3. Blood Supply of H/N, Pt. 1

Question 1

Recall that the ____ and ____
ascend into the root
of the neck bilaterally

Answer 1

common carotid

subclavian

Question 2

Recall too that the
VERTEBRAL ARTERIES
are the first branches to arise from the ____ arteries

Answer 2

subclavian

Question 3

Each artery ascends and enters a transverse foramen of the ____ vertebra

Ascent continues thru the transverse foramina of ____

____ and ____ branches arise as the vessels ascend the cervical spine

• Each artery turns medially and passes superior to the posterior arch of the ____
• After piercing the posterior atlanto- occipital membrane and dura, the artery enters the skull thru the ____

Answer 3

C6
C6-C1
muscular
spinal
atlas
foramen magnum

Question 4

At the level of the junction between pons and medulla, the two vertebral arteries form the ____ ascending the ____

Both vessels contribute to formation of a single ____ artery

After piercing the dura, a ____ artery arises from each vertebral

Answer 4

basilar artery
clivus
anterior spinal
posterior spinal

Question 5

Cerebellar
arteries arise
from the ____ system…

…which terminates in the
____ arteries

Answer 5

vertebro-basilar

posterior cerebral

Question 6

Recall that the
RIGHT COMMON CAROTID
usually arises from the \_\_\_\_
while the
LEFT COMMON CAROTID usually arises from the \_\_\_\_

Answer 6

braciocephalic

aortic arch

Question 7

Each common carotid normally bifurcates into INTERNAL and EXTERNAL branches at the ____ intervertebral level
…in the plane of the superior border
of the ____

Answer 7

C3-C4

thyroid cartilage

Question 8

Within the
____ lies the bifurcation of the common carotid a.

Within the triangle, the carotid pulse
may be taken carefully along the along
____ just anterior to ____

Answer 8

carotid triangle
carotid line
SCM

Question 9

____

are located in the vicinity of the carotid bifurcation

Answer 9

visceral sensory receptors

Question 10

Carotid visceral sensory receptors
• Carotid sinus, subsuming the dilated distal end of the ____ and the proximal portion of the
____, contains pressure receptors, sensitive to stretching of the wall of the sinus
• These ____ convey inputs to the CNS via afferent branches of the ____ nerve
• Impulses are conveyed to
the ____ to
control blood pressure by altering heart rate and cardiac output

Carotid body (2-5mm in diameter) lies just above the bifurcation of the ____ artery, between the two branches.
• ____ respond to low levels of oxygen, and high levels of carbon dioxide, i.e., lowered blood pH.
• Visceral afferent branches of the ____ nerve convey the data to the ____

Answer 10

common carotid
internal carotid
baroreceptors
glossopharyngeal
medulla oblongata

common carotid
chemoreceptors
glossopharyngeal

Question 11

Excessive stimulation
of the baroreceptors
may cause ____

Carotid body - ____
Carotid sinus - ____
— bilateral stimulation continued after (Syncope) is dangerous because it might tell the brain (after continuous baroreceptor stimulation) to stop the ____ completely. i.e. Police performing Vascular Neck restraint/ Choke hold

Answer 11

syncope (faint)
chemoreceptors
baroreceptors
heart

Question 12

Several small clusters of both chemoreceptors and baroreceptors
are also located along the ____

____ convey the command to the heart to slow down and decrease cardiac output

Answer 12

aortic arch
vagal efferents (CN X)

Question 13

Atherosclerotic plaque accumulation leads to ____ and may contribute to formation of ____. Atheromas not only block blood flow to the brain; clots may also break away and ascend to the brain, leading to cerebral artery occlusion and debilitating ____ which may cause paralysis, brain damage or death.

So a Procedure called ____ is usually no longer recommended(with patients with high heart rates) because you might dislodge some of plaque and might travel up to brain - problematic - ischemic stroke.

Carotid endarterectomy
Surgery for removal of ____ blocking the carotid arteries
can you think of a good reason why this surgery is potentially dangerous?
by detaching and mobilizing the plaque, plaque goes up and leads to ischemic stoke.

Answer 13

carotid stenosis
aneurysms
ischemic strokes

carotid massage

atheroma

Question 14

Four distinct parts of each Internal Carotid Artery may be identified

Four portions

1. ____ portion
2. ____ portion
3. ____ portion
4. ____ portion

Answer 14

cervical
petrous
cavernous
cerebral

Question 15

The ____ portion
of the ICA ascends to the base of the skull within the fascial ____, anterior to the transverse processes of the upper cervical vertebrae
however sometimes the pathway to the carotid canal is not exactly ____! might vary in population. (due to ____, etc)

it has NO ____!

Answer 15

cervical
carotid sheath
direct
hypertension

branches

Question 16

The
PETROUS
PORTION
of the ICA
runs through the \_\_\_\_ of the \_\_\_\_ BONE

Answer 16

carotid canal

temporal

Question 17

The PETROUS PORTION of the ICA has TWO branches
first, ____ artery (supplies the middle ear cavity or ____)

second, we have the artery of the ____ aka vidian artery, this will run from ICA toward to ____.

