7.2 Craniofascial Vasculature II

Question 1

What are branches of the aortic arch?

Answer 1

1. Brachiocephalic trunk will branch into
   
   1. R subclavian A.
   2. R common carotid A
2. L common carotid A.
3. L subclavian A.

Question 2

Parts of subclavian A.

Answer 2

• 1ST PART: MEDIAL TO ANTERIOR SCALENE MUSCLE
• 2ND PART: BEHIND ANTERIOR SCALENE MUSCLE
• 3RD PART: After ANTERIOR SCALENE MUSCLE -> 1ST RIB

Question 3

Subclavian A: Part 1 branches

Answer 3

1. VERTEBRAL A
2. THYROCERVICAL TRUNK branches into:
   
   1. SUPRASCAPULAR A •
      
      1. SUPRASPINATOUS M •
      2. INFRASPINATOUS M •
   2. TRANSVERSE CERVICAL A •
      
      1. TRAPEZIUS M •
   3. INFERIOR THYROID A •
   4. ASCENDING CERVICAL A •
3. INTERNAL THORACIC A

Question 4

2ND PART SUBCLAVIAN A.

Answer 4

Costocervical trunk; which branches into

1. Supreme intercostal A.
2. Deep cervical A.

Question 5

3RD PART SUBCLAVIAN A.

Answer 5

1. Dorsal scapular A:
   * Supplies rhomboid m and levator scapulae m.

Question 6

COMMON CAROTID ARTERY

Branches

Answer 6

At the carotid sinus, it will branch into

• 1. External carotid A.
• 2. Internal carotid A.

Question 7

What is the carotid sinus?

What happens if you press on it?

Answer 7

• Carotid sinus contains baroreceptors that are innvervated by glossopharyngeal N (CN 9).
• Thus, indirectly modulates our parasympathetic and sympathetic in response to changes in BP.
• Apply alot of pressure here -> increase BP -> makes you feel like you need to pass out.

Question 8

EXTERNAL CAROTID MNEMONIC

Answer 8

SOME ANATOMISTS LIKE FREAKING OUT POOR MEDICAL STUDENTS

• S: Superior thyroid A.
• A: Ascending pharyngeal A.
• L: Lingual A
• F: Facial A.
• O: Occipital A.
• P: Posterior auricular A.
• M: Maxillary A
• S: Superficial temporal A.

Question 9

SUPERIOR THYROID ARTERY branches:

Answer 9

• 1. Superior laryngeal A, which runs with superior laryngeal N.
• 2. Infrahyoid A.
• 3. Sternocleidomastoid branch

Question 10

ASCENDING PHARYNGEAL ARTERY

Supplies:

Answer 10

Muscles of pharynx

Question 11

Course of lingual A.

Answer 11

1. Goes up and medially the greater horns of the hyoid bone
2. Goes down and froward, underneath digastric m. and stylohyoid m. Hyopglossal N will cross it
3. Runs deep to hyoglossus m.

Question 12

Lingual A Terminal branches

Answer 12

1. Sublingual A: -> sublingual gland and oral floor
2. Deep lingual A: goes to the base of the tongue and runs with lingual N.

Question 13

How are the lingual N and lingual A placed in respect to hyoglossus M?

Answer 13

Lingual N is superficial to hyoglossus M.

Lingual A is deep to hyoglossus M.

Question 14

Course of facial A.

Answer 14

1. Arises in carotid triangle
2. Runs under digastric and stylohoid m, above hypoglossal N.
3. Enters groove on posterior submandibular gland,
4. Curves up over the body. of the mandible, running atero-inferior angle of masseter m.
5. Runs obliquely past nose

Question 15

FACIAL ARTERY BRANCHES

Answer 15

Cervical branches:

1. Ascending palatine A. -> walll of pharynx, soft palate, pharyngotympanic tube
2. Tonsillar branch -> palatine tonsils
3. Submental A (and glandular branches) -> submandibular gland and oral floor

In the face, it branches into:

1. Inferior labial A
2. Superior labial A.
3. Lateral nasal branch
4. Angular A (terminal branch)

Question 16

Which A. arises first: lingual A or facial A?

Answer 16

Lingual A

Question 17

Facial A/V is anterior to facial A/V

Answer 17

Facial A is anterior to facial vein and more torteous.

Question 18

Terminal portion of Occiptal A. runs with what

Answer 18

Greater occipital N.

Question 19

Posterior Aurical A. runs with ____________.

Answer 19

Posterior Auricular N.

Question 20

Maxillary A. has 3 parts.

What are they?

Answer 20

1. Mandibular Part

2. Pterygoid Part

3. Pterygopalatine Part

Question 21

Branches of Mandibular Part of Maxillary. A.

