External carotid artery and its branches diagram. External carotid artery, a. carotis externa. Anterior group of branches of the external carotid artery. Pirogov triangle. superior thyroid artery

The materials are published for review and are not a prescription for treatment! We recommend that you contact a hematologist at your healthcare facility!

The carotid artery is the largest vessel in the neck and is responsible for the blood supply to the head. Therefore, it is vital to recognize any congenital or acquired pathological conditions of this artery in time in order to avoid irreparable consequences. Fortunately, all advanced medical technologies are available for this.

carotid artery (lat. arteria carotis communis) is one of the most important vessels that feed the structures of the head. From it, the components of the Willisian circle are ultimately obtained. It feeds the brain tissue.

Anatomical location and topography

The place where the carotid artery is located on the neck is the anterolateral surface of the neck, directly under or around the sternocleidomastoid muscle. It is noteworthy that the left common carotid (carotid) artery branches off immediately from the aortic arch, while the right one comes from another large vessel - the brachiocephalic trunk emerging from the aorta.

The area of ​​the carotid arteries is one of the main reflexogenic zones. At the bifurcation site is the carotid sinus - a tangle of nerve fibers with a large number of receptors. When pressed on it, the heart rate slows down, and with a sharp blow, cardiac arrest may occur.

Note. Sometimes, to stop tachyarrhythmias, cardiologists press on the approximate location of the carotid sinus. This makes the rhythm slower.

Bifurcation of the carotid artery, i.e. its anatomical division into external and internal, can be topographically located:

• at the level of the upper edge of the laryngeal thyroid cartilage ("classic" version ");
• at the level of the upper edge of the hyoid bone, slightly below and in front of the angle of the lower jaw;
• at the level of the rounded angle of the lower jaw.

Trifurcation of the left internal carotid artery is a normal variability that can occur in two types: anterior and posterior. In the anterior type, the internal carotid artery gives rise to the anterior and posterior cerebral arteries, as well as the basilar artery. In the posterior type, the anterior, middle, and posterior cerebral arteries emerge from the internal carotid artery.

Important. In people with this variant of vascular development, the risk of aneurysm is high, because. unevenly distributed blood flow through the arteries. It is precisely known that about 50% of the blood "poured" into the anterior cerebral artery from the internal carotid artery.

Branching of the internal carotid artery - front and side

Diseases affecting the carotid artery

Atherosclerosis

The essence of the process is the formation of plaques from "harmful" lipids deposited in the vessels. Inflammation occurs in the inner wall of the artery, on which various mediator substances “flock”, including those that enhance platelet aggregation. It turns out double damage: and the narrowing of the vessel by atherosclerotic deposits growing from the inside of the wall, and the formation of a blood clot in the lumen by aggregating platelets.

A plaque in the carotid artery gives symptoms not immediately. The lumen of the artery is wide enough, therefore often the first, only, and sometimes the last manifestation of an atherosclerotic lesion of the carotid artery is a cerebral infarction.

Important. The external carotid artery is rarely severely affected by atherosclerosis. Basically and, unfortunately, this is the destiny of the internal.

carotid syndrome

He is a hemispheric syndrome. Occlusion (critical narrowing) occurs due to atherosclerotic lesions of the carotid artery. This is an episodic, often sudden disorder that includes the triad:

1. Temporary sudden and rapid loss of vision in 1 eye (on the side of the lesion).
2. Transient ischemic attacks with vivid clinical manifestations.
3. The consequence of the second point is an ischemic cerebral infarction.

Important. Different clinical symptoms, depending on the size and location, can produce plaques in the carotid artery. Their treatment often comes down to surgical removal followed by suturing of the vessel.

congenital stenosis

Fortunately, in ¾ of such cases, the artery with this pathology is narrowed by no more than 50%. For comparison, clinical manifestations occur if the degree of vasoconstriction is 75% or more. Such a defect is detected incidentally on a Doppler study or during an MRI with contrast.

Aneurysms

This is a saccular protrusion in the vessel wall with its gradual thinning. There are both congenital (due to a defect in the tissue of the vascular wall) and atherosclerotic. The rupture is extremely dangerous due to the lightning loss of a huge amount of blood.

1. Superficial temporal artery, a. temporalis superficialis, is a continuation of the trunk of the external carotid artery, passes upward in front of the auricle (partially covered at the level of its tragus by the back of the parotid gland) into the temporal region, where its pulsation is felt above the zygomatic arch in a living person.

At the level of the supraorbital edge of the frontal bone, the superficial temporal artery is divided into the frontal branch, r. frontalis, and the parietal branch, r. parietalis, feeding the supracranial muscle, the skin of the forehead and crown and anastomosing with the branches of the occipital artery. A number of branches depart from the superficial temporal artery: 1) under the zygomatic arch - branches of the parotid gland, rr. parotidei, to the salivary gland of the same name; 2) located between the zygomatic arch and the parotid duct, the transverse artery of the face, a. transversa faciei, to the facial muscles and skin of the buccal and infraorbital regions; 3) anterior ear branches, rr. auriculares anteriores, to the auricle and external auditory meatus, where they anastomose with the branches of the posterior auricular artery; 4) above the zygomatic arch - the zygomatic-orbital artery, a. zygomaticoorbitalis, to the lateral corner of the orbit, supplies the circular muscle of the eye; 5) middle temporal artery, a. temporalis media, to the temporal muscle.

