2) Blood & Lymph of H&N Flashcards by Lauren Croft

Name the major arterial supply to the H&N

Common Carotid Arteries

Vertebral Arteries

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Name the major venous drainage of the H&N

Internal Jugular Vein

External & Anterior Jugular Veins drain superficial structures

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Describe the boundaries of the carotid sheath

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

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Contents of the carotid sheath

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

sheath is thin over vein, thicker around artery

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

Outside of the sheath

Medially and posterior to it

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Where does the right common carotid artery originate from?

Bifurcation of the brachiocephalic trunk

behind the right sternoclavicular joint

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Where does the left common carotid artery originate from?

Directly from the arch of the aorta

about 2cm longer than the right CCA

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At what level do the common carotids terminate?

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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At what level do the common carotids bifurcate?

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

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What is the carotid sinus?

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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What is the purpose of a carotid sinus massage?

Used to alleviate supra-ventricular tachycardia through gentle rubbing

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What is the location & function of the carotid body?

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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What are the complications of a carotid artery atheroma?

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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Describe the branches of the ICA

No branches in neck

Supplies intra-cranial structures through carotid canal

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Describe the branches of the ECA

Stop Alcohol Late Friday Or Puke More Saturday

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

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What happens to the ECA once it enters the parotid gland

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

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Describe the vertebral arteries

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

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

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What are the boundaries of the carotid triangle?

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

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Name the layers of the SCALP

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

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Which arteries supply the scalp?

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

Why will the scalp bleed profusely if damaged?

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

Deep lacerations of epicranial aponeurosis (opposing pull of occipitofrontalis)

What is the main blood supply to the skull?

Middle meningeal artery

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

Describe the venous drainage of the scalp

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

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

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

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

Anterior & posterior branches of the Middle Meningeal artery | branch of maxillary>branch of ECA

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

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

What is the purpose of a craniotomy?

Gain access to cranial cavity Bone & skin flap reflected inferiorly to preserve blood supply

What are the dural venous sinuses?

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

Name some of the dural venous sinuses

``` Superior sagittal sinus Inferior sagittal sinus Cavernous sinus Sigmoid sinus Transverse sinus ```

Name the superficial arteries of the face

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

Describe the venous drainage of the face

Veins accompany arteries of the face | Most drain into Facial vein > IJV

What is the cavernous sinus?

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

Name some of the contents of the cavernous sinus

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

Which veins drain into the cavernous sinus?

Facial vein Superior ophthalmic vein at medial angle of eye

Where do the deep facial veins drain to?

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

Describe the relationship of the jugular veins and the SCM

EJV much easier to see | IJV lies under SCM (pulsations visible)

Name the 12 regional lymph node groups of the head

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

Name the lymph nodes that comprise the terminal group

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

What is the terminal group of lymph nodes?

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

What are the jugular lymph trunks?

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

Describe the left jugular lymph trunk

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

Describe the right jugular lymph trunk

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

What is the Thoracic duct?

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

What is the function of the right lymphatic duct?

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

What is lymphadenopathy?

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

What are the effects of Glandular Fever?

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

What is a lymphoma?

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

Describe typical H&N cancers

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

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

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

What are the 2 main functions of lymph nodes?

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

Describe the structure of a lymph node

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