11-12, 2:34 pm

External Carotid Artery l

Definition: The external carotid artery is a terminal branch of the common carotid artery, primarily
supplying structures in the front of the neck and face.
Position: It lies anterior to the internal carotid artery.

Course and Relations

1. Origin and Pathway:
•Begins in the carotid triangle at the upper border of the thyroid cartilage, opposite the disc between
the third and fourth cervical vertebrae.
•Ascends slightly backward and laterally, terminating behind the neck of the mandible by dividing into
the maxillary and superficial temporal arteries.

2. Curvature:
The artery has a slightly curved course, being anteromedial to the internal carotid artery in its lower part
and anterolateral in its upper part.

3. Superficial Relations:
•In the carotid triangle, it is relatively superficial, lying beneath the anterior border of the
sternocleidomastoid muscle.
•Crossed superficially by:
•Cervical branch of the facial nerve
•Hypoglossal nerve
•Facial, lingual, and superior thyroid
veins.

4. Deep Relations:
Deep to the external carotid artery are:
•Wall of the pharynx
•Superior laryngeal nerve (dividing
into external and internal branches)
•Ascending pharyngeal artery.

[Link] Carotid Triangle:

•Lies deep within the parotid gland.
•Superficially related to:
•Retro-mandibular vein
•Facial nerve.
•Deep structures include:
-Internal carotid artery
-Styloglossus and stylopharyngeus muscles
-IX nerve (glossopharyngeal)
-Pharyngeal branch of X nerve (vagus)
-Superior laryngeal nerve
-Superior cervical sympathetic ganglion.

Branches of External Carotid Artery

The external carotid artery gives off eight branches categorized as follows:
Anterior Branches

[Link] THYROID ARTERY:

•Arises just below the greater cornua of the hyoid bone.
•Runs downwards and forwards, supplying the thyroid gland.
•Relationship with external laryngeal nerve is crucial for surgical procedures.
•Gives off branches including:
-Superior laryngeal artery (pierces thyrohyoid membrane).
-Sternocleidomastoid branch.
Cricothyroid branch (anastomoses with opposite side).

2 Lingual Artery:
•Arises opposite the tip of the greater cornua of hyoid bone; has a tortuous course divided into three
parts
1. First part: In carotid triangle, forms an upward loop crossed by hypoglossal nerve.
2 Second part: Deep to hyoglossus muscle along upper border of hyoid bone.
3. Third part: Arteria profunda linguae (deep lingual artery) runs along anterior border of hyoglossus and
horizontally on tongue's undersurface.
•Gives off branches including suprahyoid, dorsal lingual, and sublingual arteries.

3. Facial Artery:
•Arises just above the greater cornua of hyoid bone; has tortuous course allowing movement during
swallowing and facial expressions.
•Cervical part runs deep to posterior belly of digastric muscle and submandibular gland; gives off
ascending palatine, tonsillar, submental, and glandular branches.

Posterior Branches

[Link] Artery:
•Arises from posterior aspect of external carotid opposite facial artery; crossed by hypoglossal nerve.
•Provides sternocleidomastoid branches and supplies posterior scalp.

[Link] Auricular Artery:

•Arises from posterior aspect above posterior belly of digastric muscle; runs deep to parotid gland but
superficial to styloid process.
•Supplies back of auricle, skin over mastoid process, and scalp; has a stylomastoid branch supplying
middle ear.
Medial Branch

[Link] Pharyngeal Artery:

•A small branch arising close to lower end of external carotid; runs vertically upwards between pharynx
wall and tonsil.
•Sends meningeal branches into cranial cavity through various foramina.

Terminal Branches

[Link] Artery:
•The larger terminal branch starting behind neck of mandible under parotid gland; enters infratemporal
fossa for further study.

[Link] Temporal Artery:

•Smaller terminal branch beginning behind neck of mandible under parotid gland.
•Runs vertically upwards crossing root of zygoma; divides into anterior and posterior branches above
zygoma supplying temple and scalp.
•Anterior branch anastomoses with supraorbital and supratrochlear branches; supplies parotid gland,
auricle, facial muscles, and gives off transverse facial artery and middle temporal artery.
 CAROTID TRIANGLE
Location - The carotid triangle is located in the anterior part of the neck,
It is defined by three borders: superiorly by the posterior belly of the digastric muscle, laterally by the
medial border of the sternocleidomastoid muscle, and inferiorly by the superior belly of the omohyoid
muscle
Boundaries
• Anterosuperior:
-Posterior belly of the digastric muscle
-Stylohyoid muscle
• Anteroinferior:
-Superior belly of the omohyoid muscle
•Posterior:
-Anterior border of the sternocleidomastoid muscle
•Roof
[Link]
[Link] Fascia:
-Contains the platysma muscle
-Cervical branch of the facial nerve
-Transverse cutaneous nerve of the neck
[Link] Layer of Deep Cervical Fascia
• Floor
Formed by parts of:
-Middle constrictor of the pharynx
-Inferior constrictor of the pharynx
-Thyrohyoid membrane

