Arterial supply-

Carotids
 common carotid artery
 The left common carotid artery arises
within the superior mediastinum as
the second main branch of the aortic
arch.
 It originates posterior and to the left
of the first branch, the
brachiocephalic trunk.
 Relations
 anterior:
– left brachiocephalic vein
– thymic remnant
 posteriorly:
– and inferiorly:
 left subclavian artery laterally
 trachea medially
– and superiorly:
– trachea
 left recurrent laryngeal nerve
 left anterior surface of oesophagus
 right:
– brachiocephalic artery
– inferior thyroid veins
– trachea
 left:
– vagus nerve
– phrenic nerve more laterally
– cervical pleura
 Within the neck, the left common
carotid passes from deep to the
sternoclavicular joint within the
carotid sheath superiorly and slightly
posteriorly.
 Within the sheath it is sited medial to
the internal jugular vein with the
vagus nerve interposed between
them.
 The artery gives off no branches
before its terminal division
posterolateral to the larynx just
inferior to the level of greater horn of
the hyoid bone.
 Here it forms the carotid sinus and it
divides into the left internal and
external carotid arteries.
 Applied anatomy
 Itis used to assess the waveform of
the carotid pulse.
Internal carotid artery
 Course and Relations
 In considering the course and
relations of this vessel it may be
divided into four portions:
 cervical,
 petrous,
 cavernous,
 cerebral.    
 Cervical Portion
 begins at the bifurcation of the
common carotid, opposite the upper
border of the thyroid cartilage,
 runs perpendicularly upward, in
front of the transverse processes of
the upper three cervical vertebræ, to
the carotid canal in the petrous
portion of the temporal bone.
 superficial at its commencement in the
carotid triangle, and lies behind and lateral
to the external carotid, overlapped by the
Sternocleidomastoideus, and covered by
the deep fascia, Platysma, and integument:
 it then passes beneath the parotid gland,
being crossed by the hypoglossal nerve,
the Digastricus and Stylohyoideus, and the
occipital and posterior auricular arteries.
 it is separated from the external
carotid by the Styloglossus and
Stylopharyngeus, the tip of the
styloid process and the stylohyoid
ligament, the glossopharyngeal
nerve and the pharyngeal branch of
the vagus.
 behind, with the Longus capitis, the superior cervical
ganglion of the sympathetic trunk, and the superior
laryngeal nerve;
 laterally, with the internal jugular vein and vagus
nerve, the nerve lying on a plane posterior to the
artery;
 medially, with the pharynx, superior laryngeal nerve,
and ascending pharyngeal artery.
 At the base of the skull the glossopharyngeal, vagus,
accessory, and hypoglossal nerves lie between the
artery and the internal jugular vein. 
External carotid
artery
 external carotid artery
 begins opposite the upper border of the thyroid
cartilage, and, taking a slightly curved course,
passes upward and forward, and then inclines
backward to the space behind the neck of the
mandible, where it divides into the superficial
temporal and internal maxillary arteries.
 It rapidly diminishes in size in its course up the
neck, owing to the number and large size of the
branches given off from it.
 Relations
 covered by the skin, superficial fascia,
Platysma, deep fascia, and anterior margin of
the Sternocleidomastoideus;
 it is crossed by the hypoglossal nerve, by the
lingual, ranine, common facial, and superior
thyroid veins; and by the Digastricus and
Stylohyoideus;
 higher up it passes deeply into the substance
of the parotid gland, where it lies deep to the
facial nerve and the junction of the temporal
and internal maxillary veins.
 Medial to it are the hyoid bone, the wall
of the pharynx, the superior laryngeal
nerve, and a portion of the parotid gland.
 Lateral to it, in the lower part of its
course, is the internal carotid artery.
 Posterior to it, near its origin, is the
superior laryngeal nerve;
 it is separated from the internal carotid
by the Styloglossus and Stylopharyngeus,
the glossopharyngeal nerve, the
pharyngeal branch of the vagus, and part
of the parotid gland
 Branches
 The branches of the external carotid
artery may be divided into four
sets   
 Anterior..
 Superior Thyroid.
 Lingual
 External Maxillary...
 Posterior.
 Occipital .
 .Posterior Auricular
 Ascending.
 Ascending Pharyngeal.
 Terminal
 Superficial Temporal,
 Internal Maxillary
 Artery
 The artery entering the
infratemporal fossa is the maxillary
branch of the external carotid
artery. As can be seen, it has many
branches (11 in all).

