External Carotid Artery (Superficial arteries of the head and neck)

Question 1

The common carotid branches into which two divisions and where?

Answer 1

The common carotid branches into the internal and external carotid arteries within the carotid triangle.

Question 2

Does the internal carotid have any branches in the neck?

Answer 2

No, only in the head

Question 3

Seven branches of the external carotid

Answer 3

Superior Thyroid
Ascending pharyngeal 
Lingual
Facial
Occipital 
Posterior Auricular 
Maxillary
Superficial temporal

Question 4

First branch of the external carotid.
where does it originate?
What are its main 2 branches?

Answer 4

Superior Thyroid
Originates in the carotid triangle
Gives off several branches, but the main ones are the parathyroid and thyroid branches.
80% of the superior thyroid supplies the thyroid. The remaining 20% goes to the surrounding muscles and larynx.

Question 5

Hyper or hypothyroid conditions could impact the eyes how?

Answer 5

Graves disease due to hyper or hypo thyroids (due to Ab attack of EOM’s. Causing swelling, which pushes the eyes out.

Question 6

Second branch of the external carotid
Where does it originate?
Mainly supplies blood to ___
2 branches

Answer 6

Ascending pharyngeal
Originates in the carotid triangle
Mainly supplies blood to the pharynx.
2 branches include the tympanic and the meningeal which enters at the jugular foramen to supply blood to skull bones

Question 7

Lingual artery
Where does it originate?
Where does it run?

Answer 7

Arises in the carotid triangle- opposite to the tip of the hyoid
Bends and loops up and then runs deep in the tongue muscles. Several branches join together to supply the tongue and mouth floor with blood.

Question 8

Facial artery originates where and travels where

Answer 8

Not part of the carotid triangle, arises deep to the posterior belly of the digastric muscle, ascends over the inferior/external border of the mandible(near mental foramen). Travels to cheek and on to medial angle of the eyelid (medial canthus).

Question 9

Branches of the facial artery

Answer 9

Travels to upper and lower lip, tonsils and the roof of the mouth. The lateral nasal artery is the important one. Branches to form the angular artery, which is a terminal branch, and travels to a lacrimal sac where it anastomoses with the dorsonasal branch off the ophthalmic.

Question 10

Which artery of the external carotid is the last to originate in the carotid triangle

Answer 10

The occipital artery. It arises opposite to the facial artery

Question 11

Branches of the occipital artery

Answer 11

1. Meningeal branch to the mastoid foramen

2. Occipital scalp- superficial blood vessels cause lots of bleeding.

Question 12

Location of where the posterior auricular artery branches

Answer 12

Comes off the external carotid at skull level just before the parotid gland. Smallest of the SCALP arteries. Arises just above the digastrics muscle, running posteriorly to the auricle.

Question 13

Branches of the posterior auricular arteries

Answer 13

Posterior ear

Scalp behind auricular

Question 14

Smallest branch off the external carotid

Answer 14

Ascending pharyngeal

Question 15

Where does the superficial temporal artery branch from

Answer 15

Extends out from the parotid gland and then gives off its branches.

Question 16

Branches of the superficial temporal artery

Answer 16

1. Transverse facial artery. Out and across face.
2. Zygomatic artery. Travels towards eye. Anastomosis with zygomatico- facial artery.
3. Middle temporal artery. Goes under temporal muscle in temporal fossa.
4. Frontal (terminal)- anastomoses with branches from the supraorbital. and also with the frontal arteries from the internal carotid
5. Parietal (terminal) supplies the scalp

Question 17

The superficial temporal artery has 2 branches that form anastomosis with other arteries. Which two branches are they?

Answer 17

The zygomatic artery anastomoses with the zygomatic-facial artery.

The frontal artery anastomoses with the supraorbital. Also with the frontal arteries from the internal carotid.

Question 18

Which disease can attack the superficial temporal artery?

Answer 18

Anteritic anterior ischemic optic neuropathy/Giant cell arteritis/temporal arteritis.

Question 19

What is AAION/giant cell arteritis?

Answer 19

Inflammatory condition that impacts medium and large arteries. Causes sudden painless vision loss by damage to blood vessels supplying the optic nerve (ophthalmic artery). Near complete vision loss in one eye. If untreated, same thing may happen to other eye.

Question 20

how to diagnose AAION/giant cell?

Answer 20

Temporal artery biopsy to look for the giant cells.

Question 21

Who is more likely to get AAION/giant cell and how do you treat it?

Answer 21

Women are 2x more likely. Since it is systemic, treat with steroids and refer pt to the ER. Goal is to prevent vision loss in the other eye.

Question 22

Other symptoms related to AAION/giant cell other than vision loss

Answer 22

Jaw pain, headaches, painful to brush hair

Question 23

Common artery attacked by AAION

Answer 23

Superior temporal of external carotid, ophthalmic, short posterior ciliary arteries.

Question 24

The three divisions of the maxillary artery

Answer 24

1. Occurs before the artery crosses over the sphenomandibular ligament
2. Occurs after the artery crosses over the sphenomandibular ligament
3. After the artery passes through the pterygopalatine fossa

Question 25

Branches of the first division of the maxillary artery

Answer 25

1. The inferior alveolar- lower teeth and terminates at the chin
2. The accessory meningeal branch enters the cranium by foramen ovale
3. The middle meningeal artery enters at foramen spinosum and supplies bones of skull. Enters at the spinosum and runs deep to the pteroin. Easy to rupture, resulting in compression of CN III. Eye down and out and ptosis.

Question 26

Branches of the second division of the maxillary artery supply what

Answer 26

Many branches that supply muscles of mastication including the masseter, temporal, medial and lateral pterygoid.

Buccinator muscles in your cheeck- prevent chewing your own cheek and allows you to make the duck face.

Question 27

Branches of the 3rd division of the maxillary artery

Answer 27

1. Posterior superior alveolar artery
2. Artery of the pterygoid canal. Supplies lacrimal gland.
3. Infraorbital artery- Supplies inferior EOM’s. Can anastomose with other facial arteries to supply the eye.
4. Sphenopalatine arteries supply the sinuses via the nasal cavity.

Question 28

What does the middle meningeal artery branch off of? Where does it travel and what are its risks

Answer 28

Branches off the first division of the maxillary artery of the external carotid artery.

Travels through the foramen spinosum to the pteroin, which easily can break if hit. Causing artery to rupture and swelling to occur. Swelling can push on CN III and affect eyes. Down and out with ptosis.

Can check for compression of cortiospinal pathways by the babinski sign

Question 29

Babinski sign

Answer 29

(+) Big toe goes back and small toes bend down. Means something is wrong with nervous system causing reflexes to act abnormally. This response is common in children under 2.

(-) What you want. should not happen in children older than 2.