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MBBS II HNNS > L24 – Vasculature, Lymphatics of Head, Neck > Flashcards

L24 – Vasculature, Lymphatics of Head, Neck Flashcards

1
Q

Branches off the aorta that supplies the head and neck? (3)

A

Carotid arteries:
- Right, left common carotid arteries
» internal, external carotid arteries on each side

Left, right subclavian arteries

Right Brachiocephalic/ innominate artery

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2
Q

List 2 anatomical variants of the left carotid artery origin.

A

 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)

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3
Q

Landmark for bifurcation of common carotid arteries into internal and external c.a.?

A

upper margin of thyroid cartilage (level of C4) = bifurcation of carotid

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4
Q

List 6 Head and neck structures supplied by the external carotid artery?

A

• Scalp • Face • Maxilla • Tongue • Glands • Pharynx

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5
Q

List the 8 branches of the external carotid artery?

StOP F SLAM

A
  • Superficial Temporal (Scalp)
  • Occipital(Scalp)
  • Posterior Auricular(Scalp)

• Facial(Face)

  • Superior Thyroid(Glands)
  • Lingual(Tongue)
  • Ascending Pharyngeal (Pharynx)
  • Maxillary(Maxilla)
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6
Q

Anatomical location of the segments of the Maxillary artery in relation to the lateral pterygoid muscle?

A

1st (Mandibular) Posterior to lateral pterygoid

2nd (Pterygoid/muscular) within lateral pterygoid

3rd (Pterygopalatine) anterior to lateral pterygoid

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7
Q

List the branches of the 1st segment of the maxillary artery?

DAM I AM Piss Drunk But Getting Past Police Is Actually Scary

A
  • deep auricular artery
  • anterior tympanic artery
  • middle meningeal artery exam
  • inferior alveolar artery
  • accessory meningeal artery
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8
Q

List the branches of the 2nd segment of the maxillary artery?
DAM I AM Piss Drunk But Getting Past Police Is Actually Scary

A
  • masseteric artery
  • pterygoid branches
  • (Ant and post.) Deep temporal branches
  • buccinator artery
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9
Q

List the branches of the 3rd segment of the maxillary artery?

DAM I AM Piss Drunk But Getting Past Police Is Actually Scary

A
  • greater (descending) palatine artery
  • posterior superior alveolar artery
  • pharyngeal artery
  • infraorbital artery
  • artery of the pterygoid canal
  • sphenopalatine artery
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10
Q

Structures supplied by the internal carotid artery?

A

 Brain (exam)
 Eye (exam)
 Nasal cavity
 Scalp

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11
Q

3 main branches of the internal carotid artery?

A
  • Anterior and middle cerebral arteries (circle of willis)

- Opthalmic arteries

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12
Q

List all the arteries that form the circle of willis?

A
  • Two Internal carotidarteries
  • Two Anterior cerebralarteries
  • Two Posterior cerebral arteries
  • SINGLE Anterior communicating artery
  • Two Posterior communicating artery
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13
Q

What is the course of the opthalmic arteries?

A

From internal cartoid:

Run alongside CN II optic nerve via optic canal

> > Ocular branches (lateral) or Orbital branches (medial)

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14
Q

List the ocular branches of the opthalmic artery?

CASS

A
  • Central artery of the retina most important
  • Anterior ciliary artery
  • Short & long posterior ciliary arteries
  • Superior and inferior muscular arteries
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15
Q

List the orbital branches of the opthalmic artery?

MAD SSZZ

A
  • Muscular artery
  • Ant. & Post. ethmoidal artery exam
  • Dorsal nasal artery
  • Supratrochlear artery
  • Supraorbital artery
  • Zygomatico-facial artery exam
  • Zygomatico-temporal artery exam
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16
Q

Origin, course and supply of the central artery of the retina?

A

Ocular branch of the opthalmic arteries from internal carotid artery

> > Emerges at center of optic disc, pierces + travels inside optic nerve as end-artery

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17
Q

Occlusion of which artery causes ishaemia of central retina?

A

Central artery of the retina (an ocular branch of opthalmic artery)

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18
Q

Which arteries supply the ciliary muscles?

A

Short, long posterior ciliary arteries (an ocular branch of opthalmic artery)

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19
Q

Which arteries supply the conjunctiva, sclera, choroid of the eye?

A

Anterior ciliary artery (an ocular branch of opthalmic artery)

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20
Q

Which opthalmic arteries supply the ethmoid region of the orbit?

A

Anterior, posterior ethmoidal artery (around ethmoid region) (exam)

An orbital branch of the opthalmic artery

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21
Q

Which opthalmic arteries supply the nasal region of the orbit?

A

Dorsal nasal artery

An orbital branch of the opthalmic artery

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22
Q

Which opthalmic arteries supply the region of the orbit above the eyes?

