Craniofacial Vasculature Flashcards
What thin area of bone on the skull serves as a landmark overlying the midle meningeal a.?
Pterion
The pterion serves as a landmark overlying what major artery that can cause intracranial bleeding if head trauma occurs?
What muscle provides some protection of this area?
Middle meningeal a.
Some protection from temporalis m.
_____ ____ = 3 dense regular CT layers that separate the soft tissue of the brain from the bones of the cranium
Cranial meninges
Functions of cranial meninges
Enclose and protect blood vessels that supply the brain
Contain and circulate CSF
Form dural venous sinuses that drain blood from brain
Provide cushion and protection to brain
Cranial meninges from superficial to deep
Dura mater
Arachnoid mater
Pia mater
What 3 areas are drained by the dural venous sinuses?
Compartments containing CSF
Blood from brain
Blood from superficial face
Dura mater is a tough membrane composed of 2 fibrous layers. It is the strongest of the meninges. What are the 2 layers it is composed of?
Periosteal layer: more superficial, attaches to periosteum of cranial bones
Meningeal layer: lies deep to periosteal layer
The meningeal layer of dura mater is usually fused to the periosteal layer, except in specific areas where the two layers separate to form large, blood-filled spaces called _____
Dural venous sinuses
Arachnoid mater lies immediately internal to dura mater. It is partially composed of a delicate web of collagen and elastic fibers, termed the _____ ____
Arachnoid trabeculae
Between the arachnoid mater and overlying dura mater is the _____ ____
Immediately deep to the arachnoid is the ______ _____
Subdural space
Subarachnoid space
Thin layer of delicate CT that tightly adheres to brain and follows every contour of the brain surface
Pia mater
The meningeal layer of the dura mater extends as flat partitions deep into the cranial cavity at 4 locations called ____ ____ ___
Cranial dural septa
Membranous partitions separate specific parts of the brain and provide additional stabilization and support to the entire brain. What are the 4 primary membranous partitions?
Falx cerebri
Tentorium cerebelli
Falx cerebelli
Diaphragma sellae
In the septa are dural venous sinuses — what are some examples of these?
Superior and inferior sagittal sinuses
Straight sinus
Sigmoid sinus
Transverse sinus
What cranial dural septum separates the cerebrum from the cerebellum inferiorly?
Tentorium cerebelli
What cranial dural septum separates the hemispheres of the cerebellum at its isthmus?
Falx cerebelli
What cranial dural septum divides the two hemispheres of the brain?
Falx cerebri
What nerves provide innervation to the meninges?
Opthalmic nerve (CN V1)
Maxillary nerve (CN V2)
Mandibular nerve (CN V3)
Cervical spinal nerves (C2,C3) [distributed by CN XII and CN X]
Also meningeal branches of ethmoidal nerve
Drainage of superficial facial structures via the orbit occurs by way of what veins?
Superior and inferior opthalmic vein
What large dural venous sinus exists in close relation with the sella turcica?
Cavernous venous sinus
What nerves are in close proximity to the cavernous sinus and may be impinged in the case of a venous thrombus?
CN III
CN IV
CN V (1,2,3)
CN VI
Primary arterial supply to meninges
Middle meningeal a. (Anterior, middle, and posterior branches)
The middle meningeal a. arises from what artery?
Maxillary a. (Which branches from the external carotid a.)
The middle meningeal a. supplies the meninges after passing through what opening in the skull?
Foramen spinosum
CSF is a clear, colorless liquid that circulates in the _____ of the brain and the _____ space
Ventricles; subarachnoid
Important functions of CSF
Buoyancy
Protection
Environmental stability
CSF is formed by the _____ ____ in each ventricle, produced by secretion of a fluid from the _____ cells that originate from blood plasma
Choroid plexus; ependymal
CSF is similar to blood plasma but has greater amounts of what 3 ions?
Sodium
Hydrogen
Calcium
CSF is similar to blood plasma but has greater amounts of sodium, hydrogen, and calcium. It has less _____
Potassium
Drainage of CSF to DV sinuses occurs via _____ _____ which are outpocketings of arachnnoid mater within the dural venous sinsuses
Arachnoid granulations
The bulk of the venous drainage from the head and neck terminate in the _______ vein, which joins the subclavian vein to form the _______ vein posterior to the medial end of the clavicle
Internal jugular; brachiocephalic
Primary venous drainage of neck to thorax occurs via what vein?
Left brachiocephalic
Six levels of cervical lymph nodes
I = submental and submandibular
II-IV = deep cervical LNs distributed along IJV (upper lateral, middle lateral, and lower lateral groups)
V = posterior cervical triangle
VI = anterior cervical LNs
[so I, V, and VI are considered superficial LNs]
T/F: the superficial LNs of the head and neck receive lymph from the scalp, face, and neck. They are arranged in a ring shape, extending from inferior chin to posterior aspect of the head. They ultimately drain into deep LNs
True
The deep cervical lymph nodes can be divided into what 2 groups?
