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Head & Neck > 2) Blood & Lymph of H&N > Flashcards

2) Blood & Lymph of H&N Flashcards

1
Q

Name the major arterial supply to the H&N

A

Common Carotid Arteries

Vertebral Arteries

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2
Q

Name the major venous drainage of the H&N

A

Internal Jugular Vein

External & Anterior Jugular Veins drain superficial structures

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3
Q

Describe the boundaries of the carotid sheath

A

Found deep to SCM
Fusion:
Posteriorly - prevertebral cervical fascia
Anteromedially - pretracheal cervical fascia
Anterolaterally - superficial layer of cervical fascia

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4
Q

Contents of the carotid sheath

A

CCA (medial)
Vagus nerve (CN X) (posterior, in-between)
IJV (lateral)

sheath is thin over vein, thicker around artery

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5
Q

Where does the sympathetic trunk lie in relation to the carotid sheath?

A

Outside of the sheath

Medially and posterior to it

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6
Q

Where does the right common carotid artery originate from?

A

Bifurcation of the brachiocephalic trunk

behind the right sternoclavicular joint

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7
Q

Where does the left common carotid artery originate from?

A

Directly from the arch of the aorta

about 2cm longer than the right CCA

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8
Q

At what level do the common carotids terminate?

A

Upper border of the thyroid cartilages

Midway between the angle of the mandible and the mastoid process of the temporal bone

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9
Q

At what level do the common carotids bifurcate?

A

C4

Common carotids dilate giving rise to the carotid sinus before bifurcating into the ICA & ECA

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10
Q

What is the carotid sinus?

A

Dilation of the ICA at bifurcation of CCA
BARORECEPTOR - detects changes in blood pressure
Innervation - Glossopharyngeal (IX) (carotid sinus nerve) & Vagus (X)

stimulated by changes in aBP

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11
Q

What is the purpose of a carotid sinus massage?

A

Used to alleviate supra-ventricular tachycardia through gentle rubbing

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12
Q

What is the location & function of the carotid body?

A

Red-brown mass of tissue on medial side of bifurcation of CCA (close to carotid sinus)
Peripheral CHEMORECEPTORS - detect arterial O2 concentrations
innervation - carotid sinus nerve (IX) & Vagus (X)

Stimulated by low O2 (increases rate & depth resp.)

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13
Q

What are the complications of a carotid artery atheroma?

A

Bifurcation of CCA common site for atheroma formation
Narrowing (stenosis) of artery
Rupture of clot - embolus can travel to brain
TIA or Stroke

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14
Q

Describe the branches of the ICA

A

No branches in neck

Supplies intra-cranial structures through carotid canal

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15
Q

Describe the branches of the ECA

A

Stop Alcohol Late Friday Or Puke More Saturday

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
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16
Q

What happens to the ECA once it enters the parotid gland

A

Divides into Maxillary & Superficial Temporal arteries
Accompanied by
- Facial nerve (CN VII)
- Retromandibular vein

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17
Q

Describe the vertebral arteries

A

Arise from subclavian arteries on left & right
Ascend through transverse foramen in C6 to C1
Supply brain and ICAs

C7 has tranverse foramen but vertebral arteries do not pass through

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18
Q

What is the importance of the carotid triangle in the neck?

A

Surgical approach to carotid arteries or IJV
Access to vagus & hypoglossal nerves
Carotid pulse can be palpated
Carotis sinus massage

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19
Q

What are the boundaries of the carotid triangle?

A

Superiorly - Posterior belly of Digastric
Laterally - SCM
Medially - Superior belly of Omohyoid

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20
Q

Name the layers of the SCALP

A 
Skin
Connective tissue (dense)
Aponeurosis
Loose connective tissue (contains blood vessels)
Periosteum
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21
Q

Which arteries supply the scalp?

A

Rich blood supply + anastomoses (bleed profusely)
Superficial temporal, Posterior auricular & Occipital arteries (branches of ECAs)
Supratrochlear & Suborbital arteries (Ophthalmic arteries, branches of the ICA)

22
Q

Why will the scalp bleed profusely if damaged?

A

Rich anastomoses
Walls of arteries closely attached to connective tissue, limits their constriction

Deep lacerations of epicranial aponeurosis (opposing pull of occipitofrontalis)

23
Q

What is the main blood supply to the skull?

A

Middle meningeal artery

Loss of blood supply to scalp does not lead to underlying bone necrosis due to MMA

24
Q

Describe the venous drainage of the scalp

A 
Superficial veins accompany arteries:
Superficial Temporal veins
Occipital veins
Posterior auricular veins
Deep parts of scalp (temporal region) drain into Pterygoid Venous Plexus

Supraorbital & Supratrochlear veins meet at medial angle of eye > angular vein > Facial vein

25
Q

What is the relationship between veins of the scalp and dural venous sinuses?

A

Veins of scalp connect to Diploic veins of scalp via valve-less emissary veins
Connect to dural venous sinuses

Infection from scalp spread to meninges

26
Q

What is the blood supply to the Dura Mater and Skull?

