H&N Vasculature Flashcards
origin of subclavian a.
- R subclavian from R Brachiocephalic trunk
- L subclavian from aortic arch
course of subclavian a.
ascend through superior thoracic aperture to enter root of neck posterior to clavicle, arch over 1st rib, then change name to axillary artery, lateral to anterior scalene muscle
subclavian a. supply:
upper limbs, neck ,and brain
parts of subclavian a.
- Parts: divided in three parts in reference to anterior scalene
- 1st part: medial to anterior scalene
- 2nd part: posterior (deep) to anterior scalene
- 3rd part: lateral to anterior scalene
branches of subclavian artery
- internal thoracic
- vertebral artery
- thyrocervical trunk
- inferior thyroid artery
- ascending cervical artery
- suprascaupular artery
- cervicodorsal trunk (transverse cervical artery)
- costocervical trunk
- superior (supreme) intercostal artery
- deep cervical artery
internal thoracic branch of subclavian artery
ORIGIN
arises from the anteroinferior aspect of the 1st part of the subclavian a.
internal thoracic branch of subclavian artery
COURSE
descends into thorax posterior to clavicle and 1st costal cartilage -> then descends on each sides of sternum into the anterior wall of the thoracic cavity -> gives rise to anterior intercostal arteries and vessels of the breast (historically known as internal mammary aa.)
internal thoracic branch of subclavian artery
SUPPLY
anterior thoracic wall and breasts
*branches of subclavian a. (internal thoracic and vertebral artery)
vertebral artery branch of subclavian artery
ORIGIN
Origin: from 1st part of subclavian
vertebral artery branch of subclavian artery
COURSE
Course: ascends through transverse foramina of cervical vertebrae (enters at C6) -> comes out of transverse foramina of C1 (Atlas) -> goes around lateral mass of Atlas -> crosses posterior arch (on the groove of the C1) -> then penetrates the posterior atlantooccipital membrane (at the level of the suboccipital triangle) and enters cranial cavity through FM
vertebral artery branch of subclavian artery
SUPPLY
Supply: brain and spinal cord
*branch of subclavian artery (thyrocervical trunk)
thyrocervical trunk
ORIGIN:
COURSE:
- Origen: arises from anterosuperior aspect of the 1st part of the subclavian a. (near medial border of anterior scalene)
- Course: immediately separates into 4 branches:
- inferior thyroid a. (primary visceral a. of the neck)
- ascending cervical a.
- suprascapular a.
- cervicodorsal trunk (transverse cervical a.)
Inferior thyroid a. (primary visceral a. of the neck). Terminal branch of thyrocervical
ORIGIN:
SUPPLY:
Origen: thyrocervical trunk
Supply: larynx, trachea, esophagus, thyroid and parathyroid glands, and adjacent muscles
Ascending cervical a. Terminal branch of thyrocervical trunk
ORIGIN:
COURSE:
SUPPLY:
Origin: inferior thyroid a.
Course: ascends anteriorly to cervical transverse processes. Deep to prevertebral fascia
Supply: lateral muscles of upper neck
Suprascapular a.
ORIGIN:
COURSE:
SUPPLY:
Origin: thyrocervical trunk
Course: inferolaterally across anterior scalene muscle and phrenic n. -> posterior to clavicle -> posterior aspect of scapula
Supply: muscles along posterior aspect of scapula
Cervicodorsal trunk (Transverse cervical a.)
ORIGIN:
COURSE:
SUPPLY
BRANCHES:
- Origin: thyrocervical trunk
- Course: crosses superficial to anterior scalene m. and 2-3 cm superior to clavicle
- Supply: vasa nervorum of brachial plexus, muscles along posterior aspect of scapula
- Branches:
- Superficial cervical a. (accompanies accessory n.: CN XI)
- Dorsal scapular a. (posterior aspect of scapula)
common carotid a.
ORIGIN:
COURSE:
SUPPLY:
BRACHES:
- Origin: R common carotid a. from R Brachiocephalic trunk; L common carotid a. from aortic arch
- Course: ascends within the carotid sheath until superior border of thyroid cartilage where it divides
- Supply: head and neck
- Branches
- Internal carotid a.: no branches in the neck. Ascends in the carotid sheath
- External carotid a.: numerous branches in the neck
*common carotid a.
internal carotid a.
ORIGIN:
COURSE:
SUPPLY:
BRANCHES:
CAROTID SINUS:
CARTOID BODY:
- Origin: arise from and is a direct continuation of the common carotid a.