Superior and inferior deep cervical LNs
What are the 2 main sites in the neck where the cervical lymphatic pathways intersect?
Jugulofacial venous junction
Jugulosubclavian venous junction
Lymphatics from the head pass obliquely downward to this site, where the lymph is redirected vertically downward in the neck
Jugulofacial venous junction
The main lymphatic trunk, the thoracic duct, terminates at this location, where lymph collected for the left side of the head and neck region is comingled with lymph draining from the rest of the body
Jugulosubclavian venous junction
What is the difference in potential pathology if only peripheral nodal groups are affected vs. central groups (e.g., those at the venous junctions) in the cervical region?
Peripheral nodal groups suggest localized disease process
Central groups usually signify extensive disease process
Central lymph nodes can be obtained from diagnostic evaluation by ________ biopsy
Prescalene
The internal jugular vein receives blood from the brain, face, and neck. It emerges through the ____ ____ as a continuation of the _____ sinus, and descends posteriorly then lateral to the ________ _____ artery inside the carotid sheath
Jugular foramen; sigmoid; internal carotid
T/F: valves are not found in the internal jugular vein
False: valves are variably present in the IJV, defending against retrograde flow when coughing, etc.
What are the superior and inferior bulbs of the IJV?
Dilatations near the origin and termination of the vein
The inferior petrosal sinus assists in draining the ________ sinus
It leaves through the anterior part of the _______ foramen, joining the IJV below the superior bulb
Cavernous
Jugular
The _______ vein is formed by the union of superficial temporal and maxillary vein from the pterygoid plexus
Retromandibular
The retromandibular vein passes inferiorly in the substance of the ______ gland, emerging from its lower border and divides into 2 parts
Parotid
The anterior division of the retromandibular vein joins the _____ vein
The posterior division of the retromandibular vein pierces the deep fascia and joins the posterior auricular v. to form the _____ _____ v., eventually emptying into the _________v.
Facial
External jugular; subclavian
What vein communicates with the cavernous sinus via the superior and inferior ophtalmic veins?
Angular v.
Initial tributaries of angular v.
Supra-orbital v.
Supratrochlear v.
What vein commences lateral to the root of the nose, descending onto the face posterior to the corresponding artery, following along to the lower border of the mandible?
Facial vein
The facial vein is joined by the anterior division of the retromandibular vein. It joins the _____ plexus through the deep facial vein
Pterygoid
What vein exists as a small trunk accompanying the first part of its corresponding artery, and is formed by the confluence of veins of the pterygoid plexus?
Maxillary v.
The maxillary v. passes posteriorly between the sphenomandibular ligament and the neck of the mandible. It unites with the _____ v. to form the _______ v.
Temporal; retromandibular
Network of very small veins, which lie around and within the lateral pterygoid muscle in the infratemporal region
Pterygoid plexus
The pterygoid plexus receives primarily from what 2 veins?
Inferior ophthalmic v.
Deep facial v.
The pterygoid plexus drains into a pair of large, short ______ vv. which join the superficial temporal v. to form the retromandibular v.
The _______ v. drains the plexus into the facial v. if the above v. is occluded
Maxillary
Deep facial
Function of pterygoid plexus
Acts as a peripheral pump, to aid in venous return by the pumping action of the muscle everytime the mouth is opened
Yawning, a prolonged and forcible contraction of the lateral pterygoid to open the mouth, accompanied by contraction of the diaphragm and stretching of the limbs is a reflex triggered by venous stagnation
Pharyngeal veins drain the pharyngeal plexus on the outer surface of the pharynx. They terminate in one of what 4 veins?
Internal jugular v.
Facial v.
Lingual v.
Superior thyroid v.
What v. drains the dorsum and sides of the tongue?
Dorsal lingual vv.
What vv. drain the tip of the tongue and join the sublingual vv.?
Deep lingual vv.
The dorsal lingual vv. and the deep lingual vv. terminate directly or indirectly into what veins?
Internal jugular vv.
What tributary of the IJV leaves the superior pole of the thyroid gland and empties into the facial or internal jugular?
Superior thyroid v.
What tributary of IJV is short and wide, passing from the middle of the pole directly into the internal jugular?
Middle thyroid vein
What tributary of IJV joins the internal jugular but more often joins the vertebral or posterior auricular v.?
Occipital v.
What vein starts below the chin, passing beneath the platysma m. to the suprasternal notch?
Anterior jugular v.
