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HNNS > HNS24 Vasculature And Lymphatic Of Head And Neck > Flashcards

HNS24 Vasculature And Lymphatic Of Head And Neck Flashcards

1
Q

General rule of learning blood supply

A 
Origin
—> Structures supplied
—> Branches
—> Branch details
—> Clinical examples
  1. External carotid
  2. Internal carotid
  3. Subclavian branches
  4. Veins
  5. Lymphatics
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2
Q

Aortic arch supply to head and neck

A

Left:

  • Left subclavian
  • Left common carotid —> external + internal

Right:
- Brachiocephalic (Innominate)
—> Right subclavian + Right common carotid —> external + internal

Variants:

  • Left carotid and Brachiocephalic have common origin (1%-22%)
  • Left carotid originates from Brachiocephalic (9%)
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3
Q

Carotid arteries landmarks

A

Bifurcation of carotid

  • Upper margin of thyroid cartilage
  • C4 level
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4
Q

(4 parts of Internal carotid artery)

A

(1. Cervical
2. Petrous
3. Cavernous
4. Cerebral)

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5
Q

External carotid artery

A

Supply:

  1. Scalp
  2. Face
  3. Maxilla
  4. Tongue
  5. Glands
  6. Pharynx
Branches (總共8 branches):
Anterior
1. Facial
2. Maxillary (分3段, 總共13 branches)
- 1st (Mandibular)
- 2nd (Pterygoid / muscular)
- 3rd (Pterygopalatine)
3. Superior thyroid
4. Lingual
5. Ascending pharyngeal

Middle:
1. Superficial temporal (頭頂scalp)

Posterior:

  1. Posterior auricular (scalp)
  2. Occipital (scalp)
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6
Q

Maxillary artery branches (X rmb detail branches)

A

分3段

  1. Mandibular (最先段) —> posterior to Lateral pterygoid muscle
    - deep auricular
    - anterior tympanic
    - ***middle meningeal
    - accessory meningeal
    - inferior alveolar
  2. Pterygoid / Muscular —> within Lateral pterygoid muscle (supply muscles)
    - anterior deep temporal branches
    - posterior deep temporal branches
    - pterygoid branches
    - masseteric artery
    - buccinator artery
  3. Pterygopalatine (最後段) —> anterior to Lateral pterygoid muscle
    - posterior superior alveolar artery
    - infraorbital artery
    - artery of pterygoid canal
    - greater (descending) palatine / pharyngeal artery
    - ***sphenopalatine artery
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7
Q

Internal carotid artery

A

Supply:

  1. Brain
  2. Eye
  3. Nasal cavity
  4. Scalp
Branches:
1. Anterior and Middle cerebral artery —> Circle of Willis
2. Ophthalmic arteries
—> Ocular group
—> Orbital group
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8
Q

Circle of Willis contents

A 
Internal carotid arteries x2
Anterior cerebral arteries x2
Posterior cerebral arteries x2
Anterior communicating artery ***x1
Posterior communicating artery x2
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9
Q

Ophthalmic artery (X rmb detail branches)

A

Runs alongside CN2 via Optic canal
—> Ocular group
—> Orbital group

  1. Ocular branches (eyeballs):
    - Central artery of retina (end artery)
    - Short / Long posterior ciliary arteries
    - Anterior ciliary artery
    - Superior / Inferior muscular arteries
  2. Orbital branches:
    - **Anterior / Posterior ethmoidal artery
    - Dorsal nasal artery
    - Supratrochlear artery
    - Supraorbital artery
    - **    Zygomatico-facial artery
    - ***Zygomatico-temporal artery
    - Muscular artery
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10
Q

Subclavian branches

A
  1. Vertebral arteries (transverse foramina)
    - Basilar artery
  2. Internal thoracic artery
  3. Thyrocervical trunk
    - Inferior thyroid artery (Superior: branch of external carotid)
    - Ascending cervical artery
  4. Costocervical trunk
    - Deep cervical artery
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11
Q

Vertebral artery

A
  • Ascend through transverse foramina of upper 6 cervical vertebrae
  • Enters cranium through foramen magnum
  • 2 Vertebral arteries —> Basilar artery —> 2 Posterior Cerebral arteries
    —> contribute to Circle of Willis
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12
Q

Anastomoses regions

A
  1. Face
  2. Scalp
  3. Nasal cavity
  4. Thyroids + parathyroid glands
  5. Oral cavity
  6. Palate
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13
Q

Face anastomoses (Superior to Inferior) (External + Internal)

A

External carotid

  1. Facial artery
  2. Maxillary artery
  3. Superficial temporal artery

Internal carotid
4. Ophthalmic artery

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14
Q

Scalp anastomoses (Anterior to Posterior) (External + Internal)

A

Occurs between L/R branches, different branches of same / different origin

External carotid (Posterior)