- Course: ascends through neck without branching -> enters cranial cavity through carotid canal -> runs anteriorly through cavernous sinus, where it divides
- Supply: brain and orbit
- Branches
- Anterior cerebral a.
- Middle cerebral a.
- Ophthalmic a.
- Course: passes through optic canal and enters orbit
- Supply: eyeball and extra-ocular muscles and structures
- Carotid sinus: slight dilation of the proximal part of the internal carotid a. It’s a baroreceptor and reacts to changes in blood pressure
- Carotid body: ovoid mass of tissue located on the medial side of the bifurcation of the common carotid. It’s a chemoreceptor and monitors O2 blood levels
*internal carotid a.
external carotid artery
ORIGIN:
COURSE:
SUPPLY:
BRANCHES (8):
- Origin: arise from the common carotid a.
- Course: ascends posterosuperiorly to the condylar process of the mandible, where it divides in the two terminal branches (maxillary a. and superficial temporal a.)
- Supply: most structures external to the cranium, with the exception of the orbit and part of the forehead. It also supplies deep structures of the cranium (e.g. middle meningeal a.)
- Branches (8):
- Anterior
- Superior thyroid a.
- Lingual a.
- Facial a.
- Medial
- Ascending pharyngeal a.
- Posterior
- Occipital a.
- Posterior auricular a.
- Terminal
- Superficial temporal a.
- Maxillary a.
*external carotid a.
Anterior external cartoid artery branches (3)
COURSE:
SUPPLY:
BRANCHES:
- Superior thyroid a.
- Course: runs anteroinferiorly deep to infrahyoid m.
- Supply: thyroid gland, infrahyoid mm. and SCM
- Branches:
- Superior laryngeal a. (Supply: larynx)
- Lingual a.
- Course: runs superoanteriorly deep to hypoglossal n. (CN XII) and disappears under the hyoglossus m. -> ascends towards tip of tongue
- Supply: tongue
- Branches:
- Deep lingual a.
- Sublingual aa.
- Facial a.
- Course: runs anteriorly (deep to posterior belly of digastric m. and stylohyoid m.) -> hooks around the middle of the inferior border of mandible, emerging onto the face -> diagonal course towards medial aspect of orbit
- Supply: submandibular gland, muscles of facial expression, and face (lips, nose, and orbit)
- Branches:
- Ascending palatine a.
- Tonsillar a.
- Submental a.
*Anterior external cartoid artery branches (3)
Medial external carotid artery branch (1)
COURSE:
SUPPLY:
- Ascending pharyngeal a.
- Course: ascends along pharynx deep (medial) to internal carotid a.
- Supply: pharynx, prevertebral mm., middle ear, and cranial meninges
*MEDIAL & POSTERIOR External carotid artery branches
Posterior external carotid a. branches (2)
COURSE:
SUPPLY:
- Occipital a.
- Course: ascends posteriorly parallel to posterior belly of digastric m. -> it divides in posterior part of scalp
- Supply: posterior portion of scalp
- Posterior auricular a.
- Course: ascends posteriorly between external acoustic meatus opening and mastoid process
- Supply: parotid gland, facial n., and structures in temporal bone, auricle, and small part of scalp posterior to auricle
Terminal external carotid artery branches (2)
COURSE:
SUPPLY:
BRANCHES (if any):
- Superficial temporal a.
- Course: arises from terminal bifurcation of ECA -> emerges on face between TMJ and auricle -> on scalp it divides into frontal and parietal branches
- Supply: frontolateral part of scalp
- Branches:
- Transverse facial a.:
- Course: projects anteriorly within parotid gland and superficial to masseter m.
- Supply: parotid gland and duct, masseter m., and skin of face. Anastomoses with facial a.
- Maxillary a.
- Course: runs anteriorly through infratemporal fossa -> crosses lateral pterygoid m. -> goes through pterygomaxillary fissure and into pterygopalatine fossa
- Supply: TMJ, infratemporal fossa structures, meninges and calvaria, maxillary and mandibular teeth, structures of nasal cavity, and some aspects of the orbit
*Terminal external carotid artery branches
Maxillary a. branches in INFRATEMPORAL FOSSA
COURSE:
SUPPLY:
- Middle meningeal
- Course: ascends to enter cranial cavity through foramen spinosum
- Supply: dura mater and calvaria, trigeminal ganglion, facial n. and geniculate ganglion
- Muscular branches
- Course: go to muscles of mastication and the buccinator
- Supply: muscles of mastication and buccinator
- Inferior alveolar
- Course: descends to enter the mandible via mandibular foramen -> goes anteriorly within the body of mandible -> emerges through mental foramen -> becoming the mental a.