A

Anterior & posterior branches of the Middle Meningeal artery

branch of maxillary>branch of ECA

27
Q

What is the significance of a fracture to the Pterion of the skull?

A

Middle Meningeal artery runs close to Pterion
Fracture can rupture artery & cause Extradural Haemorrhage
Bleeding deep to cranium, superficial to Dura

28
Q

What is the purpose of a craniotomy?

A

Gain access to cranial cavity

Bone & skin flap reflected inferiorly to preserve blood supply

29
Q

What are the dural venous sinuses?

A

Endothelium-lined spaces between the periosteal and meningeal layers of the Dura
Form at dural septae, receive blood from large veins that drain brain

30
Q

Name some of the dural venous sinuses

A 
Superior sagittal sinus
Inferior sagittal sinus
Cavernous sinus
Sigmoid sinus
Transverse sinus
31
Q

Name the superficial arteries of the face

A 
Facial
Superior & Inferior labial
Maxillary
Lateral nasal
Angular
Transverse facial
All arise from ECA except:
Supratrochlear
Supraorbital (ICA)
32
Q

Describe the venous drainage of the face

A

Veins accompany arteries of the face

Most drain into Facial vein > IJV

33
Q

What is the cavernous sinus?

A

A plexus of extremely thin-walled veins on the upper surface of the sphenoid bone

34
Q

Name some of the contents of the cavernous sinus

A 
ICA
CN III - Oculomotor
CN IV - Trochlear
CN VI - Abducent
CN V - Trigeminal (Ophthalmic & Maxillary)
35
Q

Which veins drain into the cavernous sinus?

A

Facial vein
Superior ophthalmic vein
at medial angle of eye

36
Q

Where do the deep facial veins drain to?

A

Pterygoid plexus
Infection Facial vein > Dural venous sinuses
Thrombophlebitis - infected clot to intracranial system

37
Q

Describe the relationship of the jugular veins and the SCM

A

EJV much easier to see

IJV lies under SCM (pulsations visible)

38
Q

Name the 12 regional lymph node groups of the head

A
  1. Occipital
  2. Retroauricular (a.k.a. mastoid)
  3. Parotid
  4. Buccal (a.k.a facial)
  5. Submandibular
  6. Submental
  7. Anterior chain
  8. Cervical
  9. Superficial cervical (along course of EJV)
  10. Retropharyngeal
  11. Laryngeal
  12. Tracheal
39
Q

Name the lymph nodes that comprise the terminal group

A

Jugulo-digastric (tonsillar) node
Jugulo-omohyoid (tongue) node
Deep cervical nodes in the post. triangle of neck
Supraclavicular nodes (inc. Virchow’s)

40
Q

What is the terminal group of lymph nodes?

A

Deep cervical nodes
Receive all afferent lymph vessels of H&N
directly/indirectly via regional groups
Closely related to carotid sheath (IJV)

41
Q

What are the jugular lymph trunks?

A

Efferent lymph vessels from deep cervical lymph nodes join to form jugular lymph trunks

42
Q

Describe the left jugular lymph trunk

A

Jugular lymph trunk joins Thoracic duct, enters Left Brachiocephalic vein at junction between Subclavian & IJV

43
Q

Describe the right jugular lymph trunk

A

Jugular lymph trunk joins a short Right Lymphatic duct & enters venous system at junction between Subclavian & IJV

44
Q

What is the Thoracic duct?

A

Body’s main duct for return of lymph to venous blood

Begins - abdomen at cisterna chyli (L2)
Extends towards left CCA & IJV
Empties into left Brachiocephalic vein

45
Q

What is the function of the right lymphatic duct?

A

Drains upper right side of body:
RHS of H&N, upper limb & thorax
Drains into Subclavian vein & IJV

46
Q

What is lymphadenopathy?

A

Enlargement of lymph nodes due to:
Infection (feel tender, smooth) e.g. Glandular fever
Malignancy (non-tender, craggy) e.g. primary/metastases

47
Q

What are the effects of Glandular Fever?

A

Epstein Barr virus (EBV)
Viral infiltration produces atypical lymphocytes
Lymphadenopathy - swollen, painful lymph nodes, sore throat, fatigue, fever

48
Q

What is a lymphoma?

A

Solid tumour of lymphoid cells
B or T cells
Originates in lymph node (primary)

49
Q

Describe typical H&N cancers

A

90% squamous cell carcinomas
Alcohol, smoking, HPV
Lymphadenopathy, mass in neck, sore throat, dysphagia, hoarseness

50
Q

What is the purpose of a block dissection of cervical lymph nodes?

A

Cervical metastases
Removal of IJV, fascia, lymph nodes & submandibular salivary gland as a block

Aim to remove all lymph tissue on affected side of neck

51
Q

What are the 2 main functions of lymph nodes?

A

Phagocytic cells act as filters for particulate matter and MOs
Antigen is present to the immune system

52
Q

Describe the structure of a lymph node

A

Lymphatic sinuses
Blood vessels
Parenchyma (cortex, paracortex, medulla)
+ Fibrous capsule which trabeculae extend from towards centre

Head & Neck (12 decks)

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