2. Maxillary artery, a. maxillaris, is also the terminal branch of the external carotid artery, but larger than the superficial temporal artery. The initial part of the artery is covered from the lateral side by the branch of the lower jaw. The artery reaches (at the level of the lateral pterygoid muscle) to the infratemporal and further to the pterygopalatine fossa, where it splits into its terminal branches. According to the topography of the maxillary artery, three sections are distinguished in it: maxillary, pterygoid and pterygo-palatine.

Fig. 4 Branches of the maxillary artery

From the maxillary artery within its maxillary department depart: 1) deep ear artery, a. auriculdris profunda, to the temporomandibular joint, external auditory canal and tympanic membrane; 2) anterior tympanic artery, a. tympdnica anterior, which follows through the stony-tympanic fissure of the temporal bone to the mucous membrane of the tympanic cavity; 3) relatively large inferior alveolar artery, a. alveolaris inferior, which enters the canal of the lower jaw and gives off dental branches on its way, rr. dentales. This artery leaves the canal through the mental foramen as the mental artery as well. mentalis, which branches in the mimic muscles and in the skin of the chin. Before entering the canal, a thin maxillo-hyoid branch branches off from the inferior alveolar artery, r. mylohyoideus, to the muscle of the same name and the anterior belly of the digastric muscle; 4) middle meningeal artery, a. meningea, is the most significant of all the arteries that feed the hard shell of the brain. Penetrates into the cranial cavity through the spinous opening of the large wing of the sphenoid bone, gives off the superior tympanic artery there, a. tympanica superior, to the mucous membrane of the tympanic cavity, frontal and parietal branches, rr. frontarietalits, to the hard shell of the brain. Before entering the spinous foramen, a meningeal accessory branch departs from the middle meningeal artery, r. meningeus accessorius (r. accessories), which at first, before entering the cranial cavity, supplies the pterygoid muscles and the auditory tube with blood, and then, passing through the foramen ovale into the skull, sends branches to the hard shell of the brain and to the trigeminal node.

Within the pterygoid section, branches supplying the masticatory muscles depart from the maxillary artery: 1) masticatory artery, a. masseterica, to the muscle of the same name; 2) temporal deep [anterior] and (temporal posterior) arteries, a. temporalis profunda (anterior) and (a. temporalis posterior), extending into the thickness of the temporal muscle; 3) pterygoid branches, rr. pterygoidei, to the muscles of the same name; 4) buccal artery, a. buccalis, to the buccal muscle and to the buccal mucosa; 5) posterior superior alveolar artery, a. alveolaris superior posterior, which through the same holes in the tubercle of the upper jaw penetrates into the maxillary sinus and supplies its mucous membrane with blood, and its dental branches, rr. dentales - teeth and gums of the upper jaw.

Three terminal branches depart from the third - pterygo-palatine - department of the maxillary artery: 1) infraorbital artery, a. infraorbitalis, which passes into the orbit through the lower fissure, where it gives off branches to the lower rectus and oblique muscles of the eye. Then, through the infraorbital foramen, this artery through the canal of the same name to the face and supplies blood to the mimic muscles located in the thickness of the upper lip, in the region of the nose and lower eyelid, and the skin covering them. Here the infraorbital artery anastomoses with branches of the facial and superficial temporal arteries. In the orbital canal, the anterior superior alveolar arteries depart from the infraorbital artery, aa. alveolares superiores anteriores, giving off dental branches, rr. dentales, to the teeth of the upper jaw; 2) descending palatine artery, a. palatina descendens, - a thin vessel, which, having given at the beginning the artery of the pterygoid canal, a. canalis pterygoidei, to the upper part of the pharynx and the auditory tube and passing through the large palatine canal, supplies blood to the hard and soft palate (aa. palatinae major et minores), anastomoses with the branches of the ascending palatine artery; 3) sphenoid-palatine artery, a. sphenopalatina, passes through the opening of the same name into the nasal cavity and gives off the lateral posterior nasal arteries, aa. nasales pasteriores laterals, and posterior septal branches, rr. septales pasteriores, to the nasal mucosa.

Internal carotid artery, a. carotis interna, supplies blood to the brain and organ of vision. The initial section of the artery - its cervical part, pars cervicalis, is located laterally and behind, and then medially from the external carotid artery. Between the pharynx and the internal jugular vein, the artery rises vertically upwards (without giving off branches) to the external opening of the carotid canal. Behind and medially from it are the sympathetic trunk and the vagus nerve, in front and laterally - the hypoglossal nerve, above - the glossopharyngeal nerve. In the carotid canal there is a stony part, pars petrosa, of the internal carotid artery, which forms a bend and gives thin carotid-tympanic arteries, aa, into the tympanic cavity. caroticotympanicae. Upon exiting the canal, the internal carotid artery bends upward and lies in a short groove of the same name in the sphenoid bone, and then the cavernous part, pars cavernosa, of the artery passes through the cavernous sinus of the dura mater. At the level of the optic canal, the brain part, pars cerebralis, of the artery makes another bend, bulging forward, gives off the ophthalmic artery and, at the inner edge of the anterior inclined process, is divided into its terminal branches - the anterior and middle cerebral arteries.