- Supply: mandible, mandibular teeth, chin, and mylohyoid m.
- Posterior superior alveolar (PSA)
- Course: descends on maxilla’s infratemporal surface
- Supply: maxillary molar and premolar teeth, adjacent gingiva, and mucous membrane of maxillary sinus
*Maxillary a. branches in INFRATEMPORAL FOSSA
Maxillary a. branches in PTERYGOPALATINE FOSSA
infraorbital a.
descending palatine
sphenopalatine a. (terminal a. of maxillary a.)
Infraorbital a. (of maxillary a. in PTERYGOPALATINE FOSSA)
COURSE:
SUPPLY:
BRANCHES:
- Course: enters orbit via inferior orbital fissure -> runs on inferior wall (floor) of orbit -> emerges in the face through infraorbital foramen
- Supply: inferior oblique and rectus mm., lacrimal sac, maxillary canines and incisors teeth, and infra-orbital region of face
- Branches
- Anterior and middle superior alveolar aa.
- Supply: incisors and canines teeth, respectively
*Infraorbital a. (of maxillary a. in PTERYGOPALATINE FOSSA)
descending palatine branch (of maxillary a. in PTERYGOPALATINE FOSSA)
COURSE:
SUPPLY:
BRANCHES:
Descending palatine
- Course: descends to the palate and divides
- Supply: greater and lesser palatine arteries supply the palate
- Branches
- Greater and lesser palatine aa.
- Supply: mucosa and glands of hard and soft palate
sphenopalatine a. (terminal artery of maxillary a. in PTERYGOPALATINE FOSSA)
COURSE:
SUPPLY:
- Course: through sphenopalatine foramen
- Supply: walls and septum of nasal cavity, frontal, ethmoidal, sphenoid, and maxillary sinuses
*Descending palatine and sphenopalatine a. of maxillary a. in PTERYGOPALATINE FOSSA
*drainage of the scalp
which veins drain anterior part of scalp?
supra-orbital and supratrochlear vv.
which vein drain scalp anterior to auricles?
superficial temporal v.
which vein drain scalp posterior to auricles?
posterior auricular v.
which vein drain posterior part of sclap and ends deep in the IJV?
occipital v.
facial v.
ORIGIN:
CLINICAL NOTE:
COURSE:
DRAIN:
- Origin: medial aspect of orbit from superior and inferior ophthalmic vein.
- Clinical Note: Superior ophthalmic vein runs on the roof of orbit -> goes through the superior orbital fissure -> enters the cavernous sinus. Infection in the face can spread to the cranial cavity through this vein
- Course: descends posteriorly and inferiorly until -> lower border of mandible -> runs posteriorly to join the common trunk on IJV
- Drain: superficial aspect of face
veins that drain the scalp:
supra-orbital and supratrochlear vv.
superficial temporal v.
posterior auricular v.
occipital v.
facial v.
superficial jugular vv. include:
anterior jugular v.
external jugular v. (EJC)
internal jugular v. (IJV)
anterior jugular v.
ORIGIN:
COURSE:
- Origin: at the hyoid bone level, from confluence of superficial submandibular veins
- Course: descends between anterior median line of neck and anterior border of SCM -> at root of neck it turns laterally and posterior (deep) to SCM -> ends in the EJV or subclavian v.
jugular venous arch
where R & L anterior jugular veins join superior to the manubrium, in the suprasternal space
*anterior and external jugular vv.
External jugular vein (EJV)
COURSE:
DRAIN:
TRIBUTARIES (ORIGIN):
Course: descends from angle of mandible superior to SCM and deep to platysma -> pierces investing layer of deep cervical fascia -> ends in subclavian v.
Drain: most of scalp and side of face
Tributaries (origin)
- Posterior auricular v.
- Course: part of scalp between auricles and superior to mastoid process (superficial to SCM)
- Retromandibular v. (posterior branch)
- Course: runs posterior to ramus of mandible, within the substance of the parotid gland. Emerges from the inferior pole of the parotid gland and divides in anterior and posterior branches
- Tributaries
- Superficial temporal v.
