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Applied Head and Neck Anatomy > 1. Vasculature > Flashcards

1. Vasculature Flashcards

1
Q

Where does the arterial supply of the head and neck arise from?

A
  • Right and left common carotid arteries
  • Vertebral arteries
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2
Q

What do the vertebral arteries branch from?

A

Subclavian arteries

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3
Q

What do the vertebral arteries supply?

A

Posterior neck and posterior parts of the brain e.g. brainstem and cerebellum

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4
Q

Where do the vertebral arteries pass through?

A

Route:

  • Ascends through the transverse foramina of the cervical vertebrae (apart from C7)
  • Subarachnoid space between the atlas and occipital bone.
  • Foramen magnum

It then curves around the medulla to join the other vertebral artery (from the other side) to form the basilar artery.

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5
Q

Where does the basilar artery run?

A

Along the anterior (ventral) aspect of the brainstem, more specifically the pons.

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6
Q

Where does the right common carotid artery originate from?

A

Brachiocephalic artery behind the right sternoclavicular joint.

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7
Q

Where does the left common carotid artery originate from?

A

Directly out of the branch of aorta

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8
Q

Is the left or right common carotid artery longer?

A

Left, as it arises out of the aorta. It courses for about 2 cm in the superior mediastinum before entering the neck.

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9
Q

What structure is the common carotid artery found in?

A

Carotid sheath

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10
Q

What is the carotid sheath?

A

Fascial envelope of fused cervical fascia

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11
Q

What are the contents of the carotid sheath?

A
  • Carotid artery
  • Internal jugular vein
  • Vagus nerve
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12
Q

Where is the carotid sheath located?

A

Deep to the sternocleidomastoid muscle

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13
Q

What is the carotid sheath derived from?

A

Fusion of three cervical fascia:

  • prevertebral layer (posteriorly)
  • pretracheal layer (anteromedially)
  • investing layer (anterolaterally)
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14
Q

Where does the carotid sheath lie thickest and thinest?

A

Thinnest = over the vein

Thickest = over the artery

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15
Q

Where do the contents of the carotid sheath lie within it?

A
  • Carotid artery lies medially
  • Internal jugular vein lies laterally
  • Vagus nerve runs posteriorly and in between the two vessels
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16
Q

Where is the sympathetic chain located?

A

Posterior and medial to the carotid sheath

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17
Q

Where do the common carotids most commonly terminate?

A

At the level of the upper border of the thyroid cartilage (C4 level) where they divide into internal and external carotid arteries.

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18
Q

What is the carotid sinus?

A

A dilated portion of the common carotid and internal common carotid arteries that contain baroreceptors. The baroreceptors detect stretch of the vessel as blood pressure.

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19
Q

What is the carotid body?

A

Cluster of nervous cells that lie external to the carotid sinus. These act as peripheral chemoreceptors than detect the content of O2 in the blood.

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20
Q

Why is the site of the carotid sinus clinically relevant?

A

Rubbing this area firmly can alleviate supra-ventricular tachycardias (SVTs) . This is known as a carotid massage.

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21
Q

How does a carotid sinus massage work?

A

Tricks baroreceptors into thinking that blood pressure is high by applying pressure to the area. This signal is relayed to the brain which orchestrates bradycardia and hypotension.

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22
Q

How can the internal carotid artery be distinguished?

A

Does not have branches in the neck. Ascends then enters the base of the skull through a bony canal called the carotid canal.

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23
Q

Where does the internal carotid artery pass through intracranially?

A

Cavernous sinus

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24
Q

Which structure does the internal carotid artery pass through before it branches?

A

Cavernous sinus

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25
Q

What does the internal carotid artery supply?

A

Brain and eye

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26
Q

What does the external carotid artery supply?

A

Extracranial structures

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27
Q

How many branches of the external carotid artery are there?

A

Eight

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28
Q

What are the branches of the external carotid artery?