The anterior jugular vv. pierce the deep fascia and are connected to the contralateral side by an anastomosing ________ arch
They angle laterally to pass deep to the _____ m. and open in the external jugular v.
Jugular
SCM
What v. begins behind the angle of the mandible by the union of the posterior auricular and posterior division of the retromandibular v.?
External jugular v.
The external jugular v. descends obliquely, deep to the platysma, and receives the posterior external jugular v. It pierces the deep fascia just above the clavicle and drains into the ______ v.
Subclavian
What are the 6 tributaries of the external jugular v.?
Posterior auricular v.
Posterior division of retromandibular v.
Posterior external jugular v.
Transverse cervical (cervicodorsal) v.
Suprascapular v.
Anterior jugular v.
3 aortic arch branches
Brachiocephalic trunk
L common carotid a.
L subclavian a.
2 primary branches of brachiocephalic trunk
R common carotid a.
R subclavian a.
3 parts of the subclavian a. are divided based on what structure?
Anterior scalene m.
1st part is medial to anterior scalene, 2nd part is behind anterior scalene, 3rd part is lateral to anterior scalene
What branches are associated with the first part of the subclavian a.?
Vertebral a.
Thyrocervical trunk
Internal thoracic a.
Branches of thyrocervical trunk
Suprascapular a.
Transverse cervical a.
Inferior thyroid a.
Ascending cervical a.
What muscles are supplied by the suprascapular a.?
Supraspinatous m.
Infraspinatous m.
What muscle is supplied by the transverse cervical a.?
Trapezius m.
What branch is associated with the 2nd part of the subclavian a.?
Costocervical trunk
2 primary branches of costocervical trunk
Supreme intercostal a.
Deep cervical a.
What is the primary vessel associated with the 3rd part of the subclavian a.?
Dorsal scapular a.
What 2 muscles are supplied by the dorsal scapular a.?
Rhomboid m.
Levator scapulae m.
What feature is superior to the bifurcation on the internal carotid a.? Why is this feature significant physiologically?
Carotid sinus
Baroreceptors in this sinus are innervated by glossopharyngeal n. (CN IX) indirectly modulate activity of ANS response to blood pressure
8 branches of external carotid a.
[Some Anatomists Like Freaking Out Poor Medical Students]
Superior thyroid a. Ascending pharyngeal a. Lingual a. Facial a. Occipital a. Posterior auricular a. Maxillary a. Superficial temporal a.
3 primary branches of superior thyroid a.
Infrahyoid a.
Superior laryngeal a.
SCM branch
What branch of the external carotid a. supplies pharynx musculature?
Ascending pharyngeal a.
The arterial course of the lingual a. begins obliquely upwards and medially to the greater horns of the hyoid bone. It then curves down and forward passing beneath the _______ and _____ mm., where it is crossed by the _______ n.
It also runs deep to the hypoglossus m.
Digastric; stylohyoid; hypoglossal
2 terminal branches of the lingual a.
Sublingual a.
Deep lingual a.
Which terminal branch of the lingual a. supplies the base of the tongue?
Deep lingual a.
The deep lingual a. runs with the lingual n. superficial to the _______ muscle
Hypoglossus m.
What terminal branch of the lingual a. supplies the sublingual gland and oral floor?
Sublingual a.
What artery arises in the carotid triangle, runs beneath the digastric m. and stylohyoid m. superficial to the hypoglossal n., entering the groove on posterior submandibular gland and curving upward over the body of the mandible, running anter-inferior angle of the masseter m.?
Facial a.
There are both cervical and facial branches of the facial a. What are the 3-4 cervical branches and what do they supply?
Ascending palatine a. — pharyngeal wall, soft palate, pharyngotympanic tube
Tonsillar branch — palatine tonsils
Submental and glandular branches — submandibular gland and oral floor
There are both cervical and facial branches of the facial a. What are the 4 facial branches of the facial a.?
Inferior labial a.
Superior labial a.
Lateral nasal branch
Angular a. (Terminal branch)
What artery arises in the carotid triangle from the posterior aspect of the external carotid a., running posterior and upwards with the terminal portion running with the greater occipital n.?
Occipital a.
What a. arises above the digastric and stylohyoid m., ascending posteriorly beneath the parotid gland, between the ear and mastoid process along the lateral side of the head behind the ear?
Posterior auricular a.
[runs with posterior auricular n.]
5 branches of posterior auricular a.
Stylomastoid a.
Posterior tympanic a.
Auricular branch
Occipital branch
Parotid branch
3 parts of maxillary a.
Mandibular part
Pterygoid part
Pterygopalatine part
Branches of mandibular part of maxillary a.
Deep auricular a.
Anterior tympanic a.
Inferior alveolar a.
Middle meningeal a.
Accessory meningeal a.
What does the deep auricular a. supply?