Fig.5 Internal carotid and vertebral arteries

1. Ophthalmic artery, a. ophthalmica, departs in the region of the last bend of the internal carotid artery and, together with the optic nerve, enters through the optic canal into the orbit. Further, the ophthalmic artery follows the medial wall of the orbit to the medial corner of the eye, where it splits into its terminal branches - the medial arteries of the eyelids and the dorsal artery of the nose. The following branches depart from the ophthalmic artery: 1) lacrimal artery, a. lacrimalis, follows between the upper and lateral rectus muscles of the eye, giving them branches, to the lacrimal gland; the thin lateral arteries of the eyelids also separate from it, aa. palpebrales laterales; 2) long and short posterior ciliary arteries, aa. ciliares posteriores longae et breves, pierce the sclera and penetrate the choroid; 3) central retinal artery, a. centralis retinae enters the optic nerve and

Fig.6 Branches of the ophthalmic artery

reaches the retina 4) muscular arteries, aa. musculares, to the upper rectus and oblique muscles of the eyeball; 5) posterior ethmoid artery, a. ethmoidalis posterior, follows the mucous membrane of the posterior cells of the ethmoid bone through the posterior ethmoid opening; 6) anterior ethmoid artery, a. ethmoidalits anterior, passes through the anterior ethmoidal foramen, where it divides into its terminal branches. One of them is the anterior meningeal artery [branch], a. meningeus anterior, enters the cranial cavity and supplies the hard shell of the brain, while others penetrate under the ethmoid plate of the ethmoid bone and nourish the mucous membrane of the ethmoid cells, as well as the nasal cavity and the anterior parts of its septum; 7) anterior ciliary arteries, aa. ciliares anteritores, in the form of several branches accompany the muscles of the eye: suprascleral arteries, aa. episclerdles, enter the sclera, and the anterior conjunctival arteries, aa. contuncttvales anteriores, supply blood to the conjunctiva of the eye; 8) supratrochlear artery, a.

Supratrochlearis, leaves the orbit through the frontal opening (together with the nerve of the same name) and branches in the muscles and skin of the forehead;

Rice. 7 Arteries and veins of the eyelids, front view

1 - supraorbital artery and vein, 2 - artery of the nose, 3 - angular artery (terminal branch of the facial artery - 4), 5 - supraorbital artery, 6 - anterior branch of the superficial temporal artery, 6' - branch of the transverse artery of the face, 7 - lacrimal artery , 8 - upper eyelid artery, 9 - anastomoses of the upper eyelid artery with the superficial temporal and lacrimal, 10 - lower eyelid artery, 11 - facial vein, 12 - angular vein, 13 - branch of the superficial temporal vein.

9) medial arteries of the eyelids, aa. palpebrales mediales, go to the medial corner of the eye, anastomose with the lateral arteries of the eyelids (from the lacrimal artery), forming two arcs: the arc of the upper eyelid, arcus palpebralis superior, and the arc of the lower eyelid, arcus palpebralis inferior; 10) dorsal artery of the nose, a. dorsalis nasi, passes through the orbicular muscle of the eye to the corner of the eye, where it anastomoses with the angular artery (the final branch of the facial artery). The medial arteries of the eyelids and the dorsal artery of the nose are the terminal branches of the ophthalmic artery.

2. Anterior cerebral artery, a. cerebri anterior, departs from the internal carotid artery slightly above the ophthalmic artery, approaches the artery of the same name on the opposite side and is connected to it by a short unpaired communicating artery, a. communicans anterior. Then the anterior cerebral artery lies in the groove of the corpus callosum, goes around the corpus callosum and goes towards the occipital lobe of the cerebral hemisphere, supplying blood to the medial surfaces of the frontal, parietal and partly occipital lobes, as well as the olfactory bulbs, tracts and striatum. The artery gives off two groups of branches to the substance of the brain - cortical and central.

3. Middle cerebral artery, a. cerebri media is the largest branch of the internal carotid artery. It distinguishes between the sphenoid part, pars sphenoidali s, adjacent to the greater wing of the sphenoid bone, and the insular part, pars i~nsulari s. The latter rises upward, enters the lateral groove of the large brain, adjacent to the islet. Then it continues into its third, final (cortical) part, pars terminalis (pars corticalis), which branches on the upper lateral surface of the cerebral hemisphere. The middle cerebral artery also gives off cortical and central branches.

4. Posterior communicating artery, a. communicans postdrior, departs from the end of the internal carotid artery to the division of the latter into the anterior and middle cerebral arteries. The posterior communicating artery is directed towards the bridge and, at its anterior edge, flows into the posterior cerebral artery (a branch of the basilar artery).

