L24 – Vasculature, Lymphatics of Head, Neck Flashcards
Branches off the aorta that supplies the head and neck? (3)
Carotid arteries:
- Right, left common carotid arteries
» internal, external carotid arteries on each side
Left, right subclavian arteries
Right Brachiocephalic/ innominate artery
List 2 anatomical variants of the left carotid artery origin.
1-22% population: left common carotid and right brachiocephalic (innominate) have common origin
9% population: left common carotid artery originates from the right brachiocephalic artery (separately)
Landmark for bifurcation of common carotid arteries into internal and external c.a.?
upper margin of thyroid cartilage (level of C4) = bifurcation of carotid
List 6 Head and neck structures supplied by the external carotid artery?
• Scalp • Face • Maxilla • Tongue • Glands • Pharynx
List the 8 branches of the external carotid artery?
StOP F SLAM
- Superficial Temporal (Scalp)
- Occipital(Scalp)
- Posterior Auricular(Scalp)
• Facial(Face)
- Superior Thyroid(Glands)
- Lingual(Tongue)
- Ascending Pharyngeal (Pharynx)
- Maxillary(Maxilla)
Anatomical location of the segments of the Maxillary artery in relation to the lateral pterygoid muscle?
1st (Mandibular) Posterior to lateral pterygoid
2nd (Pterygoid/muscular) within lateral pterygoid
3rd (Pterygopalatine) anterior to lateral pterygoid
List the branches of the 1st segment of the maxillary artery?
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- deep auricular artery
- anterior tympanic artery
- middle meningeal artery exam
- inferior alveolar artery
- accessory meningeal artery
List the branches of the 2nd segment of the maxillary artery?
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- masseteric artery
- pterygoid branches
- (Ant and post.) Deep temporal branches
- buccinator artery
List the branches of the 3rd segment of the maxillary artery?
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- greater (descending) palatine artery
- posterior superior alveolar artery
- pharyngeal artery
- infraorbital artery
- artery of the pterygoid canal
- sphenopalatine artery
Structures supplied by the internal carotid artery?
Brain (exam)
Eye (exam)
Nasal cavity
Scalp
3 main branches of the internal carotid artery?
- Anterior and middle cerebral arteries (circle of willis)
- Opthalmic arteries
List all the arteries that form the circle of willis?
- Two Internal carotidarteries
- Two Anterior cerebralarteries
- Two Posterior cerebral arteries
- SINGLE Anterior communicating artery
- Two Posterior communicating artery
What is the course of the opthalmic arteries?
From internal cartoid:
Run alongside CN II optic nerve via optic canal
> > Ocular branches (lateral) or Orbital branches (medial)
List the ocular branches of the opthalmic artery?
CASS
- Central artery of the retina most important
- Anterior ciliary artery
- Short & long posterior ciliary arteries
- Superior and inferior muscular arteries
List the orbital branches of the opthalmic artery?
MAD SSZZ
- Muscular artery
- Ant. & Post. ethmoidal artery exam
- Dorsal nasal artery
- Supratrochlear artery
- Supraorbital artery
- Zygomatico-facial artery exam
- Zygomatico-temporal artery exam
Origin, course and supply of the central artery of the retina?
Ocular branch of the opthalmic arteries from internal carotid artery
> > Emerges at center of optic disc, pierces + travels inside optic nerve as end-artery
Occlusion of which artery causes ishaemia of central retina?
Central artery of the retina (an ocular branch of opthalmic artery)
Which arteries supply the ciliary muscles?
Short, long posterior ciliary arteries (an ocular branch of opthalmic artery)
Which arteries supply the conjunctiva, sclera, choroid of the eye?
Anterior ciliary artery (an ocular branch of opthalmic artery)
Which opthalmic arteries supply the ethmoid region of the orbit?
Anterior, posterior ethmoidal artery (around ethmoid region) (exam)
An orbital branch of the opthalmic artery
Which opthalmic arteries supply the nasal region of the orbit?
Dorsal nasal artery
An orbital branch of the opthalmic artery
Which opthalmic arteries supply the region of the orbit above the eyes?
Supratrochlear artery (above eye)
Supraorbital artery (above eye)
Both orbital branches of the opthalmic artery
Which arteries supply the lateral regions of the orbit?
Zygomatico-facial artery (lateral) (exam)
Zygomatico-temporal artery (lateral) (exam)
orbital branches of the opthalmic artery
List the 3 major subclavian branches? Branches to musculature of Head and neck?
- Vertebral artery
2. Thyrocervical trunk • Inferior thyroid artery • Ascending cervical artery (+ suprascapular + dorsal scapular) 3. Internal thoracic artery
To musculature of head, neck:
4. Costocervical trunk»_space; Deep cervical artery
Sequence of structures that the vertebral arteries pass through/ join? (ascends through what structures, enters cranium where, terminates where…)
- Ascends through traverse foramina of the upper six cervical vertebrae
- Enters cranium via foramen magnum
- 2 vertebral arteries join to form the Basilar artery & terminates into 2 Posterior cerebral arteries
- Contributes to Circle of Willis
3 ways that carotid stenosis increases the risk of stroke?