- Course: from part of scalp anterior to auricles, descends to infratemporal region to meet the maxillary v.
- Maxillary v.
- Course: drains the pterygoid venous plexus in the infratemporal region -> runs posteriorly to join superficial temporal v.
Pterygoid venous plexus
LOCATION:
CONNECTIONS:
location: infratemporal fossa (under temporalis m and around pterygoid mm.
Connections: Anteriorly to facial v. Superiorly to cavernous sinus. Posteriorly with EJV via maxillary v. Potential for infection spread among those areas
*EJV
internal jugular vein (IJV)
ORIGIN:
COURSE:
Origin: jugular foramen in the posterior cranial fossa
Course: descends through the neck in carotid sheath deep to SCM -> joins subclavian vein (posterior to sternal end of clavicle)
Superior bulb of the IJV
dilation at the origin of the IJV
Inferior bulb of the IJV
dilation at the end of the IJV
Bicuspid valve
located in the inferior bulb of the IJV, prevent backflow of blood into the vein
Internal jugular vein + subclavian vein -> ___ -> ___
Internal jugular vein + subclavian vein -> Brachiocephalic vein -> superior vena cava
*IJV
internal jugular vein (IJV) branches:
pharyngeal v.
facial v.
lingual v.
superior thyroid
middle thyroid
inferior thyroid
pharyngeal v. (branch of IJV)
ORIGIN & COURSE:
Origin and Course: plexus of veins around the outer surface of pharynx -> drain into the pharyngeal veins -> drain in the IJV portion that is posterior to the ramus of the mandible
facial v. (branch of IJV)
ORIGIN & COURSE:
Origin and Course: where the facial and anterior retromandibular join-> then it drains in the IJV at the angle of the mandible (often in common trunk)
lingual v. (branch of IJV)
ORIGIN & COURSE:
Origin: tip of tongue
Course: goes posteriorly to drain in the IJV at the level of the angle of mandible (often in common trunk)
superior thyroid (branch of IJV)
ORIGIN & COURSE
Origin: superior part of thyroid gland
Course: goes posterosuperiorly to drain in the IJV inferior to the angle of the mandible
middle thyroid (branch of IJV)
ORIGIN & COURSE
Origin: middle part of thyroid gland
Course: runs posteriorly to drain in the lower portion of the IJV
inferior thyroid (branch of IJV)
ORIGIN & COURSE:
Origin: inferior side of thyroid gland
Course: goes inferiorly to drain directly in the brachiocephalic vein
superficial lymphatic vessels accompany __, while deep lymphatic vessels accompany __.
Superficial lymphatic vessels accompany veins, while deep lymphatic vessels accompany arteries
All lymphatic vessels from H&N drain directly or indirectly into ____ ___ ___ ___, which constitute a chain of lymphatic nodes located along the IJV -> jugular lymphatic trunk, which joins the thoracic duct (L) and the IJV or brachiocephalic vein (R)
deep cervial lymph nodes
superficial lymphatic nodes (superficial ring of lymph nodes)
LOCATION:
Occipital
Location: occipital region, over the superior nuchal line
Mastoid
Location: posterior to external acoustic meatus opening
Superficial parotid
Location: anterior to external auditory meatus, superficial to the gland and deep to the skin
Submandibular
Location: in the submandibular triangle, inferior to body of mandible
Submental
Location: in the submental triangle, inferior to chin
jugular lymphatic trunk
LOCATION & DRAINAGE:
Location: base of neck
Drainage: receive drainage from all of the deep nodes located superiorly to it -> thoracic duct (L) and IJV or brachiocephalic v. (R)
*course of superficial and deep lymphatic vessels
*deep lymphatic nodes
deep lymphatic nodes:
jugulodigastric
juguloomohyoid
Jugulodigastric
LOCATION:
DRAIN:
CLINICAL:
Location: carotid triangle, anterior and superficial to IJV, just below angle of mandible, and the crossing of the posterior belly of digastric m.
Drain: superficial, tongue, and palatine tonsils nodes and vessels
Clinical: this is the node that swells up in the neck during an infection. In case of cancer or metastasis in the head or neck is the 1st node to swell
Juguloomohyoid
LOCATION:
DRAIN:
CLINICAL:
Location: at base of neck, above the crossing of the omohyoid m. over the IJV
Drain: tongue nodes and vessels
Clinical: if enlarged, it could be a sign of tongue carcinoma