5. Anterior villous artery, a. choroidea anterior, - a thin vessel, departs from the internal carotid artery behind the posterior communicating artery, penetrates into the lower horn of the lateral ventricle, and then into the third ventricle. With its branches, it participates in the formation of vascular plexuses. It also gives off numerous thin branches to the gray and white matter of the brain: to the optic tract, lateral geniculate body, internal capsule, basal nuclei, hypothalamic nuclei, and to the red nucleus. The following arteries participate in the formation of anastomoses between the branches of the internal and external carotid arteries: a. dorsalis nasi (from the ophthalmic artery) and a. angularis (from the facial artery), a. supratrochlearis (from the ophthalmic artery) and g. frontalis (from the superficial temporal artery), a. carotis interna and a. cerebri posterior (through the posterior communicating artery).

Subclavian artery, a. subclavia, starts from the aorta (left) and brachiocephalic trunk (right). The left subclavian artery is about 4 cm longer than the right. The subclavian artery exits the chest cavity through its upper aperture, goes around the dome of the pleura, enters (together with the brachial plexus) into the interstitial space, then passes under the clavicle, bends over 1 rib (lies in its groove of the same name) and below the lateral edge of this rib penetrates into axillary cavity, where it continues as the axillary artery. Conventionally, the subclavian artery is divided into three sections: 1) from the place of origin to the inner edge of the anterior scalene muscle, 2) in the interstitial space and 3) at the exit from the interscalene space. In the first section, three branches depart from the artery: the vertebral and internal thoracic arteries, the thyroid-cervical trunk, in the second section - the costal-cervical trunk, and in the third - sometimes the transverse artery of the neck.

1. Vertebral artery, a. vertebralis, - the most significant of the branches of the subclavian artery, departs from its upper semicircle at the level of the VII cervical vertebra. The vertebral artery has 4 parts: between the anterior scalene muscle and the long muscle of the neck is its prevertebral part, pars prevertebra. Next, the vertebral artery goes to the VI cervical vertebra - this is its transverse process (cervical) part, pars transversaria (cervicalis), then goes up through the transverse foramina of the VI-II cervical vertebrae. Having left the transverse opening of the II cervical vertebra, the vertebral artery turns laterally and the next section is the atlantic part, pars atlantica. Having passed through the hole in the transverse process of the atlas, it goes around its superior articular fossa [surface] behind, pierces the posterior atlantooccipital membrane, and then the dura mater of the spinal cord (in the spinal canal) and through the large occipital foramen enters the cranial cavity - here its intracranial part begins , pars intracranialis. Behind the pons of the brain, this artery joins with a similar artery on the opposite side, forming the basilar artery. From the second, transverse process, part of the vertebral artery depart spinal (radicular) branches, rr. spinales (radiculares), penetrating through the intervertebral foramina to the spinal cord, and muscle branches, rr. musculares, to the deep muscles of the neck. All other branches are separated from the last - intracranial part: 1) anterior meningeal branch, r. meningeus anterior, and posterior meningeal branch, r. meningeus posterior / meningeal branches, rr. meningei]; 2) posterior spinal artery, a. spinalis posterior, goes around the medulla oblongata from the outside, and then goes down along the posterior surface of the spinal cord, anastomosing with the artery of the same name on the opposite side; 3) anterior spinal artery, a. spinalis anterior, connects with the artery of the same name on the opposite side into an unpaired vessel, heading down in the depths of the anterior fissure of the spinal cord; 4) posterior inferior cerebellar artery (right and left), a. the inferior posterior cerebelli, rounding the medulla oblongata, branches out in the posterior inferior parts of the cerebellum.

Basilar artery, a. basilaris, - an unpaired vessel, is located in the basilar groove of the bridge. At the level of the anterior edge of the bridge, it is divided into two terminal branches - the posterior right and left cerebral arteries. From the trunk of the basilar artery depart: 1) anterior inferior cerebellar artery (right and left), a. inferior anterior cerebelli, branch on the lower surface of the cerebellum; 2) labyrinth artery (right and left), a. labyrinthi, pass next to the vestibulocochlear nerve (VIII pair of cranial nerves) through the internal auditory meatus to the inner ear; 3) arteries of the bridge, aa. pontis (branches to the bridge); 4) middle cerebral arteries, aa. mesencephalicae (branches to the midbrain); 5) superior cerebellar artery (right and left), a. superior cerebelli, branches in the upper parts of the cerebellum.

Rice. 8 Arteries forming the circle of Willis

Posterior cerebral artery, a. cerebri posterior, goes around the brain stem, branches on the lower surface of the temporal and occipital lobes of the cerebral hemisphere, gives off cortical and central branches. The artery communicans posterior (from the internal carotid artery) flows into the posterior cerebral artery, resulting in the formation of the arterial (willisian) circle of the brain, circulus arteriosus cerebri.

The right and left posterior cerebral arteries, which close the arterial circle from behind, participate in its formation. The posterior cerebral artery is connected to the internal carotid artery on each side by the posterior communicating artery. The anterior part of the arterial circle of the cerebrum is closed by the anterior communicating artery, located between the right and left anterior cerebral arteries, which branch off from the right and left internal carotid arteries, respectively. The arterial circle of the cerebrum is located at its base in the subarachnoid space. It covers the front and sides of the optic chiasm; the posterior communicating arteries lie lateral to the hypothalamus, the posterior cerebral arteries are in front of the pons.