- Narrow the artery = decrease blood flow
- Roughen the arterial wall = thrombosis (form blood clots to block blood flow)
- Embolism: plaque deposits / blood clots break away and travel to brain (e.g. Circle of Willis) = cut off blood flow
How to investigate carotid bruit in potential stroke patients?
Auscultate / Doppler Ultrasound
List the arteries and their origin in the anastomoses of the scalp?
From external carotid artery:
Superficial temporal
Occipital
Posterior auricular
From Internal carotid artery: upper branches of ophthalmic artery: Supratrochlear Supraorbital Zygomatico-temporal (Orbital group, not ocular)
List the arteries and their origin in the anastomoses of the face?
From external carotid artery:
Superficial temporal artery
Facial artery
Maxillary artery
From internal cartoid: Ophthalmic artery (most anterior) >> dorsal nasal >> angular >> Facial a. of ECA
List the arteries and their origin in the anastomoses of the nasal cavity?
From external carotid:
1) Maxillary artery:
- Sphenopalatine
- Greater palatine
2) Facial artery:
- Superior labial
- Lateral nasal
From internal carotid:
Ophthalmic artery: Anterior + posterior ethmoidal arteries (septal branches)
Area of nasal cavity that is prone to bleeding? Explain why this area
Little’s Area (Kiesselbach’s area) prone to nosebleeds (because of significant anastomoses)
List the arteries and their origin in the anastomoses of the thyroid, parathyroid gland?
From external carotid:
Superior thyroid artery (supplies superior thyroid)
From subclavian:
- Inferior thyroid artery supplies inferior thyroid, parathyroid glands
(Thyroid ima artery: 1-2% of population, Supplies inferior thyroid)
What is the clinical significant of the thyroid ima artery?
Cut thyroid ima vessel during neck surgery, e.g., thyroidectomy, leads to uncontrollable bleeding
List the arteries and their origin in the anastomoses of the oral cavity?
EXTERNAL CAROTID ONLY
1) Facial Artery
• Superior Labial
• Lateral Nasal
+ Greater and Lesser palatine
2) Maxillary artery
• Superior and inferior alveolar
+ Buccal
3) Lingual artery
• Dorsal lingual • Deep lingual • Sublingual
List the arteries and their origin in the anastomoses of the palate?
External carotid only:
Maxillary artery:
1) Sphenopalatine artery
2) Greater palatine artery
3) Lesser palatine artery
Describe the course of the sphenopalatine artery from maxillary artery to reach palate?
after passing through the nasal cavity
> > enters the palate through incisive foramen
Describe the course of the greater palatine artery from maxillary artery?
Greater palatine canal»_space; emerges onto the palate through the greater palatine foramen
passing forward to join sphenopalatine artery
Describe the course of the lesser palatine artery from maxillary artery?
Passes through lesser palatine foramen
supplies the soft palate
List the veins that drain the neck?
- Anterior jugular veins
- External jugular veins
- Internal jugular veins
- Vertebral veins
Tract the drainage of the Facial vein? (formed by union of which veins, communicates with which, drain into which veins?)
- Begins as Angular vein by the union of Supratrochlear & Supraorbital veins
- Communicates with Ophthalmic, Infraorbital & Deep facial veins
- Drains either directly into Internal jugular vein or through the Common facial vein
Tract the drainage of the Retromandibular vein? (formed by union of which veins, drain into which veins?)
- Formed by the union of Superficial temporal & Maxillary vein
- Divided into:
a) Anterior division-joins Facial vein to form Common facial vein»_space; IJV
b) Posterior division-joins Post. auricular vein to form Ext. jugular vein
Starting and end point of the anterior jugular veins? What does it drain and which veins does it join?
Drains blood from anterior neck:
- Starting point: Uniting of mental veins (under chin)
- Ends:at the External jugular vein OR Subclavian vein
- Communication between the two anterior jugular veins at the Jugular Venous Arch
Starting and end point of the external jugular veins? What muscle does it lie across? Branches?
Drains blood from structures outside the skull & external face
- Starting point: parotid gland (under mandible)
- Ends:at the Subclavian vein
- Lies superficial to the sternocleidomastoid muscle (SCM)
Posterior EJV, Transverce cervical vein, Suprascapular vein, Jugular venous arch
Starting and end point of the internal jugular veins? What structures travel along this vein? Branches??
- Starting point: at the jugular foramen as a continuation of sigmoid sinus (at base of skull)
- Ends: at the Subclavian vein forming the Brachiocephalic vein
- Travels down neck in the Carotid sheath with the internal/common carotid arteries & vagus nerve
Pharyngeal vein, Common facial vein, Lingual vein Superior and Middle thyroid vein, Occipital vein, Br. to External jugular vein
Starting, course, and end point of the Vertebral vein?
• Starting point:small veins at the base of the skull
> > Travels down transverse foramen (alongside vertebral arteries) starting at C1, Does not pass through the foramen magnum!