Answer 17

caroticotympanic
tympanic cavity

pterygoid canal
pterygopalatine fossa

Question 18

The Vidian artery anastomoses with a branch of the ____ in the pterygopalatine fossa

Answer 18

maxillary artery

Question 19

Upon exiting the carotid canal and petrous temporal, the ICA passes over the ____ and then travels anteriorly thru the ____

Answer 19

foramen lacerum

cavernous sinus

Question 20

The CAVERNOUS PORTION
of the ICA

1. ____ - to dura of the sinus
2. ____ branch - trigeminal impression on petrous temporal
3. ____ branch - supplies all these nerves running through
4. Meningeal branch - supplies the dura of the ____
5. ____ artery
6. ____ branches

Answer 20

cavernous sinus branch
trigeminal ganglion
neural
anterior cranial fossa
inferior hypophyseal
tentorial

Question 21

Blood in the hypophyseal arteries enters capillaries contributing to the HYPOPHYSEAL PORTAL SYSTEM allowing fast hormonal communication between ____ and
____

Answer 21

hypothalamus

anterior pituitary

Question 22

Note again the proximity of the cavernous portion of the ICA to ____, ____ and ____ - aneurysm may produce ____

Cavernous portion
of the Internal carotid
in the ____

Answer 22

CN III
CN IV
CN VI
opthamoplegia

cavernous sinus

Question 23

Coronal section through the “CAROTID SIPHON”

we saw the ICA running through the cavernous sinus anteriorly, now it is going to turn backward we call this turn in the sagittal plane in the ICA as it leaves the cavernous sinus and continues upward and turns: ____

Answer 23

siphon

Question 24

A coronal section thru the ____, just posterior to the tips of the anterior clinoid processes will actually intersect each internal carotid artery ____

Answer 24

middle cranial fossa

internal carotid artery

Question 25

The ____ arises as the vessel pierces the dural roof of the cavernous sinus

Answer 25

cerebral (supraclinoid) portion

Question 26

The CEREBRAL PORTION of the ICA Muscular branches to ____ muscles Anterior and Posterior Ethmoidal arteries - supply the ____ and ____ ____ artery Posterior Ciliary arteries - supplies the ____ and ____ ____ artery

Answer 26

``` extraocular ethmoid sinuses nasal cavity lacrimal eyeball sclera central retinal ```

Question 27

Central Retinal Artery Each branch is an examples of an ____ (= no peripheral anastomoses) The artery sends four branches thru the ____

Answer 27

end artery | optic disk

Question 28

These three branches of the OPHTHALMIC ARTERY supply the skin of the ____ as well as of the root and bridge of the ____... These branches of the OPHTHALMIC ARTERY... supply the skin of the forehead as well as the root and bridge of the nose.... ... anastomose with branches of the ____ supplying the face and scalp

Answer 28

forehead nose external carotid

Question 29

The CEREBRAL PORTION of the ICA 1. OPHTHALMIC courses thru the ____ 2. SUPERIOR HYPOPHYSEAL to the ____ (demanding organ) 3. ____ aka PCOM

Answer 29

optic canal pituitary posterior communicating

Question 30

``` The POSTERIOR COMMUNICATING ARTERY (PCOM) plays an important role in formation of the “____,” communicating between the ____ and ____ circulations ```

Answer 30

circle of willis internal carotid vertebro-basilar

Question 31

The CEREBRAL PORTION of the ICA The terminal bifurcation of the ICA gives rise to the ____ and ____ arteries 4. ____ supplies choroid plexus circulation of CSF (cerebrospinal fluid)

Answer 31

anterior middle cerebral anterior choroidal

Question 32

The inaccurately named “CIRCLE OF WILLIS” is a critical site of anastomosis between ____ and ____ circulations

Answer 32

vertebro-basilar | internal carotid

Question 33

MIDDLE CEREBRAL ARTERY Courses thru the ____where it branches and projects to many parts of the lateral cerebral cortex Also supplies blood to the ____ and the ____ important in providing blood to the lateral aspect of the cerebral hemisphere. including the ____ ( important for language )

Answer 33

lateral (Sylvian) sulcus anterior temporal lobe insular cortex right side

Question 34

ANTERIOR CEREBRAL ARTERY Supplies medial portions of the ____ lobe, ____ lobe and ____ and tract POSTERIOR CEREBRAL ARTERY Supplies ____ lobe and ____

Answer 34

frontal superior medial olfactory bulb occipital thalamus

Question 35

Cerebral vasculature The course and relationships of the major arteries at the base of the brain is important because of: (1) Their physiological distribution to specific brain regions (2) Their frequency of involvement in ____ or ____ caused by either occlusion (____ strokes) or rupture (____ strokes) of their branches; and (3) Their potential for forming ____ which may produce signs and symptoms of encroachment upon adjacent ____ even before rupture