External acoustic meatus, external tympanic membrane, and TMJ
What does the anterior tympanic a. supply?
Internal TM
The inferior alveolar enters the ______ foramen and supplies the mandible, mandibular teeth, chin, and mylohyoid m.
Mandibular
What are the 2 branches of the inferior alveolar a.?
Mylohyoid m.
Mental a.
The middle meningeal a. enters the cranium via the foramen spinosum. What structures does it supply?
Dura mater of the lateral wall Trigeminal ganglion Facial n. Geniculate ganglion Tympanic cavity Tensor tympani m.
The accessory meningeal a. enters the cranium via the foramen ______
Ovale
What structures are supplied by the accessory meningeal a.?
Extracranial mm. of infratemporal fossa
Otic ganglion
Sphenoid bone
A ruptured middle meningeal a. due to skull fracture may lead to what injury
Epidural hematoma
Branches of the pterygoid part of maxillary a.
Deep temporal a. —> temporalis m.
Pterygoid branches —> pterygoid m.
Masseteric a. —> TMJ and masseter m.
Buccal a. —> buccal fat-pad, buccinator m., buccal oral mucosa
Branches of pterygopalatine part of maxillary a.
Posterior superior alveolar a.
Infraorbital a.
Artery of pterygoid canal
Pharyngeal branch
Descending palatine a.
Sphenopalatine a.
2 branches of descending palatine a. and what they supply
Greater palatine a. —> hard palate
Lesser palatine a. —> soft palate, palatine tonsil and pharyngeal wall
What branch of the maxillary a. supplies maxillary moar and premolar teeth, adjacent gingiva and mucous membrane of maxillary sinus?
Posterior superior alveolar a.
What branch of the maxillary a. supplies the inferior oblique m., inferior rectus m., lacrimal sac, maxillary canines, incisor teeth, and skin of infraorbital region of the face?
Infraorbital a.
The infraorbital a. traverses inferior orbital fissure, and the ________ groove and foramen
Infra-orbital
What branch of the maxillary a. runs posterior through pterygoid canal and supplies mucosa of the upper pharynx, pharyngotympanic tube, and tympanic cavity?
Artery of pterygoid canal
What branch of the maxillary a. runs through palatovaginal canal to supply the mucosa of the nasal roof, nasopharynx, sphenoidal air sinus, and pharyngotympanic tube?
Pharyngeal branch
What is the terminal branch of the pterygopalatine part of the maxillary a? What does it supply?
Sphenopalatine a. —> traverses sphenopalatine foramen and supplies walls and septum of nasal cavity, frontal/ethmoidal/sphenoid/maxillary sinuses and anteriormost palate
The superficial temporal a. begins between the TMJ and the ear and enters the _______ _____; it terminates by dividing into _____ and ____ branches
Temporal fossa; frontal; parietal
The superficial temporal a. branches run close to what nerve?
Auriculotemporal n.
5 primary branches of the superficial temporal a.
Transverse facial a.
Middle temporal a.
Anterior auricular a.
Terminal branches: frontal a., parietal a.
How does the internal carotid artery enter the cranial cavity?
Through the petrous part of the temporal bone via the carotid canal; then courses anteriorly through the cavernous sinuses, running in the carotid groove
The internal carotid a. does not branch in the neck, but it does in the cranial cavity. What are the 3 primary branches?
Ophthalmic a.
Anterior cerebral a.
Middle cerebral a.
The vertebral a. branches off the 1st part of the subclavian a. then runs through the transverse foramen from C___ to C___. It takes a sharp turn between C__ and C__. It stretches with rotation and extension of the head
C6-C1; C1-C2
Condition characterized by decreased posterior circulation d/t intermittent vertebral a. occlusion, resulting from atherosclerosis and triggered by head rotation or extension
Vertebrobasilar insufficiency
Symptoms of vertebrobasilar insufficiency
Syncope, vertigo, dizziness
Double vision or loss of vision
Numbness or weakness in hands or feet
Slurred speech
Nausa/vomiting
Loss of coordination or weakness
Risk factors for vertebrobasilar insufficiency
Smoking HTN or hyperlipidemia Diabetes or obesity Age 50+ Family hx
What makes up the circle of willis?
Anterior cerebral a. Anterior communicating a. Middle cerebral a. Posterior communicating a. Posterior cerebral a.
Condition characterized by proximal stenosis or occlusion of the subclavian a. causing reverse flow through the vertebral a. of the affected side to supply blood to upper extremity, decreasing blood flow to the brain
Subclavian steal syndrome
Symptoms of subclavian steal syndrome
Presyncope or syncope
Different BP in upper extremities
Neurologic deficits or memory problems
Causes of subclavian steal syndrome
Athersclerosis
Cervical rib