The maxillary
artery
lies lateral to the lateral
pterygoid muscle
 From the external carotid artery in the parotid gland,
the artery enters the posterior aspect of the
infratemporal fossa by passing deep to the neck of
the mandibular condyle.
 It crosses the lateral side of the lateral pterygoid
muscle and enters the pterygomaxillary fissure.
 It is divided into a first or mandibular part, second or
pterygoid part and third or pterygopalatine part.
 The mandibular and pterygoid parts are associated
with the infratemporal fossa
 and the pterygopalatine part is associated with the
deep face and the nasal region.
Maxillary artery
 Maxillary artery
deep auricular (da)
anterior tympanic (at)
middle meningeal (mm)
accessory middle meningeal (amm)
inferior alveolar (ia)
buccal (b)
deep temporal (dt)
posterior superior alveolar (psa)
descending palatine (dp)
infraorbital (io)
sphenopalatine (sp)
The mandibular
division
of the maxillary artery has 5
branches, all entering a canal
 The middle meningeal artery is the principal artery to
periosteal dura of the cranial cavity.
 The inferior alveolar ar:tery runs into the mandibular
foramen and supplies the teeth and the mandible. The
angle of the mandible is poorly supplied and may suffer
from alveolar osteitis (dry socket).
 The deep auricular artery supplies the auditory meatus
 The anterior tympanic artery accompanies the chorda
tympani through the petrotympanic fissure to reach the
middle ear.
 The accessory meningeal branch (inconsistent) enters
the foramen ovale and supplies the trigeminal ganglion
and the surrounding dura.
 The pterygoid
portion
of the maxillary artery has 5
branches supplying muscles of
mastication in the infratemporal
fossa:
2 deep temporal branches,
 a masseteric branch,
 a pterygoid branch,
 and a buccal branch.
 Branches of the third part
 Posterior superior alveolar
 Infraorbital
 Greater palatine palatine
 Pharyngeal branch
 Artery of pterygoid canal
 Sphenopalatine
 Thesphenopalatine and descending
palatine arteries pass through a
small space between the pterygoid
process of the sphenoid and the
maxilla, the pterygomaxillary fissure.
 The pterygoid plexus of veins
follows the maxillary artery in the
infratemporal fossa, lying mostly
lateral to the artery
 applied
 This is a route for infection: the veins
have connections with the
cavernous sinus via the deep
facial, inferior ophthalmic and
emissary veins in the sphenoid bone.
 Veins of the head have NO valves.
The subclavian artery
 Origin
 On the right side the subclavian
artery arises from the innominate
artery behind the right
sternoclavicular articulation;
 On the left side it springs from the
arch of the aorta.

 Parts of subclavian artery
 divided into three parts.
 first portion-from the origin of the vessel
to the medial border of the Scalenus
anterior
 the second lies behind this muscle
 the third extends from the lateral
margin of the muscle to the outer
border of the first rib, where it becomes
the axillary artery.
 First Part of the Right
Subclavian Artery
 arises from the innominate artery,
behind the upper part of the right
sternoclavicular articulation,
 passes upward and lateralward to
the medial margin of the Scalenus
anterior.
 It ascends a little above the clavicle,
 Relations.
 in front, by the integument, superficial fascia,
Platysma, deep fascia, the clavicular origin of the
Sternocleidomastoideus, the Sternohyoideus, and
Sternothyreoideus, and the deep fascia.

 It is crossed by the internal jugular and vertebral

veins, by the vagus nerve and the cardiac
branches of the vagus and sympathetic, and by
the subclavian loop of the sympathetic trunk
which forms a ring around the vessel.

 The anterior jugular vein is directed lateralward

in front of the artery, but is separated from it by
the Sternohyoideus and Sternothyreoideus.
 Below and behind the artery is the pleura,
which separates it from the apex of the
lung;
 behind is the sympathetic trunk, the Longus
collie and the first thoracic vertebra.
 The right recurrent nerve winds around the
lower and back part of the vessel.
 First Part of the Left
Subclavian Artery
 arises from the arch of the aorta,
behind the left common carotid,
 at the level of the fourth thoracic
vertebra;
 it ascends in the superior mediastinal
cavity to the root of the neck and
then arches lateralward to the medial
border of the Scalenus anterior.
 Relations
 in front, with the vagus, cardiac, and phrenic
nerves, the left common carotid artery, left
internal jugular and vertebral veins, and the
commencement of the left innominate vein,
and is covered by the Sternothyreoideus,
Sternohyoideus, and Sternocleidomastoideus;
 behind, it is in relation with the esophagus,
thoracic duct, left recurrent nerve, inferior
cervical ganglion of the sympathetic trunk,
and Longus colli;
 higher up, however, the esophagus and
thoracic duct lie to its right side; the latter
ultimately arching over the vessel to join
the angle of union between the subclavian
and internal jugular veins.
 Medial to it are the esophagus, trachea,
thoracic duct, and left recurrent nerve;
lateral to it, the left pleura and lung.   
 Second Parts
 subclavianartery lies behind the
Scalenus anterior; it is very short,
and forms the highest part of the
arch described by the vessel.
 Relations
 in front, by the skin, superficial fascia, Platysma,
deep cervical fascia, Sternocleidomastoideus,
and Scalenus anterior.
 On the right side of the neck the phrenic nerve is
separated by the Scalenus anterior,
 On the left side it crosses the first part of the
artery close to the medial edge of the muscle.
 .
 Behind the vessel are the pleura and
the Scalenus medius;
 above, the brachial plexus of nerves;
 below, the pleura.
 The subclavian vein lies below and in
front of the artery, separated from it
by the Scalenus anterior
 Third portion
 runs downward and lateralward from
the lateral margin of the Scalenus
anterior to the outer border of the
first rib, where it becomes the
axillary artery.
 This is the most superficial portion of
the vessel
 Relations
 in front, by the skin, the superficial fascia,
the Platysma, the supraclavicular nerves,
and the deep cervical fascia.
 The external jugular vein crosses its
medial part and receives the transverse
scapular, transverse cervical, and anterior
jugular veins
 Behind the veins, the nerve to the
Subclavius descends in front of the artery.
 The terminal part of the artery lies behind
the clavicle and the Subclavius and is
crossed by the transverse scapular
vessels.
 The subclavian vein is in front of and at a
slightly lower level than the artery.
 Behind, it lies on the lowest trunk of the
brachial plexus, which intervenes
between it and the Scalenus medius.
 Above and to its lateral side are the
upper trunks of the brachial plexus and
the Omohyoideus.
 Below, it rests on the upper surface of the
first rib.    
 Branches
 Vertebral A
 Internal thoracic A
 Thyrocervical trunk -
1. Inferior thyroid a
2. Suprascapular
3. Superficial cervical
 Costocervical trunk-
1. Superior intercoastal
2. Deep cervical A
 Dorsal scapular A