A
  • Superior thyroid artery
  • Ascending pharyngeal artery
  • Lingual artery
  • Facial artery
  • Occipital artery
  • Posterior auricular artery
  • Maxillary artery
  • Superficial temporal artery

“Some Anatomists Like Freaking Out Poor Medical Students”

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29
Q

What are the terminal branches of the external carotid artery?

A

Maxillary and Superifical Temporal arteries

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30
Q

Where do the terminal branches of the external carotid artery arise?

A

Through the parotid gland (superfical temporal artery and maxillary artery)

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31
Q

What is the blood supply of the parotid gland?

A

Superfical temporal and maxillary artery

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32
Q

What does the maxillary artery supply?

A

Deep tissues and bone structures of the face:

  • Paranasal air sinises
  • Nasal cavity
  • Parotid gland
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33
Q

What is the origin of the middle meningeal artery?

A

Maxillary artery

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34
Q

Where does the middle meningeal artery run?

A

Through the base of the skull

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35
Q

What does the middle meningeal artery supply?

A

Meninges and skull bones

36
Q

What does the superficial temporal artery supply?

A

Tissues of the scalp

37
Q

*** Why do many of the branches of the external carotid artery make a loop at their origin?

A
38
Q

Where do most of the structures of the head and neck drain into?

A

Facial Vein

39
Q

Where does the facial vein run?

A

From the medial angle of the eye towards the inferior border of the mandible with the facial artery

40
Q

What does the facial vein drain into?

A

Internal jugular vein

41
Q

Which veins connect to the facial vein?

A

Superior and inferior opthalmic veins

42
Q

What do the superior and inferior opthalmic veins have a connection to?

A

Cavernous sinus and pterygoid venous plexus

43
Q

Where does the cavernous sinus lie?

A

Intra-cranially forming part of the intra-cranial venous system

44
Q

Where can the facial vein drain into and what clinical implications does this have?

A

Intracranially via the superior and inferior opthalmic veins. An infection in the ‘danger triangle’ of the superfical face can spread to intracranial structures.

45
Q

Where can sceptic thrombi of the facial vein drain embolise to?

A

The cavernous sinus through the opthalmic veins causing a cavernous sinus thrombosis. This is serious but extremely rare.

46
Q

What do emissary veins connect?

A

Veins of the scalp and intra-cranial (dural) venous sinuses

47
Q

How could an infection spread from the scalp into the cranial cavity?

A

Passes through veins of the scalp to emissary veins into the intra-cranial (dural) venous sinuses

48
Q

What does the left and right internal jugular vein arise out of?

A

Sigmoid sinus

49
Q

Where does the internal juglar vein run?

A

The length of the neck within the carotid sheath; from the lobule of the sternoclavicular joint.

50
Q

Why do many of branches of the external carotid artery make a loop at their origin?

A

To allow for flexion and extension of the head

51
Q

What is the interal jugular vein covered by anteriorly?

A

Sternocleidomastoid

52
Q

How does the sternocleidmastoid muscle split to to form an opening to the internal jugular vein?

A

At the inferior end of the vein SCM splits into clavicular and sternal heads

53
Q

Where can the internal jugular vein be accessed?

A

At the inferior end inbetween the clavicular and sternal heads of the SCM

54
Q

Why would you need access to the internal jugular vein?

A
  • To insert a central venous catheter (central line)
  • To measure jugular venous pulsation
55
Q

When are central lines used in patients?

A
  • Monitoring central venous pressure
  • Administration of drugs
  • Repeated blood sampling
  • Temporary haemodialysis

Often used in patients who are very unwell

56
Q

How do you measure jugular venous pulsation?

A
  • Position patients at 45 degrees
  • View right side
57
Q

Why is the right IJV favoured over the left to view jugular venous pulsations?

A

Right has a more direct route into the right atrium so better reflects pressures within the right side of the heart.

58
Q

Which veins drain into the internal jugular vein?