External carotid artery, a. carotis externa. Anterior group of branches of the external carotid artery. Pirogov triangle.

External carotid artery, a. carotis externa, supplies blood to the outer parts of the head and neck, which is why it was called external, in contrast to the internal carotid artery, which penetrates the cranial cavity. From its place of origin, the external carotid artery rises upward, passes medially from the posterior abdomen m. digastrici and m. stylohyoideus, perforates the parotid gland and, behind the neck of the condylar process of the lower jaw, is divided into its terminal branches.

The branches of the external carotid artery are for the most part remnants of the arterial arches and feed the organs arising from the branchial arches. They go (in number 9) as if along the radii of a circle corresponding to the head, and can be divided into three groups of three arteries each - anterior, middle and posterior groups, or triplets.

The anterior group is due to the development and location of organs supplied by the arteries of this group and which are derivatives of the gill arches, namely: the thyroid gland and larynx - a. thyroidea superior, language - a. lingualis and faces - a. facialis.

1. A. thyroidea superior, superior artery of the thyroid gland, departs from the external carotid artery immediately above its beginning, goes down and forward to the thyroid gland, where it anastomoses with other thyroid arteries.
Gives away along the way a. laryngea superior, which together with n. laryngeus superior perforates lig. thyrohyoideum and supplies the muscles, ligaments and mucous membrane of the larynx with branches.

2. A. lingualis, lingual artery, departs at the level of the large horns of the hyoid bone, goes up through Pirogov triangle covered with m. hyoglossus, and heads towards the tongue. Before entering it, it gives branches to the hyoid bone, palatine tonsils and the hyoid gland. Entering the tongue, the trunk of the lingual artery continues to the tip of the tongue called a. profunda linguae, which along the way gives multiple branches to the back of the tongue, rr. dorsales linguae.

3. A. facialis, facial artery, departs somewhat higher than the previous one at the level of the angle of the lower jaw, passes medially from the posterior abdomen m. digastricus and reaches the front edge of m. masseter, where it bends over the edge of the jaw into the face. Here, in front of m. masseter, it can be pressed against the lower jaw. Then it goes to the medial corner of the eye, where the final branch (a. angularis) anastomoses with a. dorsalis nasi(branch a. ophthalmica from the system of the internal carotid artery). Before bending through the lower jaw, it gives branches to nearby formations: to the pharynx and soft palate, to the palatine tonsils, to the submandibular gland and diaphragm of the mouth, to the salivary glands; after bending - to the upper and lower lips.

External carotid artery, a. carotis externa, supplies blood to the outer parts of the head and neck, which is why it was called external, in contrast to the internal carotid artery, penetrating into the cranial cavity. From the place of its origin, the external carotid artery rises upward, passes medially from the posterior abdomen m. digastrici and m. stylohyoideus, perforates the parotid gland and, behind the neck of the condylar process of the lower jaw, is divided into its terminal branches.

The branches of the external carotid artery are for the most part remnants of the arterial arches and feed the organs arising from the branchial arches. They go (in number 9) as if along the radii of a circle corresponding to the head, and can be divided into three groups of three arteries each - anterior, middle and posterior groups, or triplets.

The anterior group is due to the development and location of organs supplied by the arteries of this group and which are derivatives of the gill arches, namely: the thyroid gland and larynx - a. thyroidea superior, tongue - a. lingualis and faces - a. facialis.