Contents

Arteries
1. Common Carotid Artery:
Includes the carotid sinus and carotid body at its termination
[Link] Carotid Artery
[Link] Carotid Artery:
Branches include:
•Superior thyroid artery
•Lingual artery
•Facial artery
•Ascending pharyngeal artery
•Occipital artery
 PARANASAL SINUS
Definition: Air-filled spaces within certain bones surrounding the nasal cavities.
Types: Include four main sinuses:
•Frontal Sinus
•Maxillary Sinus
•Sphenoidal Sinus
•Ethmoidal Sinuses

Functions:
•Lighten the skull
•Warm and humidify inspired air
•Add resonance to the voice
Development:
•Rudimentary or absent at birth.
•Rapid enlargement occurs between ages 6-7 and after puberty.
•Growth from birth to adulthood is due to bone enlargement; in old age, it results from resorption
of surrounding cancellous bone.

[Link] Sinus
•Location: Lies in the frontal bone, deep to the superciliary arch; extends above the medial end of the
eyebrow and into the roof of the orbit.
•Drainage: Opens into the middle meatus of the nose at the anterior end of the hiatus semilunaris via:
-Infundibulum
-Frontonasal duct
•Size: Usually unequal in size; average dimensions are approximately 2.5 cm in height, width, and
anteroposterior depth; better developed in males.
•Development: Rudimentary or absent at birth, well-developed by ages 7-8, and reaches full size after
puberty.
•Vascular Supply:
•Arterial: Supplied by the supraorbital artery.
•Venous: Drains into the supraorbital and superior ophthalmic veins.
•Lymphatic: Drains to submandibular nodes.
•Nerve Supply: Innervated by the supraorbital nerve.
[Link] Sinus
•Location: Situated in the body of the maxilla; largest of all paranasal sinuses; pyramidal shape with
base directed medially towards the nose.
•Drainage: Opens into the middle meatus of the nose at the lower part of the hiatus semilunaris;
opening size reduced by surrounding structures.
•Size: Variable dimensions with averages of height 3.5 cm, width 2.5 cm, and anteroposterior depth 3.5
cm.
•Anatomical Relations:
-Roof formed by the floor of the
-Floor formed by alveolar process of maxilla, about 1 cm below nasal floor; marked by elevations
from upper molar and premolar teeth roots.
•Development: First paranasal sinus to develop.
•Vascular Supply:
•Arterial: Supplied by facial, infraorbital, and greater palatine arteries.
Venous: Drains into facial vein and pterygoid plexus.
•Lymphatic: Drains to submandibular nodes.
•Nerve Supply: Innervated by posterior superior alveolar branches from maxillary nerve and
anterior/middle superior alveolar branches from infraorbital nerve.
[Link] Sinus
•Location: Found within the body of sphenoid bone; separated by a septum; usually unequal in size.
•Drainage: Opens into sphenoethmoidal recess of corresponding nasal cavity half.
•Anatomical Relations:
-Superiorly related to optic chiasma and hypophysis cerebri.
-Laterally related to internal carotid artery and cavernous sinus.
•Vascular Supply:
•Arterial: Supplied by posterior ethmoidal and internal carotid arteries.
•Venous: Drains into pterygoid venous plexus and cavernous sinus.
•Lymphatic: Drains to retropharyngeal nodes.
•Nerve Supply: Innervated by posterior ethmoidal nerve and orbital branches of pterygopalatine
ganglion.

[Link] Sinuses
•Location: Composed of numerous small intercommunicating spaces within ethmoid bone; bordered
by various bones (frontal, sphenoid, palatine, lacrimal).
•Division: Divided into three groups:
- Anterior Ethmoidal Sinus:
•Composed of 1 to 11 air cells; drains into anterior part of hiatus semilunaris.
•Supplied by anterior ethmoidal nerve and vessels; lymphatics drain into submandibular nodes.
-Middle Ethmoidal Sinus:
•Composed of 1 to 7 air cells; drains into middle meatus of nose.
•Supplied by anterior ethmoidal nerve/vessels and orbital branches of pterygopalatine ganglion;
lymphatics drain into submandibular nodes.
-Posterior Ethmoidal Sinus:
•Composed of 1 to 7 air cells; drains into superior meatus of nose.
•Supplied by posterior ethmoidal nerve/vessels and orbital branches of pterygopalatine ganglion;
lymphatics drain into retropharyngeal nodes
CLINICAL ANATOMY
1. Sinusitis: Infection of a sinus causing headache and thick, purulent nasal discharge; diagnosed
through transillumination and radiography, with affected sinuses appearing opaque.
2. Maxillary Sinus: Most commonly infected sinus, potentially from nasal sources or carious teeth.
Drainage is challenging due to the ostium's higher position, requiring surgical methods:
•Antrum Puncture: .
•Caldwell-Luc Operation

