Video: Blood vessels of nasal cavity

Hello everyone! This is Megan from Kenhub, and welcome to our tutorial on blood vessels of the nasal cavity. During this tutorial, we'll have a look at the arterial supply and venous drainage of the nasal cavity. At the end of the tutorial, we'll go over a few clinical pathologies related to the blood vessels of the nasal cavity.

So here we can see an illustration of the skull that's been bisected along the midsagittal plane to expose vasculature and nerve supply of the nasal cavity. Here we can see the lateral wall of the right nasal cavity and here we can see the medial wall which has been reflected upwards. Now, this image does look overwhelming but don't panic because as we progress through the tutorial, we're going to break it down into individual structures. As with other anatomical illustrations, the red vessels represent arteries, the blue vessels represent veins, and the yellow fibers represent nerves. So let's begin with the arterial supply.

The nasal cavity has a very rich blood supply derived from both the internal carotid artery and the external carotid artery, which is highlighted in this image in green. As you may know, the external carotid artery has many branches. Part of the blood supply to the nasal cavity is derived from two of these branches – the facial artery and the maxillary artery.

Let's first take a look at the facial artery and its main branches to the nasal cavity. As you can see, the facial artery branches anteriorly of the external carotid artery then curves upwards over the mandible and over the angle of the mouth to run alongside the nose. As it passes the nose, it gives off a branch which supplies the nasal cavity. This branch is referred to as the lateral nasal branch of the facial artery and we can see it highlighted in green here. This branch supplies the skin of the nose.

Now, let's look at the other branch of the external carotid artery that supplies the nasal cavity which is the maxillary artery. The maxillary artery is one of the two terminal branches of the external carotid artery. As you can see, it passes underneath the mandible before it courses up the face giving off many branches. In this next illustration, we can see another view of the maxillary artery as well as the other terminal branch, the superficial temporal artery. We will now have a look at some of the branches of the maxillary artery which supply the nasal cavity.

The first branch of the maxillary artery we will look at is the sphenopalatine artery. The sphenopalatine artery passes through the sphenopalatine foramen which is a hole within the skull which you can see located at the posterior aspect of the superior meatus. If you wish to learn more about the structures of the nasal cavity such as the meatuses or the conchae, visit our website for tutorials on the medial and lateral wall of the nasal cavity.

So once the sphenopalatine artery passes through the sphenopalatine foramen, it gives off two main sets of branches. The first set of branches are referred to as the posterior lateral nasal branches of the sphenopalatine artery. As you can see, they spread over the conchae and the meatuses between them and help supply the paranasal sinuses. The other set of branches is referred to as the posterior septal branches of the sphenopalatine artery. In this illustration, the medial wall of the right nasal cavity has been reflected upwards to show the nasal septum in the top part of the image. As you can see, the posterior septal branches supply the posterior aspect of the septum.

Let's now look at the other main branch of the maxillary artery, the greater palatine artery. Like the sphenopalatine artery, the greater palatine artery arises from a foramen or hole within the skull. The foramen that the greater palatine artery passes through is known as the greater palatine foramen and we can see it in this illustration here. This artery supplies the hard palate and although you cannot see it in this image, it anastomoses with the sphenopalatine artery to supply the nasal septum.

So let's summarize the names of the arteries which supply the nasal cavity and are derived from the external carotid artery. Two main arteries derived from the external carotid artery supply the nasal cavity – the facial artery and the maxillary artery. The facial artery has one main branch that supplies the nasal cavity – the lateral nasal branch. The maxillary artery has two branches that supply the nasal cavity – the greater palatine artery and the sphenopalatine artery. The sphenopalatine artery has two main sets of branches itself – the posterior lateral branches and the posterior septal branches.

So let's move on to look at the arterial supply that's derived from the internal carotid artery. There is one branch of the internal carotid artery that is involved in the arterial supply of the nasal cavity and that is the ophthalmic artery. The ophthalmic artery is the first branch of the internal carotid artery and gives off most of its branches to the eye but also gives off a few branches to the nasal cavity. The ophthalmic artery gives off two main branches to the nasal cavity – the anterior ethmoidal artery and the posterior ethmoidal artery. We will now look at each of these arteries and their branches in more detail.

The first artery that branches off to the nose from the ophthalmic artery is the posterior ethmoidal artery. As you can see, it runs through this canal here which is known as the posterior ethmoidal canal. Once it's passed through this canal, it then enters into the nasal cavity. It then gives off some branches to supply the posterior ethmoidal cells and the nasal septum. These branches are known as the septal and lateral nasal branches of the posterior ethmoidal artery. After the ophthalmic artery gives off the posterior ethmoidal artery, it then continues anteriorly before it gives off the anterior ethmoidal artery.