1. A. thyroidea superior, the superior artery of the thyroid gland, departs from the external carotid artery immediately above its beginning, goes down and forward to the thyroid gland, where it anastomoses with other thyroid arteries. Gives away a along the way. laryngea superior, which together with n. laryngeus superior perforates lig. thyrohyoideum and supplies the muscles, ligaments and mucous membrane of the larynx with branches.
2. A. lingualis, the lingual artery, leaves at the level of the large horns of the hyoid bone, goes up through Pirogov's triangle, covered with m. hyoglossus, and heads towards the tongue. Before entering it, it gives branches to the hyoid bone, palatine tonsils and the hyoid gland. Entering the tongue, the trunk of the lingual artery continues to the tip of the tongue called a. profunda linguae, which along the way gives off multiple branches to the back of the tongue, rr. dorsales linguae.
3. A. facialis, the facial artery, departs slightly higher than the previous one at the level of the angle of the lower jaw, passes medially from the posterior abdomen m. digastricus and reaches the front edge of m. masseter, where it bends over the edge of the jaw into the face. Here, in front of m. masseter, it can be pressed against the lower jaw. Then it goes to the medial corner of the eye, where the final branch (a. angularis) anastomoses with a. dorsalis nasi (a. ophthalmica branch from the internal carotid artery system). Before bending through the lower jaw, it gives branches to nearby formations: to the pharynx and soft palate, to the palatine tonsils, to the submandibular gland and diaphragm of the mouth, to the salivary glands; after bending - to the upper and lower lips. back group.
4. A. occipitalis, the occipital artery, lies in the groove on the processus mastoideus, appearing under the skin in the back of the head, branches to the crown. On its way a. occipitalis gives a number of small branches: to the surrounding muscles, to the auricle, to the dura mater in the region of the posterior cranial fossa.
5. A. auricularis posterior, the posterior auricular artery, runs up and back to the skin behind the auricle. Its branches are distributed in the auricle, in the skin and muscles of the occiput, as well as in the tympanic cavity, where its branch penetrates through the foramen stylomastoidieum.
6. A. sternocleidomastoidea - to the muscle of the same name. The middle group consists of remnants of the arterial arches.
7. A. pharyngea ascendens, the ascending pharyngeal artery, goes up the wall of the pharynx, supplying it, the soft palate, the palatine tonsil, the auditory tube, the tympanic cavity and the dura mater.
8. A. temporalis superficialis, superficial temporal artery, one of the two terminal branches of the external carotid artery, goes as a continuation of the trunk a. carotis externa in front of the external auditory canal to the temple, located under the skin on the fascia of the temporalis muscle. Here the artery can be pressed against the temporal bone. Its terminal branches, ramus frontalis and ramus parietalis, branch out in the region of the crown and temple. Along the way, it gives branches to the parotid gland, to the lateral surface of the auricle and to the external auditory canal; part of the branches goes to the back of the face, to the outer corner of the eye, to m. orbicularis oculi and zygomatic bone. A. temporalis superficialis also supplies m. temporalis.
9. A. maxillaris, the maxillary artery, is the other terminal branch of the external carotid artery. Its short trunk is divided into three sections to facilitate the study of branches: the first goes around the neck of the jaw, the second passes into the fossa infratemporalis along the surface of m. pterygoideus lateralis, the third penetrates into the fossa pterygopalatina.

The branches of the first section go up to the external auditory canal, into the tympanic cavity, where they penetrate through the fissura petrotympanica; to the hard shell of the brain - a. meningea media, the middle meningeal artery (the largest branch), where it penetrates through the foramen spinosum, and down to the lower teeth, a. alveolaris inferior, inferior alveolar artery. The latter passes into the lower jaw through the canalis mandibulae. Before entering the channel a. alveoldris inferior gives r. mylohyoideus to the named muscle, and in the canal it supplies the lower teeth with its branches and leaves it through the foramen mentale, being called a. mentalis, which branches out in the skin and muscles of the chin.

The branches of the second section go to all the chewing and buccal muscles, receiving the names corresponding to the muscles, as well as to the mucous membrane of the sinus maxillaris and the upper molars - aa. alveolares superiores posteriores, posterior superior alveolar arteries.

Branches of the third department:

1. a. infraorbital, the infraorbital artery, enters through the fissura orbitalis inferior into the orbit, then through the canalis infraorbitalis it enters the anterior surface of the upper jaw and sends branches to the lower eyelid, to the lacrimal sac and down to the upper lip and to the cheek. Here it anastomoses with the branches of the facial artery, so that if the blood flow in the trunk of a. maxillaris blood can enter its pool through a. facialis. Still in the eye socket a. infraorbitalis gives branches to the muscles of the eyeball; passing in the infraorbital canal, supplies branches to the canine and incisors (aa. alveolares superiores anteribres) and the mucous membrane of sinus maxillaris;
2. branches to the palate, pharynx and auditory tube, some of which descend into the canalis palatinus major, exit through the foramina palatina majus et minores and branch out in the hard and soft palate;
3. a. sphenopalatina, the sphenopalatine artery, penetrates through the opening of the same name into the nasal cavity, giving branches to its lateral wall and to the septum; the front of the nasal cavity receives blood through the aa. ethmoidales anterior et posterior (from a. ophthalmica).

The superior thyroid artery (a. thyreoidea superior) departs from the external carotid artery at its beginning, at the level of the greater horn of the hyoid bone, goes forward and downward, and at the upper pole of the thyroid gland is divided into anterior and posterior glandular branches(rr.glandulares anterior et posterior). The anterior and posterior branches are distributed in the thyroid gland, anastomose in the thickness of the gland with each other, as well as with the branches of the inferior thyroid artery. On the way to the thyroid gland, the following lateral branches depart from the superior thyroid artery:

1. superior laryngeal artery(a.laryngea superior) along with the nerve of the same name goes medially above the upper edge of the thyroid cartilage under the thyroid-hyoid muscle, pierces the thyroid-hyoid membrane and supplies the muscles and mucous membrane of the larynx, epiglottis;
2. sublingual branch(r.infrahyoideus) goes to the hyoid bone and the muscles attached to this bone;
3. sternocleidomastoid branch(r.sternocleidomastoideus) unstable, approaches the muscle of the same name from its inner side;
4. cricothyroid branch(r.criocothyroideus) supplies blood to the muscle of the same name, anastomoses with the same artery on the other side.