[Link] Sinus Carcinoma: Originates from mucosal lining; symptoms depend on growth direction:
•Orbit invasion leads to proptosis and diplopia.
•Floor invasion may cause palate bulging or ulceration.
•Forward growth causes facial swelling; backward growth leads to severe referred pain.
•Medial growth results in nasal obstruction and epistaxis; lateral growth produces facial swelling
and a palpable mass.
[Link] Sinusitis and Ethmoiditis: Can result in eyelid edema due to sinus infection.
[Link] Referral:
•Ethmoid sinus pain may refer to the forehead (ophthalmic nerve).
•Maxillary sinusitis pain may refer to upper teeth and infraorbital skin (maxillary nerve).

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PALATE (Soft&Hard)
Hard Palate

Structure
•Partition: Serves as a barrier between the nasal and oral cavities.
•Composition:
[Link] two-thirds formed by the palatine processes of the maxillae.
[Link] one-third formed by the horizontal plates of the palatine bones.
•Margins:
[Link] margins are continuous with the alveolar arches and gums.
[Link] margin provides attachment to the soft palate.
•Surfaces:
[Link] surface forms the floor of the nasal cavity.
[Link] surface forms the roof of the oral cavity.

Vessels and Nerves

[Link]: Supplied by the greater palatine branch of the maxillary artery.
[Link]: Drain into the pterygoid plexus.
[Link]:
Innervated by the greater palatine and nasopalatine branches of the pterygopalatine ganglion
(through maxillary nerve).
[Link]: Drain primarily to the upper deep cervical nodes and partly to the retropharyngeal nodes.
Soft Palate
Structure
•Description: A movable, muscular fold suspended from the posterior border of the hard palate.
•Separation: Divides the nasopharynx from the oropharynx, acting as a crossroads for food and air.
•Surfaces:
[Link] (oral) surface is concave with a median raphe.
[Link] surface is convex, continuous with the floor of the nasal cavity.
•Borders:
~Superior border attached to hard palate; blends with pharynx.
~Inferior border is free, forming the boundary of the pharyngeal isthmus, featuring a conical projection
called the uvula.

•Muscles Consists of:

•Tensor veli palatini
•Levator veli palatini
•Musculus uvulae
•Palatoglossus
• Palatopharyngeus
•Nerve Supply
[Link] Nerves:
•All muscles except tensor veli palatini are supplied by the pharyngeal plexus (derived from cranial part
of accessory nerve via vagus).
•Tensor veli palatini is supplied by the mandibular nerve.
[Link] Nerves:
•General sensory from middle and posterior lesser palatine nerves (branches of maxillary nerve).
•Glossopharyngeal nerve also contributes sensory innervation.

•Taste Sensation:
-Taste fibers from oral surface travel via lesser palatine nerves to facial nerve pathways.
•Secretomotor Nerves:
Derived from superior salivatory nucleus through greater petrosal nerve.

Passavant’s Ridge
Upper fibers of palatopharyngeus form a sphincter muscle (Passavant’s muscle), creating a ridge in the
nasopharynx that aids in closing off passages during swallowing.

•Movements and Functions

[Link] two gates:
~Pharyngeal isthmus (airway)
~Oropharyngeal isthmus (food passage)
[Link] include:
~Isolating mouth from oropharynx during chewing to allow breathing.
~Locking Passavant’s ridge during swallowing to prevent food entering nasal cavity.
~Modifying voice quality through varying closure degrees at pharyngeal isthmus.
~Directing airflow during sneezing and coughing.

Blood Supply
•Arteries:
~Greater palatine branch of maxillary artery.
~Ascending palatine branch of facial artery.
~Palatine branch of ascending pharyngeal artery.
•Veins: Drain into pterygoid and tonsillar plexuses.
•Lymphatics: Drain into upper deep cervical and retropharyngeal lymph nodes.

CLINICAL ANATOMY
[Link] Palate
Definition: A congenital defect resulting from the non-fusion of the right and left palatal processes,
leading to varying degrees of openings in the palate.
Types:
1. Least Severe
2. Most Severe.

[Link] of Vagus Nerve Paralysis

Symptoms:
• Nasal regurgitation of liquids.
• Nasal twang in voice.
• Flattening of the palatal arch.
• Deviation of uvula towards the normal side.
[Link] and Obstruction
Risk: Food or fluid can cause laryngeal obstruction and asphyxia.
Response: The Heimlich maneuver can be employed to remove the obstruction.

