Blood Supply to the Head and Neck

• Most arteries in the anterior cervical triangle arise from the common carotid artery or one of the branches of the external carotid artery.
• Most veins in the anterior cervical triangle are tributaries of the large internal jugular vein.

The Common Carotid Arteries

• The right common carotid artery begins at the bifurcation of the brachiocephalic trunk, posterior to the right sternoclavicular joint.
• The left common carotid artery begins arises from the arch of the aorta and ascends into the neck, posterior to the left sternoclavicular joint.

• Each common carotid artery ascends into the neck within the carotid sheath to the level of the superior border of the thyroid cartilage.
• Here it terminates by dividing into the internal and external carotid arteries. 

The Internal Carotid Artery

• This is the direct continuation of the common carotid artery and it has no branches in the neck.
• It supplies structures inside the skull.
• The internal carotid arteries are two of the four main arteries that supply blood to the brain.

• Each artery arises from the common carotid at the level of the superior border of the thyroid cartilage.
• It then passes superiorly, almost in a vertical plane, to enter the carotid canal in the petrous part of the temporal bone.

• A plexus of sympathetic fibres accompany it.

• During its course through the neck, the internal carotid artery lies on the longus capitis muscle and the sympathetic trunk.
• The vagus nerve (CN X) lies posterolateral to it.

• The internal carotid artery enters the middle cranial fossa beside the dorsum sellae of the sphenoid bone.
• Within the cranial cavity, the internal carotid artery and its branches supply the hypophysis cerebri (pituitary gland), the orbit, and most of the supratentorial part of the brain. 

The External Carotid Arteries 

• This vessel begins at the bifurcation of the common carotid, at the level of the superior border of the thyroid cartilage.
• It supplies structures external to the skull.

• The external carotid artery runs posterosuperiorly to the region between the neck of the mandible and the lobule of the auricle.
• It terminates by dividing into two branches, the maxillary and superficial temporal arteries.
• The stems of most of the six branches of the external carotid artery are in the carotid triangle. 

The Superior Thyroid Artery

• This is the most inferior of the 3 anterior branches of the external carotid.
• It arises close to the origin of the vessel, just inferior to the greater horn of the hyoid.
• The superior thyroid artery runs anteroinferiorly, deep to the infrahyoid muscles and gives off the superior laryngeal artery. This artery pierces the thyrohyoid membrane in company with the internal laryngeal nerve and supplies the larynx.

The Lingual Artery

• This arises from the external carotid artery as it lies on the middle constrictor muscle of the pharynx.
• It arches superoanteriorly, about 5 mm superior to the tip of the greater horn of the hyoid bone, and then passes deep to the hypoglossal nerve, the stylohyoid muscle, and the posterior belly of digastric muscle.

• It disappears deep to the hyoglossus muscle.
• At the anterior border of this muscle, it turns superiorly and ends by becoming the deep lingual artery.

The Facial Artery

• This arises from the carotid artery either, in common with the lingual artery, or immediately superior to it.
• In the neck the facial artery gives off its important tonsillar branch and branches to the palate and submandibular gland.
• The facial artery then passes superiorly under the cover of the digastric and stylohyoid muscles and the angle of the mandible.

• It loops anteriorly and enters a deep groove in the submandibular gland.

• The facial artery hooks around the inferior border of the mandible and enters the face. Here the pulsation of this artery can be felt (anterior to the masseter muscle).

The Ascending Pharyngeal Artery

• This is the 1^st or 2^nd branch of the external carotid artery.
• This small vessel ascends on the pharynx, deep to the internal carotid artery.
• It sends branches to the pharynx, prevertebral muscles, middle ear and meninges.

The Occipital Artery

• This arises from the posterior surface of the external carotid near the level of the facial artery.
• It passes posteriorly along the inferior border of the posterior belly of digastric.
• It ends in the posterior part of the scalp.
• During its course, it is superficial to the internal carotid artery and three cranial nerves (CN IX, CN X and CN XI).

The Posterior Auricular Artery

• This is a small posterior branch of the external carotid artery.
• It arises from it at the superior border of the posterior belly of the digastric muscle.
• It ascends posteriorly to the external acoustic meatus and supplies adjacent muscles, the parotid gland, the facial nerve, structures in the temporal bone, the auricle, and the scalp. 

The Internal Jugular Vein

• This is usually the largest vein in the neck.
• The internal jugular vein drains blood from the brain and superficial parts of the face and neck.
• Its course corresponds to a line drawn from a point immediately inferior to the external acoustic meatus to the medial end of the clavicle.

• This large vein commences at the jugular foramen in the posterior cranial fossa, as the direct continuation of the sigmoid sinus.

• The dilation at its origin is called the superior bulb of the internal jugular vein.
• From here it runs inferiorly through the neck in the carotid sheath.