The lingual artery (a.lingualis) branches off from the external carotid artery just above the superior thyroid artery, at the level of the greater horn of the hyoid bone. It goes below the hyoid-lingual muscle, between this muscle (laterally) and the middle constrictor of the pharynx (medially), passes into the region of the submandibular triangle. Then the artery enters the thickness of the tongue from below. On its way, the lingual artery gives off several branches:

1. suprahyoid branch(r.suprahyoideus) goes along the upper edge of the hyoid bone, supplies blood to this bone and the muscles adjacent to it;
2. dorsal branches of the tongue(rr.dorsales linguae) depart from the lingual artery under the hyoid-lingual muscle, go up;
3. hypoglossal artery(a. sublingualis) goes forward to the hyoid bone above the maxillo-hyoid muscle, lateral to the duct of the sublingual salivary gland, supplies blood to the mucous membrane of the floor of the mouth and gums, the sublingual salivary gland, anastomoses with the chin artery.
4. deep artery of the tongue(a.profunda linguae) is large, is the final branch of the lingual artery, goes up into the thickness of the tongue to its tip between the genio-lingual muscle and the lower longitudinal muscle (tongue).

The facial artery (a.facialis) departs from the external carotid artery at the level of the angle of the lower jaw, 3-5 mm above the lingual artery. In the region of the submandibular triangle, the facial artery is adjacent to the submandibular gland (or passes through it), giving it glandular branches(rr.glandulares), then bends over the edge of the lower jaw to the face (in front of the chewing muscle) and goes up and forward, towards the corner of the mouth, and then to the region of the medial corner of the eye.

The following branches depart from the facial artery:

1. ascending palatine artery(a.palatina ascendens) from the initial part of the facial artery, goes up the lateral wall of the pharynx, penetrates between the styloglossus and stylopharyngeal muscles (supplies them with blood). The final branches of the artery are sent to the palatine tonsil, the pharyngeal part of the auditory tube, the mucous membrane of the pharynx;
2. tonsil branch(r.tonsillaris) goes up the side wall of the pharynx to the palatine tonsil, the wall of the pharynx, the root of the tongue;
3. submental artery(a.submentalis) follows the outer surface of the maxillofacial muscle to the chin and neck muscles located above the hyoid bone.

On the face, in the corner of the mouth, depart:

1. inferior labial artery(a.labialis inferior) and
2. superior labial artery(a. labialis superior).

Both arteries go into the thickness of the lips, anastomose with similar arteries of the opposite side;

1. angular artery(a.angularis) is the terminal branch of the facial artery, goes to the medial corner of the eye. Here it anastomoses with the dorsal artery of the nose, a branch of the ophthalmic artery (from the system of the internal carotid artery).

Posterior branches of the external carotid artery:

The occipital artery (a.occipitalis) departs from the external carotid artery almost at the same level as the facial artery, goes back, passes under the posterior belly of the digastric muscle, and then lies in the temporal bone groove of the same name. Between the sternocleidomastoid and trapezius muscles, it extends to the posterior surface of the head, where it branches in the skin of the occiput to occipital branches(rr.occipitales), which anastomose with similar arteries of the opposite side, as well as with the muscular branches of the vertebral artery and the deep cervical artery (from the subclavian artery system).

Lateral branches depart from the occipital artery:

1. sternocleidomastoid branches(rr.sternocleidomastoidei) to the muscle of the same name;
2. ear branch(r.auricularis), anastomosing with the branches of the posterior auricular artery; goes to the auricle;
3. mastoid branch(r.mastoideus) penetrates through the hole of the same name to the hard shell of the brain;
4. descending branch(r.descendens) goes to the muscles of the back of the neck.

The posterior auricular artery (a.auricularis posterior) departs from the external carotid artery above the upper edge of the posterior belly of the digastric muscle and follows obliquely backwards. The following branches depart from the posterior auricular artery:

1. ear branch(r.auricularis) goes along the back side of the auricle, which it supplies with blood;
2. occipital branch(r.occipitalis) goes back and up along the base of the mastoid process; blood supply to the skin in the region of the mastoid process, the auricle and the back of the head;
3. stylomastoid artery(a.stylomastoidea) penetrates through the hole of the same name into the canal of the facial nerve of the temporal bone, where it gives posterior tympanic artery(a.tympanica posterior), which through the canal of the tympanic string goes to the mucous membrane of the tympanic cavity, the cells of the mastoid process (mastoid branches), to the stapedius muscle (stirrup branch). The terminal branches of the stylomastoid artery reach the dura mater of the brain.

Medial branches of the external carotid artery:

The ascending pharyngeal artery (a.pharyngea ascendens) departs from the internal semicircle of the external carotid artery at its beginning, rises up to the side wall of the pharynx. The following branches depart from the ascending pharyngeal artery:

1. pharyngeal branches(rr.pharyngeales) go to the muscles of the pharynx, soft palate, palatine tonsil, auditory tube;
2. posterior meningeal artery(a.meningea posterior) follows into the cranial cavity through the jugular foramen;
3. inferior tympanic artery(a.tympanica inferior) through the lower opening of the tympanic tubule penetrates into the tympanic cavity to its mucous membrane.