Answer 35

cerebral vascular "strokes" ischemic hemorrhagic aneurysms

Question 36

``` Blood clots originating from the ____ side of the heart or more distal sites of frequent thrombus formation, such as the ____ or ____, may embolize and precipitate ischemic stroke in branches of the ____ and ____ ```

Answer 36

``` left aortic arch carotid bifurcation ACA MCA ```

Question 37

Ruptured ____ in the vicinity of the Circle of Willis have a high mortality rate Rupture of ____ accounts for an estimated 5 percent of strokes

Answer 37

saccular (berry) aneurysms | basilar artery aneurysms

Question 38

``` The EXTERNAL CAROTID ARTERY blood to the ____ and ____ ```

Answer 38

face | scalp

Question 39

``` 1- ____ 2- ____ 3- ____ headed towards tongue 4- ____ 5- ____ 6- ____ 7- ____ gives blood to all our teeth 8- ____ ``` SALFOPMS some aggressive lovers find odd positions more stimulating

Answer 39

``` superior thyroid ascending pharyngeal lingual facial occipital posterior auricular maxillary superficial temporal ```

Question 40

The thyroid gland also receives blood from the ____ arteries arising from the ____

Answer 40

inferior thyroid | thyrocervical trunk

Question 41

Recall that ligation of the thyroid arteries in thyroidectomy endangers the ____

Answer 41

laryngeal nerves

Question 42

ASCENDING PHARYNGEAL ____ branch of the ECA Arises from the deep surface of the artery and ascends between ____ and ____ to the base of the cranium ``` Pharyngeal branches (3-4) supply ____ and ____ (bw superior and middle constrictors) ``` Palatine branch (variable) to ____, ____ and ____.

Answer 42

``` smallest ICA pharynx constrictors stylopharyngeus soft palate palatine tonsil auditory tube ```

Question 43

Prevertebral to longus capitis and longus colli Inferior Tympanic ascends thru the ____ to the medial wall of the middle ear Neuro-meningeal - CN ____ (thru jugular foramen) - ____ meninges

Answer 43

tympanic canaliculus IX-XII PCF

Question 44

LINGUAL artery Arises opposite the tip of the greater horn of the ____ Principal source of blood to the ____ and floor of the ____ ____ LINGUAL artery ____ artery Hypoglossal nerve assoc with sublingual artery ____ artery we have several dorsal lingual arteries Dorsal Lingual arteries (2-3): posterior dorsum of tongue and lingual tonsil, epiglottisis, palatoglossal arch, soft palate and sometimes the palatine tonsil

Answer 44

``` hyoid tongue floor of the mouth deep sublingual dorsal lingual ```

Question 45

``` Sublingual artery: supplies the .. • ____ (salivary gland) • mandibular and buccal ____ • ____ (muscle of oral floor) ``` ``` Deep Lingual artery: • inferior surface of ____ • ____ ( bilateral contraction protrudes the tongue) ```

Answer 45

sublingual gland gingivae mylohyoid tongue genioglossus

Question 46

The facial artery is tortuous to facilitate maximal depression of the ____ The facial artery enters the face near a shallow notch in the inferior border of the mandible some ____ centimeters anterior to the angle of the mandible ____!

Answer 46

mandible 2-3 pulse point

Question 47

Facial artery- cervical branches 1. Ascending Palatine to ____, ____, ____ 2. Tonsilar to ____ and ____ 3. Glandular (3-4) to the ____ 4. ____ to the chin and lower lip

Answer 47

``` soft palate palatine tonsil auditory tube lingual tonsil tongue submandibular gland submental ```

Question 48

Abundant muscular branches supply the mimetic muscles ``` ____ artery ____ nasal ____ labial ____ abial (FACIAL branches) ``` Anatomoses are numerous between corresponding contralateral branches of the ____ as well as with other ____ & ____ derivatives

Answer 48

``` angular lateral superior inferior facial ECA ICA ```

Question 49

The labial arteries run between ____ and the labial mucosa A branch of the larger ____ contributes to the complex anastomosis of blood vessels of the nasal septum to be discussed later

Answer 49

orbicularis oris | superior labial artery

Question 50

The ANGULAR artery anastomoses with branches of the ophthalmic artery as previously described, making a critical anastomosis between ____ and ____ circulations Periorbital anastomoses of the ____ branches with • the ____ branch of the facial, • the ____, and • the ____ of the maxillary provide multiple opportunities for communications between the ____ and ____ arterial systems.

Answer 50

ECA ICA ``` opthalmic artery angular superficial temporal infraorbital branch ICA ECA ```

Question 51

With occlusion of the ____ at its origin, there will be collateral flow from these external carotid branches into the internal carotid via the ____, which can be both identified and quantified by ____

Answer 51

ICA opthalmic artery doppler ultrasonography