Like the posterior ethmoidal artery, this artery also transverses the canal before entering the nasal cavity. This canal is known as the anterior ethmoidal canal. Once it enters the nasal cavity, the anterior ethmoidal artery gives off a few branches. The first set of branches it gives off are the anterior septal branches. These branches supply the anterior septum. The anterior ethmoidal artery also gives off anterior lateral nasal branches which supply the anterolateral wall of the nasal cavity. After the anterior ethmoidal artery gives off these branches, it then terminates as the external nasal branches which supply the skin of the nose. We can see part of the external nasal branches highlighted in green here.

Okay, let's now summarize the blood supply of the nasal cavity derived from the internal carotid artery. There is one main artery that's derived from the internal carotid artery that supplies the nasal cavity and that is the ophthalmic artery. This artery has two main branches – the posterior ethmoidal artery and the anterior ethmoidal artery. The posterior ethmoidal artery then further branches into the lateral septal and nasal branches. The anterior ethmoidal artery gives off three further sets of branches – the anterior septal branches, the anterior lateral nasal branches, and the external nasal branches.

Now that we've looked at all these arteries, we can move on to the venous drainage of the nasal cavity. The venous drainage is very similar to that of the arterial supply. The first vein we'll look at is the lateral nasal branch of the facial vein which is highlighted in green here. This vein follows the course of its corresponding artery – the lateral nasal branch of the facial artery – which is highlighted here in red. This vein drains the skin of the nose and drains into the upper part of the facial vein which is referred to as the angular vein.

The next vein we'll look at is the sphenopalatine vein. This vein runs through the sphenopalatine foramen like the sphenopalatine artery and it drains into the pterygoid plexus. The pterygoid plexus is a collection of veins located between the temporalis and the lateral pterygoid muscle. The sphenopalatine vein receives two tributaries, the first of which is shown in this image. This is referred to as the posterior lateral nasal branch of the sphenopalatine vein. This tributary drains the posterolateral nasal cavity. So the posterior lateral nasal branches drain into the sphenopalatine vein which then drains into the pterygoid plexus.

The other tributary is called the posterior septal branches of the sphenopalatine vein which you can see here highlighted in green. Remember, the medial wall of the right nasal cavity has been reflected upwards representing the nasal septum. Like the name suggests, this tributary drains the posterior septum. Like the posterior lateral nasal branches, the posterior septal branches drain into the sphenopalatine vein which then drains into the pterygoid plexus.

The next vein we'll look at is the greater palatine vein. This vein drains the hard palate and also drains into the pterygoid plexus. The next veins we'll look at are the septal and lateral nasal branches of the posterior ethmoidal vein. These veins drain the posterior ethmoidal cells and the nasal septum. These branches drain into the posterior ethmoidal vein which then drains into the superior ophthalmic vein. The superior ophthalmic vein then drains into the cavernous sinus.

The final vein we'll talk about which drains the nasal cavity is the anterior ethmoidal vein. The anterior ethmoidal vein receives two main tributaries before it drains into the superior ophthalmic vein which in turn drains into the cavernous sinus. The first of these two tributaries is shown here and is called the anterior septal branches of the anterior ethmoidal vein. So, the anterior septal branches drain into the anterior ethmoidal vein which drains into the superior ophthalmic vein and finally, that drains into the cavernous sinus.

The other main tributary of the anterior ethmoidal vein is referred to as the anterior lateral nasal branches of the anterior ethmoidal vein. These branches drain the anterolateral aspect of the nasal cavity. So similar to the anterior septal branches, the anterior lateral nasal branches drain into the anterior ethmoidal vein which drains into the superior ophthalmic vein which then drains into the cavernous sinus.

To finish up this tutorial, let's go over a few clinical notes which are related to the blood supply of the nasal cavity. The first thing I'll mention is the region in the anteroinferior part of the nasal septum called Kiesselbach's or Little's area. In this area, four arteries form a vascular plexus which is known as Kiesselbach's plexus. The four arteries include three that we have mentioned earlier – the anterior ethmoidal artery which as a reminder is derived from the ophthalmic artery, the sphenopalatine artery which is the terminal branch of the maxillary artery, and the greater palatine artery also derived from the maxillary artery.

The fourth artery which makes up this plexus is a small branch of the superior labial artery known as the septal branch of the superior labial artery. This plexus is clinically relevant because the majority of anterior nosebleeds arise from it. Nosebleeds are often referred to clinically as epistaxis. In anterior bleeds, blood will usually run out of the nose whereas posterior bleeds which are commonly due to the maxillary artery will run down the throat.

So that concludes our tutorial on blood vessels of the nasal cavity. I hope you enjoyed it and thank you for listening.

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Now, good luck everyone, and I will see you next time.