Terminal branches of the external carotid artery:

The superficial temporal artery (a.temporalis superficialis) is a continuation of the trunk of the external carotid artery, passes upward in front of the auricle (under the skin on the fascia of the temporal muscle) into the temporal region. Above the zygomatic arch in a living person, a pulsation of this artery is felt. At the level of the supraorbital margin of the frontal bone, the superficial temporal artery divides into frontal branch(r.frontalis) and parietal branch(r.parietalis), feeding the supracranial muscle, the skin of the forehead and crown and anastomosing with the branches of the occipital artery. The superficial temporal artery gives off a number of branches:

1. branches of the parotid gland(rr.parotidei) depart under the zygomatic arch in the upper part of the salivary gland of the same name;
2. transverse facial artery(a.transversa faciei) goes forward next to the excretory duct of the parotid gland (below the zygomatic arch) to the facial muscles and skin of the buccal and infraorbital regions;
3. anterior ear branches(rr.auriculares anteriores) go to the auricle and external auditory meatus, where they anastomose with the branches of the posterior auricular artery;
4. zygomatico-orbital artery(a.zygomaticoorbitalis) departs above the zygomatic arch to the lateral corner of the orbit, supplies blood to the circular muscle of the eye;
5. middle temporal artery(a.temporalis media) perforates the fascia of the temporal muscle, which this artery supplies with blood.

The maxillary artery (a.maxillaris) is also the terminal branch of the external carotid artery, but larger than the superficial temporal artery. The initial part of the artery is covered from the lateral side by the branch of the lower jaw. The artery reaches (at the level of the lateral pterygoid muscle) to the infratemporal and further to the pterygopalatine fossa, where it splits into its terminal branches. According to the topography of the maxillary artery, three sections are distinguished in it: maxillary, pterygoid and pterygo-palatine. The following arteries depart from the maxillary artery within its maxillary region:

1. deep ear artery(a.auricularis profunda) goes to the temporomandibular joint, external auditory canal and eardrum;
2. anterior tympanic artery(a.tympanica anterior) through the stony-tympanic fissure of the temporal bone follows to the mucous membrane of the tympanic cavity;
3. inferior alveolar artery(a.alveolaris inferior) large, enters the canal of the lower jaw and gives out dental branches (rr.dentales) on its way. This artery leaves the canal through the mental foramen as the mental artery (a.mentalis), which branches in the mimic muscles and in the skin of the chin. Before entering the canal, a thin maxillary-hyoid branch (r.mylohyoideus) branches off from the inferior alveolar artery to the muscle of the same name and the anterior belly of the digastric muscle;
4. middle meningeal artery(a.meningea media) - the largest of all arteries that feed the hard shell of the brain. This artery enters the cranial cavity through the spinous opening of the large wing of the sphenoid bone, gives off the superior tympanic artery (a.tympanica superior), which leaves through the muscle canal, stretching the eardrum, to the mucous membrane of the tympanic cavity, as well as the frontal and parietal branches (rr. frontalis et parietalis) to the hard shell of the brain. Before entering the spinous foramen, an additional branch (r.accessorius) departs from the middle meningeal artery, which at first, before entering the cranial cavity, supplies blood to the pterygoid muscles and the auditory tube, and then, having passed through the foramen ovale inside the skull, sends branches to the hard shell of the head brain and to the trigeminal node.

Within the pterygoid region, branches supplying the masticatory muscles depart from the maxillary artery:

1. masticatory artery(a.masseterica) goes to the muscle of the same name;
2. anterior and posterior deep temporal arteries(aa.temporales profundae anterior et posterior) go into the thickness of the temporal muscle;
3. pterygoid branches(rr.pterygoidei) go to the muscles of the same name;
4. buccal artery(a.buccalis) goes to the buccal muscle and buccal mucosa;
5. posterior superior alveolar artery(a.alveolaris superior posterior) penetrates into the maxillary sinus through the same holes in the tubercle of the upper jaw and supplies its mucous membrane with blood, and its dental branches (rr.dentales) - the teeth and gums of the upper jaw.

Three terminal branches depart from the third - pterygo-palatine department of the maxillary artery:

1. infraorbital artery(a.infraorbitalis) passes into the orbit through the lower palpebral fissure, where it gives branches to the lower rectus and oblique muscles of the eye. Then, through the infraorbital foramen, this artery exits through the canal of the same name to the face and supplies blood to the mimic muscles located in the thickness of the upper lip, in the region of the nose and lower eyelid, and the skin covering them. Here the infraorbital artery anastomoses with branches of the facial and superficial temporal arteries. In the infraorbital canal, the anterior superior alveolar arteries (aa.alveolares superiores anteriores) depart from the infraorbital artery, giving dental branches (rr.dentales) to the teeth of the upper jaw;
2. descending palatine artery(a.palatina descendens), first giving the artery of the pterygoid canal (a.canalis pterygoidei) to the upper pharynx and auditory tube and passing through a small palatine canal, it supplies the hard and soft palate through the large and small palatine arteries (aa.palatinae major et minores ); gives off the sphenopalatine artery (a.sphenopalatma), which passes through the opening of the same name into the nasal cavity, and the lateral posterior nasal arteries (aa.nasales posteriores laterales) and the posterior septal branches (rr.septales posteriores) to the nasal mucosa.