Carotid Artery

Question 1

How many fascias do we find in the neck ? What are they called ?

Answer 1

1. Prevertebral Fascia
2. Visceral
3. Investing
4. Superficial

Question 2

What are the boundaries of the carotid sheath ?

Answer 2

Posteriorly Prevertebral Fascia

Anteriorly Investing Fascia with M. sternocleidomastoideus within it.

Medially Visceral fascia

Laterally Investing Fascia with M. sternocleidomastoideus within it.

Question 3

What are the 5 Structures embedded in the carotid sheath ?

Answer 3

1. Carotid artery.
2. Internal jugular vein.
3. Vagus nerve
4. On the sheath anteriorly lies the ansa cervicalis.
5. Posteriorly the cervical sympathetic chain.

Question 4

Where is the carotid bifurcation usually located ?

Answer 4

At the level of the superior border of the thyroid cartilage.

Question 5

What are the 8 branches of the external carotid artery ?

Answer 5

1. Superior thyroid
2. ascending pharyngeal
3. lingual
4. fascial
5. occipital
6. posterior auricular
7. superficial temporal
8. internal maxillary

Question 6

Where does the internal jugular vein lie in the neck ?

Answer 6

It lies deep to the sternocleidomastoid muscle.

Question 7

What are the 3 Groups of nerves in the neck ?

Answer 7

1. The cranial nerves
2. The nerves of the cervical plexus
3. The nerves of the brachial plexus

Question 8

What cranial nerves are related to the distal ICA ?

Answer 8

1. Fascial IIV
2. Glossopharyngeal IX
3. Vagus X
4. Spinal accessory XI
5. Hypoglossal XII

Question 9

What nerves share the carotid sheath in mid neck ?

Answer 9

1. Vagus 2. cervical sympathetic chain 3. ansa cervicalis

Question 10

How does the ECA divide the posterior suspensory complex of the larynx ?

Answer 10

Laterally by passing between the digastric and styloglossus muscles

Medially by passing between the styloglossus and stylopharyngess muscles

Question 11

What artery crosses the distal ICA beneath the posterior belly of the digastric muscle ?

Answer 11

The occipital artery

Question 12

What nerves are most commonly injured in carotid surgery ?

Answer 12

The hypoglossal XII and the recurrent laryngeal nerves.

Question 13

Where does the marginal mandibular branch of the facial nerve course ?

Answer 13

It emerges from behind the parotid gland and runs below the angle of the mandible before turning upwards to run parallel with the mandibular ramus.

Question 14

What happens when the marginal mandibular branch of the facial nerve is injured ?

Answer 14

It innervates the lower lip; injury results in inability to draw the angle of the mouth downward with compensatory drooping of the contralateral lip.

Question 15

How may we help reduce injuries to ramus mandibularis ?

Answer 15

1. Position retractors superficial to the platysma.
2. Curving longitudinal incisions posteriorly toward the mastoid process.

Question 16

How do we mobilise the hypoglossal nerve during high carotid dissections ?

Answer 16

By careful division of descendes hypoglossi (ansa cervicalis) and the sternomastoid artery and vein.