Answer 21

1. Deep Auricular A
   
   1. Supplies external acoustic meatus, external tympanic membrane and TMJ
2. Anterior tympanic A
   
   1. Supplies internal TM
3. Inferior alveolar A -> supplies mandible, mandibular teeth, chin and mylohoid m.
   
   1. Mylohoid A
   2. Mental A
4. Middle meningeal A
   
   1. Supplies dura matera, trigeminal ganglion, facial nerve, geniculate ganglion, tympanic cavity. and tensor tympani m.
5. Accessory meningeal A
   
   1. Supplies extravranial muscle of infratemporal fossa, otic ganglion and sphenoid bone

Question 22

What happens if we hit. pterion?

Answer 22

Tear middle meningeal A bc it is outside dura mater -> epidural hemotoma.

Question 23

PTERYGOID PART OF MAXILLARY A

Answer 23

1. Deep temporal A.
   * supplies temporalis m.
2. Pterygoid branches
   * Supplies pterygoid m.
3. Masseteric A.
   * Supplies TMJ and masseter M.
4. Buccal A

• Supplies cheek
• runs with buccal N

Question 24

PTERYGOPALATINE PART OF MAXILLARY A

Answer 24

1. POSTERIOR SUPERIOR ALVEOLAR A
   * Supplies: MAXILLARY MOAR & PREMOLAR TEETH, ADJACENT GINGIVA & MUCOUS MEMBRANE OF MAXILLARY SINUS
2. INFRAORBITAL A
   * Supplies: INFERIOR OBLIQUE M, INFERIOR RECTUS M, LACRIMAL SAC, MAXILLARY CANINES, INCISORS TEETH & SKIN OF INFRA-ORBITAL REGION OF THE FACE
3. ARTERY OF PTERYGOID CANAL
   * Supplies: SUPPLIES MUCOSA OF UPPER PHARYNX, PHARYNGOTYMPANIC TUBE & TYMPANIC CAVITY
4. PHARYNGEAL BRANCH
   * Supplies: SUPPLY MUCOSA OF NASAL ROOF, NASOPHARYNX, SPHENOIDAL AIR SINUS, AND PHARYNGOTYMPANIC TUBE
5. DESCENDING PALATINE A

• Greater palatine A: hard palate
• Lesser palatine A.: soft palate, palatine tonsils, pharyngeal wall

6. SPHENOPALATINE A
   * SUPPLIES WALLS & SEPTUM OF NASAL CAVITY, FRONTAL/ETHMOIDAL/SPHENOID/MAXILLARY SINUSES & ANTERIORMOST PALATE

Question 25

Superficial temporal A

Branches run close with what?

Answer 25

auriculotemporal N, which carries postganglionic parasympathetic from V3

Question 26

SUPERFICIAL TEMPORAL ARTERY BRANCHES

Answer 26

1. TRANSVERSE FACIAL A •
2. MIDDLE TEMPORAL •
3. ANTERIOR AURICULAR •
4. TERMINAL BRANCHES: FRONTAL A & PARIETAL A

Question 27

Internal carotid A.

Answer 27

Does not branch in neck -> goes inside cranial cavity through petrous part of temporal bone via carotid canal -> cavernous sinuses -> carotid groove -> branches into:

1. Opthalamic A.

2. Anterior cerebral A

3. Middle cerebral A.

Question 28

VERTEBRAL ARTERY:

Path:

Fx:

Answer 28

1. Branches off 1st part of subclavian A.
2. Goes through transverse foramina
3. Sharp turn when you get above C1

Fx: stretches with rotation. and extension

Question 29

CN: VERTEBROBASILAR INSUFFICIENCY

Answer 29

Decreased posterior circulation d/t blockage of vertebral A d/t arterosclerosis when we rotate head or extend.

Question 30

VERTEBROBASILAR INSUFFICIENCY Sx

Answer 30

dizziness, vertigo, double vision, slurred speech, N/V

Question 31

VERTEBROBASILAR INSUFFICIENCY risk:

Answer 31

smoking, HTN, DB, over 50, family. hx

Question 32

CN: SUBCLAVIAN STEAL SYNDROME

Answer 32

• Proximal stenosis or occlusion of subclavian A: causing reverse flow of blood from vertebral A to go to the upper extremity -> DECREASE BLOOD TO BRAIN.
• Sx: syncope, different BP in UE, neurological problems
• Causes: artherosclerosis, cervical rib

Question 33

SUBCLAVIAN STEAL SYNDROME

Dx:

TxL

Answer 33

Dx: doppler US, CT angio

Tx: stent and baloon, endarterectomy