• Ends: Brachiocephalic vein
Which layer of the meninges form the dural venous sinuses?
Formed between two layers of dura mater
Where do dural venous sinuses drain into ultimately?
Internal jugular veins
List the cerebral dural venous sinuses at the back of head?
Superior (falx cerebri), inferior sagittal Straight Confluence of sinuses Transverse Sigmoid
List the cerebral dural venous sinuses at the middle and anterior part of the head?
Sphenoparietal
Superior, inferior petrosal
Basilar (small)
Cavernous sinus (big) (exam)
Location of cavernous sinus?
Paired sinus in middle cranial fossa;on side of the body of sphenoid bone
Cavernous sinus receives blood from?
- Cerebral veins
- Superior and inferior Ophthalmic veins (from the orbit)
- Emissary veins (from pterygoid plexus)
- Facial veins
Give 2 passage that provides a way for extracranial infections to move intracranially?
1) Facial vein (communicates with cavernous sinus) has no valves»_space; Infections of the face may extend to intracranial venous sinuses → Caverneous sinus thrombosis (CST)
2) Emissary veins penetrate cranial bone via foramen, connect dural venous sinus with scalp veins →Possible route for spread of infection (osteomyelitis, meningitis, encephalitis)
List the sturctures that go through the cavernous sinus?
Internal carotid artery
Abducens nerve (CN VI)
List the structures that lie on the lateral wall of the cavernous sinus?
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Trigeminal nerve (CN V): ophthalmic (V1), maxillary (V2)
Which structure within the cavernous sinus is vulnerable to injury? Give 3 potential causes of damage?
Abducens nerve (CN VI) passes through the cavernous sinus = Vulnerable to injury
Aneurysm of internal carotid artery
Pituitary adenoma
Cavernous sinus thrombosis (CST)
Consequence: abducens nerve paralysis
List the deep veins in the head that connects with the facial vein? How do they connect to Cavernous sinus?
- Ophthalmic veins
- Infraorbital vein
- Deep facial vein
All these channels have interconnections with intracranial Cavernous sinus directly or via emissary veins»_space; cavernous sinus
Location of Pterygoid venous plexus?
lies in the infratemporal fossa between the pterygoid muscles
What does the Pterygoid venous plexus drain?
Drains nasal cavity & paranasal sinuses, nasopharynx, oral cavity, teeth, muscles of mastication
Describe how the superior and inferior opthalmic veins from the orbit go to the cavernous sinus?
Superior ophthalmic veins:
Form at confluence of supratrochlear, supraorbital, angular veins
Pass across superior part of orbit
Leave orbit through superior orbital fissure → cavernous sinus
Inferior ophthalmic veins: Smaller, runs on orbital floor
Leave the orbit by:
1) Joining with superior ophthalmic vein → cavernous sinus, or;
2) Passing through inferior orbital fissure → pterygoid venous plexus (superior connection to cavernous sinus)
What veins do the pterygoid plexus receive? Which veins does it connect with anteriorly, posteriorly and superiorly?
Inf. ophthalmic vein
- Anteriorly with Facial vein (by deep facial vein)
- Posteriorly with Retromandibular vein (via maxillary vein)
- Superiorly with Cavernous sinus (by emissary veins)
What do emissary veins pass through in the cranium? What do they connect?
passing through foramen in cranial bones
Connect Dural venous sinuses, meningeal veins to veins external of skull
some connect to diploic veins (= large thin-walled,
valveless veins lying in the diploë (middle spongy layer) of cranial bones)
Which veins joins to form the superior opthalmic veins?
Confluence of supratrochlear, supraorbital and angular veins
Describe one pathway for intracranial metastasis to other parts of the body?
Dural venous sinuses connect with internal and external vertebral venous plexuses in skill
> > Collect blood from vertebral column (thoracic, abdominal, pelvic organs)
Connect with intracranial venous sinuses
Allow retrograde spread of thoracic / abdomen / pelvis to vertebral column, spinal cord, brain
Sequence of drainage of superficial nodes?
Superficial nodes (around base of head i.e. submental, submandicular…etc)
> > superficial cervical nodes (along external jugular vein)
> > deep cervical nodes (along internal jugular vein)
List the 5 groups of superficial lymph nodes of the head?
Drain lymph from scalp, face, neck (from back to front):
- Occipital nodes
- Mastoid nodes (retroauricular/posterior auricular nodes)
- Pre-auricular, parotid nodes
- Submandibular nodes
- Submental nodes
> > Drain to superficial cervical nodes or directly to deep cervical nodes
Course of superficial cervical lymph nodes? receive lymph from where?
Along external jugular vein
Receive lymphatic drainage from posterior, posterolateral scalp
Drain to deep cervical nodes
Course and drainage of Deep cervical nodes? How are these nodes divided anatomically?
Along internal jugular vein
Receives all the lymph from head, neck
Divided into:
1) Superior group with jugulo-digastric node (tonsilar)
2) Inferior group with jugulo-omohyoid node (lingual)