• The internal jugular vein leaves the anterior triangle of the neck by passing deep to the SCM muscle.
• Posterior to the sternal end of the clavicle, it unites with the subclavian vein to form the brachiocephalic vein.
• Near its termination is the inferior bulb of the jugular vein contains a bicuspid valve similar to that of the subclavian vein.

• The deep cervical lymph nodes lie along the course of the internal jugular vein, mostly lateral and posterior.

Tributaries of the Internal Jugular Vein

• This large vein is joined at its origin by the: inferior petrosal sinus, the facial, lingual, pharyngeal, superior and middle thyroid veins, and often the occipital vein.

Internal Muscles of the Pharynx

• The internal, chiefly longitudinal muscular layer, consists of 3 muscles: stylopharyngeus, palatopharyngeus, and salpingopharyngeus.
• They all elevate the larynx and pharynx during swallowing and speaking.

The Stylopharyngeus Muscle

• This is a long, thin, conical muscles that descends inferiorly between the external and internal carotid arteries.
• It enters the wall of the pharynx between the superior and middle constrictor muscles.

• Origin: styloid process of temporal bone.
• Insertion: posterior and superior borders of thyroid cartilage with palatopharyngeus muscle.
• Innervation: glossopharyngeal nerve (CN IX).

• It elevates the pharynx and larynx and expands the sides of the pharynx, thereby aiding in pulling the pharyngeal wall over a bolus of food.

The Palatopharyngeus Muscle

• This is a thin muscle and the overlying mucosa form the palatopharyngeal arch.

The Salpingopharyngeus Muscle

• This is a slender muscle that descends in the lateral wall of the pharynx.
• The over lying mucous membrane forms the salpingopharyngeal fold.

• Origin: cartilaginous part of the auditory tube.
• Insertion: blends with palatopharyngeus muscle.
• Innervation: through the pharyngeal plexus.

• It elevates the pharynx and larynx and opens the pharyngeal orifice of the auditory tube during swallowing.

The Medial Wall of the Orbit 

• This wall is paper-thin and is formed by the orbital lamina or lamina papyracea of the ethmoid bone, along with contributions from the frontal, lacrimal, and sphenoid bones (L. papyraceus, "made of papyrus" or parchment paper).

• There is a vertical lacrimal groove in the medial wall, which is formed anteriorly by the maxilla and posteriorly by the lacrimal bone.
• It forms a fossa for the lacrimal sac and the adjacent part of the nasolacrimal duct.

• Along the suture between the ethmoid and frontal bones are two small foramina; the anterior and posterior ethmoidal foramina.
• These transmit nerves and vessels of the same name.

Veins of the Face

The Supratrochlear Vein

• This vessel begins on the forehead from a network of veins connected to the frontal tributaries of the superficial temporal vein.
• It descends near the medial plane with its fellow on the other side.
• These veins diverge near the orbits, each joining a supraorbital vein to form the facial vein near the medial canthus (angle of the eye).

The Supraorbital Vein

• This vessel begins near the zygomatic process of the temporal bone.
• It joins the tributaries of the superficial and middle temporal veins.
• It passes medially and joins the supratrochlear vein to form the facial vein near the medial canthus.

The Facial Vein

• This vein provides the major venous drainage of the face.

• It begins at the medial canthus of the eye by the union of the supraorbital and supratrochlear veins.
• It runs inferoposteriorly through the face, posterior to the facial artery, but takes a more superficial and straighter course than the artery.
• Inferior to the margin of the mandible, the facial vein is joined by the anterior branch of the retromandibular vein.
• The facial veins ends by draining into the internal jugular vein.

The Superficial Temporal Vein

• This vein drains the forehead and scalp and receives tributaries from the veins of the temple and face.
• In the region of the temporomandibular joint, this vein enters the parotid gland.

The Retromandibular Vein

• The union of the superficial temporal and maxillary veins forms this vessel, posterior to the neck of the mandible.
• It descends within the parotid gland, superficial to the external carotid artery but deep to the facial nerve.
• It divides into an anterior branch that unites with the facial vein, and a posterior branch that joins the posterior auricular vein to form the external jugular vein.

The Lips

• These are mobile muscular folds that surround the mouth, the entrance of the oral cavity.

• The lips (L. labia) are covered externally by skin and internally by mucous membrane.
• In between these are layers of muscles, especially the orbicularis oris muscle.

• The upper and lower lips are attached to the gingivae in the median plane by raised folds of mucous membrane, called the labial frenula.

Sensory Nerves of the Lips

• The sensory nerves of the upper and lower lips are from the infraorbital and mental nerves, which are branches of the maxillary (CN V²) and mandibular (CN V³) nerves.