Anatomy - Open TEA of the left carotid bifurcation with patch angioplasty and temporary intraluminal shunt

Anatomy Perioperative management Technique Complications Evidence Total Video

Common carotid artery

Origin	left: aortic arch right: brachiocephalic trunk
Course	ascending behind the sternocleidomastoid muscle within the carotid sheath
Division	Carotid bifurcation (Bifurcatio carotidis): Division into internal carotid artery and external carotid artery
Vascular territory	1. Internal carotid artery Brain Eye Forehead Anterior nasal cavity 2. External carotid artery Extracranial structures of the head and neck

Internal carotid artery

Origin	Branch of the common carotid artery (carotid bifurcation)
Course from caudal to cranial	1. Cervical part Section between origin of the common carotid artery to the skull base entry into the cranial cavity via the carotid canal gives off no branches 2. Petrous part runs in the petrous bone small branches to the tympanic cavity and pterygoid canal 3. Cerebral part runs in the subarachnoid space passes through the dura mater Branching into anterior cerebral artery and middle cerebral artery Anterior cerebral artery communicates via the anterior communicating artery with the contralateral anterior cerebral artery

Origin

Branch of the common carotid artery (carotid bifurcation)

Course from caudal to cranial

1. Cervical part

Section between origin of the common carotid artery to the skull base
entry into the cranial cavity via the carotid canal
gives off no branches

2. Petrous part

runs in the petrous bone
small branches to the tympanic cavity and pterygoid canal

3. Cerebral part

runs in the subarachnoid space
passes through the dura mater
Branching into anterior cerebral artery and middle cerebral artery
Anterior cerebral artery communicates via the anterior communicating artery with the contralateral anterior cerebral artery

The circle of Willis is an arterial vascular ring at the base of the brain, which serves the blood supply of the brain. It is composed – from anterior to posterior - of the following vessels:

Anterior communicating artery (unpaired)
Anterior cerebral artery (left and right)
Internal carotid artery (left and right) or its direct continuation, the middle cerebral artery
Posterior communicating artery (left and right)
Posterior cerebral artery (left and right, both from the basilar artery).

However, there are numerous variants in the formation of the circle regarding the caliber of the branches and the connections (hypoplasias of individual branches or even agenesis of partial sections). This is clinically relevant for collateral supply in stenoses.

External carotid artery

The supply areas of the external carotid artery can be divided into four groups depending on location: anterior, middle and posterior group as well as terminal branches.

1. Anterior Group

Branches (cranial → caudal)	Branches	Supply
Superior thyroid artery	Infrahyoid branch Cricothyroid branch Sternocleidomastoid branch	corresponding muscles
	Superior laryngeal artery	Inner side of larynx
	Glandular branches	Thyroid gland
Lingual artery	Suprahyoid branch	Hyoid bone
	Dorsal lingual branches	Dorsum of tongue
	Sublingual artery	Sublingual gland
	Deep lingual artery	Tip of tongue
Facial artery	Ascending palatine artery	soft palate tonsils pharynx
	Submental artery	Submandibular gland suprahyoid muscles
	Inferior labial artery	Lower lip
	Superior labial artery	Upper lip
	Angular artery	medial canthus

2. Middle Group

Branches (cranial → caudal)	Branches	Supply
Ascending pharyngeal artery	Pharyngeal branches	Pharynx
	Inferior tympanic artery	Tympanic cavity
	Posterior meningeal artery	Dura mater

3. Posterior Group

Branches (cranial → caudal)	Branches	Supply
Occipital artery	Mastoid branch	Mastoid cells
	Occipital branches	Occipital region
	Meningeal branch	Dura mater
Posterior auricular artery	Auricular branch	external ear
	Occipital branch	Occipital region
	Stylomastoid artery	Facial nerve Tympanic cavity Mastoid cells
	Posterior tympanic arteries	Tympanic cavity Mastoid cells
	Pharyngeal branches	Pharynx
	Parotid branch	Parotid gland

4. Terminal branches

Branches (cranial → caudal)			Supply
Superficial temporal artery	Transverse facial artery		Face
	Zygomatico-orbital artery		lateral canthus
	Middle temporal artery		Temporal muscle
	Frontal branch		Scalp
Maxillary artery	Mandibular part	Deep auricular artery	Temporomandibular joint external auditory canal
		Anterior tympanic artery	Tympanic cavity
		Inferior alveolar artery	Teeth Mandible Mylohyoid branch: floor of mouth Mental branch: chin
		Middle meningeal artery	Meninges
	Pterygoid part	Masseteric artery	Masseter muscle
		Pterygoid branches	Pterygoid muscles
		Deep temporal arteries	Temporal muscle
		Buccal artery	Buccinator muscle
	Pterygopalatine part	Posterior superior alveolar artery	Teeth Maxilla
		Infraorbital artery	Maxilla
		Descending palatine artery	Tonsils soft palate
		Sphenopalatine artery	Nasal cavity Nasal septum
		Artery of pterygoid canal	Pharynx Tympanic cavity

Venous Systems

Superficial and deep venous systems unite in the venous angle ("venous angle") to form the V. brach

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Common carotid artery
Internal carotid artery
External carotid artery
Venous Systems
Lymphatic vessels
Nervous System

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