A
  • Facial vein
  • Veins draining thyroid gland and the tongue
59
Q

What is the route of drainage of the IJV to the right atrium?

A
  1. Brachiocephalic vein (joins with subclavian vein)
  2. Superior vena cava
  3. Right atrium
60
Q

What drains into the external jugular vein?

A

Veins draining the scalp and deep structures of the face

61
Q

Where does the external juglar vein lie?

A

Beneath the skin in the superficial cervical fascia of the neck. Lies deep to platysma and superfical to SCM

62
Q

Where does the external jugular vein drain into?

A

Subclavian vein, after travelling through the investing layer of deep cervical fascia

63
Q

Where do the common carotids arise from?

A
  • Left carotid artery arises directly from the arch of aorta
  • Right carotid artery arises from the brachiocephalic trunk
64
Q
A
65
Q

Where do the vertebral, internal thoracic and thyrocervical arteries arise from?

A

Subclavian artery at the base of the neck

66
Q

Does the common carotid artery give off branches in the neck?

A

No, it bifurcates to give the internal and external carotid arteries

67
Q

Which blood vessel supply the neck?

A

Ascending cervical artery and transverse cervical artery

68
Q

What is the blood supply to the shoulder?

A

Suprascapular artery

69
Q

What is the blood supply to the lower pole of the thyroid gland?

A

Inferior thyroid artery

70
Q

Which arteries come off of the thyrocervical trunk?

A
  • ascending cervical artery
  • tranverse cervical artery
  • suprascapular artery
  • inferior thyroid artery
71
Q

Where do the vertebral arteries arise from?

A

Subclavain arteries

72
Q

Where do the vertebral arteries pass through?

A

Transverse foramina in C6 - C1 (that order) and then pass through the foramen magnum

73
Q

What is the blood supply to the brain?

A

Vertebral arteries and internal carotid arteries

74
Q

How does the internal cartoid artery enter to skull?

A

Through the carotid canal

75
Q

Where does the common carotid artery bifurcate?

A

At the level of the superior border of the thyroid cartilage

76
Q

Where in the neck is a common site for atheroma?

A

At the bifurcation of the carotid artery

77
Q

What can the rupture of a carotid artery atheroma cause?

A

Brain embolism; transient ischaemic attack or stroke

78
Q

What is an atheroma?

A

A fatty deposit in the inner lining (intima) of an artery resulting from atherosclerosis

79
Q

What is the carotid sinus?

A

A swelling at the region of bifurcation where baroreceptors for detecting changes in arterial blood pressure are located.

80
Q

What is the carotid body?

A

Peripheral chemoreceptors detecting arterial O2, lying outside of the cartoid artery at the level of bifurcation.

81
Q

What nerves can be accessed through the carotid triangle?

A

Vagus and hypoglossal

82
Q

Where is the carotid triangle located?

A

Subdivision of the anterior triangle of the neck.

Boundaries:

  • Superior - posterior belly of digastric muscle
  • Lateral - medial border of the sternocleidomastoid muscle
  • Inferior - superior belly of the omohyoid muscle
83
Q

What are the contents of the carotid triangle?

A
  • Carotid artery (bifurcates within the triangle)
  • Hypoglossal nerve
  • Vagus nerve
  • Internal jugular vein
84
Q

Where is the carotid pulse felt?

A

Below bifurcation of the carotid artery, can be palpated more inferiorly

85
Q

Where does the internal carotid artery enter the skull?

A

Through the carotid canal in petrous part of temporal bone. Turns medially and horizontally.

86
Q

What is the route of the internal carotid artery?

A
  1. Enters skull through carotid canal in petrous part of temporal bone
  2. Turns medially and horizontally
  3. Enters the cranial cavity and then makes S-shaped bend
  4. Courses through the cavernous sinus intracranially
87
Q
A

Applied Head and Neck Anatomy (4 decks)

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