  1. Superficial temporal
  2. Occipital
  3. Posterior auricular
Internal carotid (Anterior)
4. Upper branches of Ophthalmic artery
—> Supratrochlear
—> Supraorbital
—> Zygomatico-temporal branches
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15
Q

Nasal cavity anastomoses (External + Internal)

A

External carotid
1. Facial
—> Superior labial
—> Lateral nasal

  1. Maxillary
    —> Sphenopalatine
    —> Greater palatine

Internal carotid
3. Ophthalmic artery
—> Ethmoidal branches

Clinical significance
- Kiesselbach’s area (Little’s area) —> common for nosebleeds

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16
Q

Thyroid and Parathyroid blood supply (External + Subclavian)

A
  1. Superior thyroid artery (from External carotid)
    —> supply Superior thyroid
  2. Inferior thyroid artery (from Subclavian via Thyrocervical trunk)
    —> supply Inferior thyroid + Parathyroid
  3. Thyroid ima artery (1-2% of population)
    —> supplies Inferior thyroid
    —> Clinical significance: cut vessel during neck surgery (thyroidectomy) —> uncontrollable bleeding
17
Q

Oral cavity blood supply anastomoses (External ONLY)

A

***External carotid ONLY!!!

  1. Facial
    —> superior labial
    —> lateral nasal
  2. Maxillary artery
    —> superior / inferior alveolar buccal
  3. Lingual artery
    —> dorsal lingual
    —> deep lingual
    —> sublingual
18
Q

Palate blood supply

A

***Maxillary artery ONLY (between branches of sub-branch) —> rich blood supply

  1. Sphenopalatine
    (- after passing through nasal cavity enters palate through Incisive foramen)
  2. Greater palatine
    (- merges onto palate through Greater palatine foramen, passing forward to join Sphenopalatine artery)
  3. Lesser palatine
    (- passes through Lesser palatine foramen and supply soft palate)
19
Q

Carotid Bruit

A

Carotid stenosis

Clinical significance: Stroke risk
3 ways:

  1. Narrow artery
    —> ↓ blood flow
  2. Thrombosis
    - roughen arterial wall
    —> blood clots
    —> ↓ blood flow
  3. Embolism
    - plaque deposits / blood clots break away
    —> travel to brain
    —> ↓ blood flow within brain

Diagnosis

  • Doppler ultrasound
  • Digital angiography
20
Q

Central artery of retina occlusion

A

ICA —> Ophthalmic arteries —> Ocular branch

  1. Central artery of retina
    - pierces the Optic nerve —> run inside optic nerve
    - emerges at centre of optic disc
    - End-artery (ONLY blood supply to retina)
    - emboli from Carotid can travel to it
  2. Ciliary artery
    - supply Conjunctiva, Sclera, Choroid
21
Q

Venous drainage: Overview

A

Brain and meninges:

  1. Cerebral veins
  2. Dural venous sinuses

Head and face:
1. Veins follow arteries and have same names (e.g. facial artery and vein)

Neck:

  1. Anterior jugular veins
  2. External jugular veins
  3. Internal jugular veins
  4. Vertebral veins
22
Q

Veins of face

A
  1. Facial vein:
    - Union of Supratrochlear + Supraorbital vein
    —> Angular vein
    —> Facial vein
    —> communicates with Ophthalmic, Infraorbital, Deep facial veins
    —> directly into Internal jugular vein
    OR
    —> via Common Facial vein first (variable) —> Internal jugular vein
  2. Retromandibular vein:
    - Union of Superficial temporal + Maxillary vein
    - divided into:
    —> Anterior division: joins Facial vein —> Common facial vein
    —> Posterior division: joins Posterior auricular vein —> External jugular vein
23
Q

Anterior jugular vein

A

Anterior neck drainage

Starting point:
Union of Mental veins (under chin)
—> communications between 2 Anterior jugular veins at Jugular Venous Arch
—> **External jugular vein / **Subclavian vein directly

24
Q

External jugular vein

A

Structures outside skull + External face drainage

Lies ***superficial to Sternocleidomastoid (SCM)

Starting point:
**Parotid gland (under mandible)
—> **Subclavian vein

25
Q

Internal jugular vein

A

Starting point:
**Jugular foramen (at base of skull, as continuation of Sigmoid sinus)
—> **Subclavian vein
—> ***Brachiocephalic vein

Travels down neck in Carotid sheath with Internal / Common carotid arteries + Vagus nerve

26
Q

Vertebral vein

A 
Starting point:
Small veins (at base of skull)
—> Brachiocephalic vein

Travels down transverse foramina (alongside Vertebral arteries) starting at C1
—> although NOT pass through foramen magnum

