 of
the internal carotid just superior to the bifurcation of the common carotid at the level of the
superior border of thyroid cartilage. The carotid sinus is sensitive to pressure changes in the
arterial 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.
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5. S- Shaped Course of
Internal Carotid Artery
Internal Carotid Artery
A) Cervical part of the interal carotid
q Branches : no branches
B) Intrapetrous part of internal carotid
Branches :
1. Caroticotympanic branch : enters the middle ear by
piercing the thin plate of bone separating the carotid canal
from the middle
2. 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

6. (D) Cerebral part of internal carotid
Branches :
1. Ophthalmic artery
2. Anterior cerebral artery
3. Middle cerbral artery
4. Posterior communicating 5. Anterior choroidal
Structures between external and internal carotid :
Internal carotid artery
Anterior cerebral artery
Middle
cerebral artery
1-deep part of parotid gland
2- styloid process
3- styloglossus muscle
4- stylopharyngeus muscle
5- glossopharyngeal nerve
6- pharyngeal branch of the vagus nerve
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7. superior Thyroid Artery
Lingual Artery
Facial Artery
Ascending Pharyngeal Artery
Occipital Artery
Styloglossus
Stylopharyngeus
Glossopharyngeal Nerve
Pharyngeal Branch of Vagus Nerve
Styloid Process
Posterior
Auricular Artery
Superficial Temporal Artery
Maxillary Artery
Posterior belly of digasteric
External Carotid Artery

8. Branches of External Carotid Artery
It 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.
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9. Facial artery
Origin : from the external carotid just above the tip of the greater cornu of the hyoid bone
Course 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 and
then 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 the
lower border of the mandible
Ø Curves around the lower border of the mandible where it pierces the deep fascia to enter the face at the
anteroinferior angle of the masseter.
Branches
1. 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 constrictor
muscle and supplies the tonsil and root of the
tongue .
3. Glandular branches : to the submandibular
gland
4.Submental artery : accompanies the
mylohyoid nerve and supplies the sublingual
salivary gland.
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10. 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
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11. The subclavian artery
Origin :
1. On the right side : it takes origin behind the sternoclavicular joint
as a terminal branch of the brachiocephalic artery.
2. On the left side : arises in the thorax from the arch of the aorta
and 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 anterior
Ø The third part : lateral to the scalenus anterior
Branches of the subclavian artery
(A) First part: gives 3 branches
1. 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
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12. Internal Jugular Vein
Beginning : in the jugular foramen as direct
continuation of the sigmoid sinus
Course : descends in the neck within the carotid
sheath lateral to the internal and
common carotid arteries.
Termination: ends behind the medial end of the
clavicle 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 vein
6. Middle thyroid vein.
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13. Thyroid gland
Site : in the lower part of the front and sides of
the neck.
Shape : It is roughly H-shaped; the vertical limbs
repersent 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 tracheal
rings.
3. The isthmus lies opposite the second, thrid and
fourth 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 upwards
Ølimited superiorly by the attachment of the
sternothyroid muscle to the
oblique line of the thryoid cartilage.
(B) Base : is on the level with the 4th or 5th tracheal
rings.
(C) lateral (superficial) surface : is convex and
is covered by :
1. Sternothyroid
2. Sternohyoid.
3. Superior belly of omohyoid
4. Anterior border of the sternomastoid

14. (D) Medial surface : related to :
a. Two tubes : trachea and oesophagus
b. 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 Isthmus
Ø Connects the lower parts to the lobes
Ø 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 veins
Posterior surface: related to 2nd , 3rd and 4th tracheal
rings.
Upper border : is related to the anastomosing branches
between the two
superior thyroid arteries.
Lower border :
Ø The inferior thyoid veins leave the gland at this border.
ØRelated to the anastomosing branches between the two
inferior
thyroid arteries.

15. Arterial supply
1. 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.
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16. Venous drainage
1) 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.
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