Supply to face😊

Subclavian Artery

• Divided into 3 parts by scalenus anterior muscle

1st Part	VIT C D
ㅤ	Vertebral artery
ㅤ	Internal thoracic artery
ㅤ	Thyrocervical trunk ↳ Suprascapular artery ↳ Inferior thyroid artery ↳ Transverse cervical artery
2nd Part	ㅤ
ㅤ	Costocervical trunk
3rd Part	ㅤ
ㅤ	Dorsal scapular artery

Inferior Thyroid Artery supplies

• Thyroid

• Parathyroid

• Cervical part of oesophagus

• Thymus

External Carotid Artery (ECA)

• Branch of common carotid artery

• Bifurcation at C3/C4 level
• More common at C4
• At upper border of lamina of thyroid cartilage
• Mnemonic: EC 4 (C4) TC

Branches of ECA

• Medial branch
• Ascending pharyngeal artery
• Only medial branch
• First branch of ECA (VVIMP)

• Anterior branches
1. Superior thyroid artery
2. Lingual artery
3. Facial artery

• Posterior (dorsal) branches
• Occipital artery
• Posterior auricular artery
• Only ECA branches given off in digastric triangle

• Terminal branches
• Maxillary artery → largest branch (16 branches)
• Superficial temporal artery

Arteries in Carotid Triangle

• CCA

• ECA

• ICA

• Ascending pharyngeal artery
• First ECA branch

Vertebra & Vertebral Artery

• Cervical vertebrae:
• Small body, large triangular foramen.
• Foramen transversarium – vertebral artery (except C7).
• NOTE: C7 foramen transversarium:
• transmits only vertebral vein (and sympathetic fibers)

• Thoracic vertebrae:
• Heart-shaped body, circular foramen.

• Lumbar vertebrae:
• Large kidney-shaped body.

Vertebral Artery

• Origin: 1st part of subclavian artery.

• Course: 4 parts
1. Pre-foraminal (V1)
2. Foraminal (V2)
3. Atlanto-axial / Suboccipital (V3)
• Exits C1 foramen transversarium.
• Winds around posterior arch of atlas (C1) in suboccipital triangle.
• forms sulcus arteriae vertebralis.
• Pierces atlanto-occipital membrane and dura mater.
4. Intracranial (V4)
• Enters cranial cavity via foramen magnum.
• Both sides unite at lower pons → form basilar artery.

Facial Artery

• Branch of ECA

• Origin: just above greater cornu of hyoid bone

Parts

• Cervical part

• Facial part

Branches

• Ascending palatine artery

• Tonsillar artery

• Glandular artery

• Submental artery

• Inferior labial artery

• Superior labial artery

• Lateral nasal artery

• Angular artery

• Septal branch

Maxillary artery

Branches

• gives off 16 branches
• 1st part → 5 branches
• 2nd → 5 branches
• 3rd → 6 branches

1st PART:

A-ADMI/ MET (MET = 2 meninges, 2 ear, 1 teeth)

2nd Part → Muscular Branch → Muscles of Mastication

1. 'A' to Med. Pterygoid

2. 'A' to Lat. Pterygoid

3. Masseteric Art.

4. Deep temporal Art. [to Temporalis]

5. Buccal Art → Buccinator [Accessory ms of mastication]

3rd Part

Mnemonic: "PIG PAS"

1. P – Posterior Superior Alveolar Artery

2. I – Infraorbital Artery

3. G – Greater Palatine Artery

4. P – Pharyngeal Artery

5. A – Artery to Pterygoid Canal (Vidian Artery)

6. S – Sphenopalatine Artery
• Largest branch of maxillary artery
• Main artery involved in posterior epistaxis

Venous drainage of face

 

• Venous drainage of Face:
• Via deep facial vein → pterygoid venous plexus
• Via angular vein → superior ophthalmic vein
• Superior ophthalmic vein is valveless

Nerve Supply to face

• Motor supply: Facial nerve.

• Sensory supply: Trigeminal nerve.

Branches of Trigeminal Nerve and Areas Supplied

Note

• Great auricular nerve supplies
• skin over angle of mandible/shaving area/beard area.

Lymph Nodes in the Neck

7 Groups

• I: Submental, submandibular.

• II: Upper jugular nodes

• III: Mid jugular nodes

• IV: Lower jugular nodes

• V: Occipital nodes in posterior triangle of neck

• VI: Anterior nodes (hyoid to sternum)

• VII: Mediastinal nodes.

Jugular nodes

• Lies close to IJV.

• Deep to SCM

Applied Aspect

In Carcinoma of Oral Cavity

• Incision: Mod. Schrodinger incision

Type	Description
Radical ND (Crile)	Removes = 1-5 LNs + SCM, IJV, SAN + Submandibular gland, parotid tail
Modified Radical ND	Removes = 1-5 LNs + Saves ≥ 1 structure (SAN/ IJV/ SCM) Types: • I (SAN saved) • II (SAN + IJV saved) • III (all saved) → Functional Neck Dissection Rest all same as Crile
Selective ND	Central: • Level 6 (Delphian LN); Supraomohyoid: • Levels I-III → (SOHND) Extended: • Levels I-IV → (Extended SOHND)

Type of MRND	Structures Preserved
MRND I	Spinal Accessory Nerve (SAN)
MRND II	SAN + Internal Jugular Vein (IJV)
MRND III	SAN + IJV + Sternocleidomastoid (SCM)

• NOTE: T1/T2 lesions →
• Sentinel lymph node biopsy (SLNB)
• Prophylactic ND (SOHND)
• Both offer Better prognosis.

• Complications:
• Haemorrhage
• Carotid blowout (high mortality)
• Nerve injuries:
• Ramus mandibularis/ Marginal mandibular (drooping of angle of mouth)
• SAN (shoulder dysfunction),
• hypoglossal, ansa cervicalis
• Modified Schoebinger incision
• 2 finger breadth below angle of mandible
• To prevent marginal mandibular N injury