27
Q

Dural venous sinuses

A
  • Formed between 2 layers of dura mater
  • receive blood from brain
  • Drain into ***Internal jugular vein
  1. Superior / Inferior sagittal
  2. Straight
    —> Confluence of sinuses
    —> Transverse
    —> Sigmoid
  3. Superior / Inferior petrosal
  4. Basilar
  5. Sphenoparietal
    ***6. Cavernous
28
Q

***Cavernous sinus

A
  • Large paired sinus
  • in Middle cranial fossa (side of body of Sphenoid bone)

Receives blood from:

  1. Cerebral veins
  2. Ophthalmic veins (from orbit)
  3. Emissary veins (from pterygoid plexus)

Clinical significance:
1. Connections provide infectious pathway:
Extracranial sites (eyes, face) —> Intracranial locations

  1. Structures in sinus are vulnerable to injury (aneurysms of internal carotid, pituitary adenoma, cavernous sinus thrombosis):
    Within sinus:
    - Internal carotid artery
    - CN6

On the lateral wall:

  • CN3
  • CN4
  • CN5: V1, V2
29
Q

Vertebral venous plexus

A

Internal + External vertebral venous plexus

  • Vertebral column drainage
  • receives blood from Thoracic, Abdominal, Pelvic organs

Internal vertebral venous plexus
- Connect with intracranial Dural venous sinuses (e.g. Occipital, Basilar sinuses)

Clinical significance:
***Intracranial pathway for metastasis
Bloods in these valve-less veins
—> allow retrograde spread of cancer cells from Thoracic, Abdominal, Pelvic regions
—> Vertebral column, Spinal cord, Brain
30
Q

Intracranial venous connections

A 
Clinical significance:
Facial vein (no valves) connects with:
1. Ophthalmic veins
2. Infraorbital vein
3. Deep facial vein
—> pass into deeper regions of head

Interconnections with intracranial Cavernous sinus directly / via Emissary veins

Valve-less Facial vein
—> infections of face
—> extend to intracranial venous sinuses
—> ***Cavernous sinus thrombosis

31
Q

Pterygoid venous plexus

A

Infratemporal fossa (between pterygoid muscle)

Drainage:
Nasal cavity, Paranasal sinuses, nasopharynx, oral cavity, teeth, muscles of mastication

Receives Inferior ophthalmic vein (via Inferior orbital fissure)

Important connections:
Anteriorly: Facial vein (by deep facial vein)
Posteriorly: Retromandibular vein (via maxillary vein)
Superiorly: Cavernous sinus (by emissary veins)

32
Q

Diploic and Emissary veins

A

Diploic veins

  • large thin-walled, valveless veins
  • lying in Diploe (middle spongy layer of cranial bone)
  • connected to Emissary veins

Emissary veins (由skull出面—>skull入面)

  • small valveless veins
  • pass through foramen in cranial bones
  • connect to Dural venous sinuses + Meningeal veins —> Veins external of skull

Clinical significance:

  • Both valve-less veins
  • Possible route for spread of infection from outside to inside (e.g. osteomyelitis, meningitis, encephalitis)
  • Function as alternative pathways for venous OUTflow from intracranial structures
33
Q

Venous channels in Orbit

A
  1. Superior ophthalmic veins
    - superior part of orbit
    - leaves orbit via Superior orbital fissure —> Cavernous sinus
    (- Supratrochlear + Supraorbital + Angular veins)
  2. Inferior ophthalmic veins
    - smaller
    - inferior part of orbit (orbit floor)
    - leaves orbit by:
    —> joining Superior ophthalmic vein —> Cavernous sinus
    OR
    —> passing though inferior orbital fissure —> Pterygoid venous plexus
34
Q

Lymphatic drainage pattern of head and neck

A

Superficial LN (5 groups around base of head) —>
1. Superficial cervical nodes (along **External jugular vein (SCM))
—> Deep cervical nodes (along **Internal jugular vein)
OR
2. Deep cervical nodes directly

Clinical significance:

  1. Obstruction —> Lymphoedema
  2. Channel for spread of malignant disease + infection of head and neck
  3. Site of primary tumour
35
Q

Superficial LN (X rmb details)

A

5 groups of Superficial LN
—> form a ***ring at junction of head and neck
—> drain lymph from scalp + face + neck

  1. Occipital
  2. Mastoid (Posterior auricular nodes)
  3. Pre-auricular + Parotid
  4. Submandibular
  5. Submental
36
Q

Superficial and Deep cervical LN

A

Superficial cervical LN:

  • along ***External jugular vein
  • Posterior + Posterolateral scalp drainage

Deep cervical LN:

  • along ***Internal jugular vein
  • ALL lymph from head and neck
  • 2 groups:
    1. Superior group (with Jugulo-digastric node / tonsilar)
    2. Inferior group (with Jugulo-omohyoid node / lingual)

HNNS (58 decks)

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