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STOMACH BED
The posterior surface of the stomach is related to structures forming the stomach bed, all of which are
separated from the stomach by the caoity of the lesser [Link] structures are:
a. Diaphragm.
b. Left kidney.
c. Left suprarenal gland.
d. Pancreas (Fig. 19.9).
e. Transverse mesocolon.
f. Splenic flexure of the colon.
g. Splenic artery (Sometimes the spleen is
also included in the stomach bed, but it is
separated from the stomach by the cavity of the greater sac (and not of the lesser sac). Gastric nerves
and vessels ramify deep to the peritoneum
 CAVERNOUS SINUS
Anatomy of the Cavernous Sinus
•Location:
Situated in the middle cranial fossa, on either side of the sphenoid bone.
Extends from the medial end of the superior orbital fissure anteriorly to the apex of the petrous temporal
bone posteriorly.
•Dimensions: Approximately 2 cm long and 1 cm wide.
•Structure:
[Link] divided into spaces (caverns) by trabeculae (less visible in living tissue).
[Link] and medial wall formed by endosteal dura mater; lateral wall and roof formed by meningeal dura
mater.

•Relations of the Cavernous Sinus

Structures Outside the Sinus
Superiorly - ~Optic tract, optic chiasma, olfactory tract, internal carotid artery, anterior perforated
substance.
Inferiorly :Foramen lacerum and junction of body and greater wing of sphenoid bone.
Medially :Hypophysis cerebri (pituitary gland) and sphenoidal air sinus.
Laterally :Temporal lobe with uncus.
Below Laterally :Mandibular nerve.
Anteriorly : Superior orbital fissure and apex of the orbit.
Posteriorly: Apex of petrous temporal bone and crus cerebri of midbrain.

Structures Within the Lateral Wall of the Sinus (from above downwards)
•Oculomotor Nerve (CN III):
•Trochlear Nerve (CN IV):
•Ophthalmic Nerve (V1):
•Maxillary Nerve (V2):
•Trigeminal Ganglion:

Structures Passing Through the Medial Aspect of the Sinus

•Internal Carotid Artery:
•Abducent Nerve (CN VI):

Tributaries or Incoming Channels

[Link] the Orbit
~Superior ophthalmic vein.
~Branch of inferior ophthalmic vein or sometimes the vein itself.
~Central vein of retina may drain into superior ophthalmic vein or cavernous sinus.
[Link] the Brain
~Superficial middle cerebral vein.
~Inferior cerebral veins from temporal lobe.
[Link] the Meninges
~Sphenoparietal sinus.
~Frontal trunk of middle meningeal vein may drain into pterygoid plexus or cavernous sinus.

Draining Channels or Communications

Drains into:
[Link] sinus via superior petrosal sinus.
[Link] jugular vein via inferior petrosal sinus and plexus around internal carotid artery.
[Link] plexus through emissary veins via foramen ovale, foramen lacerum, and emissary
sphenoidal foramen.
[Link] vein through superior ophthalmic vein.
[Link] and left cavernous sinuses communicate through anterior and posterior intercavernous
sinuses and basilar plexus.
Factors Helping Expulsion of Blood from the Sinus

[Link] pulsations of internal carotid artery within the sinus.

[Link] effects on blood flow.
[Link] position influencing venous drainage.

CLINICAL ANATOMY
[Link] Sinus Thrombosis
Causes: Thrombosis can occur due to sepsis from infections in the dangerous facial area, nasal
cavities, or paranasal sinuses.
Symptoms:
•Nervous Symptoms:
[Link] pain in the eye and forehead, particularly in the ophthalmic nerve distribution.
[Link] of cranial nerves III, IV, and VI, affecting muscle control.
•Venous Symptoms:
[Link] edema of eyelids, cornea, and root of the nose.
[Link] (protrusion of the eyeball) due to orbital vein congestion.

Complications: A communication between the cavernous sinus and internal carotid artery may arise
from head injury, leading to pulsating exophthalmos (eyeball protrusion that pulsates with heartbeat).

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LUMBAR PUNCTURE
CSF can be obtained by:
a. Lumbar puncture
b. Cisternal puncture
c. Ventricular puncture.
Lumbar puncture is the easiest method and iscommonly used.
PROCEDURE
In Adults: The patient lies on their side with a maximally flexed spine. The needle is inserted between
the L3 and L4 vertebrae after local anesthesia, passing through various tissue layers to reach the
subarachnoid space for cerebrospinal fluid (CSF) collection.

In infants: In infants, the spinal cord typically ends at L3. Thus, the needle is inserted between L4 and L5
to avoid spinal cord injury. Proper positioning and local anesthesia are crucial for minimizing discomfort
and ensuring success during the procedure.

(• Cisternal puncture is done when lumbar)

puncture fails.