A

 Supratrochlear artery (above eye)

 Supraorbital artery (above eye)

Both orbital branches of the opthalmic artery

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23
Q

Which arteries supply the lateral regions of the orbit?

A

 Zygomatico-facial artery (lateral) (exam)

 Zygomatico-temporal artery (lateral) (exam)

orbital branches of the opthalmic artery

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24
Q

List the 3 major subclavian branches? Branches to musculature of Head and neck?

A
  1. 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&raquo_space; Deep cervical artery

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25
Q

Sequence of structures that the vertebral arteries pass through/ join? (ascends through what structures, enters cranium where, terminates where…)

A
  • 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
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26
Q

3 ways that carotid stenosis increases the risk of stroke?

A
  1. Narrow the artery = decrease blood flow
  2. Roughen the arterial wall = thrombosis (form blood clots to block blood flow)
  3. Embolism: plaque deposits / blood clots break away and travel to brain (e.g. Circle of Willis) = cut off blood flow
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27
Q

How to investigate carotid bruit in potential stroke patients?

A

Auscultate / Doppler Ultrasound

28
Q

List the arteries and their origin in the anastomoses of the scalp?

A

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)
29
Q

List the arteries and their origin in the anastomoses of the face?

A

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
30
Q

List the arteries and their origin in the anastomoses of the nasal cavity?

A

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)

31
Q

Area of nasal cavity that is prone to bleeding? Explain why this area

A

Little’s Area (Kiesselbach’s area) prone to nosebleeds (because of significant anastomoses)

32
Q

List the arteries and their origin in the anastomoses of the thyroid, parathyroid gland?

A

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)

33
Q

What is the clinical significant of the thyroid ima artery?

A

Cut thyroid ima vessel during neck surgery, e.g., thyroidectomy, leads to uncontrollable bleeding

34
Q

List the arteries and their origin in the anastomoses of the oral cavity?

A

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

35
Q

List the arteries and their origin in the anastomoses of the palate?

A

External carotid only:

Maxillary artery:

1) Sphenopalatine artery
2) Greater palatine artery
3) Lesser palatine artery

36
Q

Describe the course of the sphenopalatine artery from maxillary artery to reach palate?

A

after passing through the nasal cavity

> > enters the palate through incisive foramen

37
Q

Describe the course of the greater palatine artery from maxillary artery?

A

Greater palatine canal&raquo_space; emerges onto the palate through the greater palatine foramen

passing forward to join sphenopalatine artery

38
Q

Describe the course of the lesser palatine artery from maxillary artery?

A

Passes through lesser palatine foramen

supplies the soft palate

39
Q

List the veins that drain the neck?

A
  • Anterior jugular veins
  • External jugular veins
  • Internal jugular veins
  • Vertebral veins
40
Q

Tract the drainage of the Facial vein? (formed by union of which veins, communicates with which, drain into which veins?)

A
  • 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
41
Q

Tract the drainage of the Retromandibular vein? (formed by union of which veins, drain into which veins?)

A
  • Formed by the union of Superficial temporal & Maxillary vein
  • Divided into:
    a) Anterior division-joins Facial vein to form Common facial vein&raquo_space; IJV

b) Posterior division-joins Post. auricular vein to form Ext. jugular vein

42
Q

Starting and end point of the anterior jugular veins? What does it drain and which veins does it join?

A

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
43
Q

Starting and end point of the external jugular veins? What muscle does it lie across? Branches?

A

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

44
Q

Starting and end point of the internal jugular veins? What structures travel along this vein? Branches??

A
  • 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

45
Q

Starting, course, and end point of the Vertebral vein?

A

• 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

46
Q

Which layer of the meninges form the dural venous sinuses?

A

Formed between two layers of dura mater

47
Q

Where do dural venous sinuses drain into ultimately?

A

Internal jugular veins

48
Q

List the cerebral dural venous sinuses at the back of head?

A 
 Superior (falx cerebri), inferior sagittal 
 Straight 
 Confluence of sinuses 
 Transverse 
 Sigmoid
49
Q

List the cerebral dural venous sinuses at the middle and anterior part of the head?

A

 Sphenoparietal
 Superior, inferior petrosal
 Basilar (small)
 Cavernous sinus (big) (exam)

50
Q

Location of cavernous sinus?

A

Paired sinus in middle cranial fossa;on side of the body of sphenoid bone

51
Q

Cavernous sinus receives blood from?

A
  • Cerebral veins
  • Superior and inferior Ophthalmic veins (from the orbit)
  • Emissary veins (from pterygoid plexus)
  • Facial veins
52
Q

Give 2 passage that provides a way for extracranial infections to move intracranially?

A

1) Facial vein (communicates with cavernous sinus) has no valves&raquo_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)

53
Q

List the sturctures that go through the cavernous sinus?

A

 Internal carotid artery

 Abducens nerve (CN VI)

54
Q

List the structures that lie on the lateral wall of the cavernous sinus?

A

 Oculomotor nerve (CN III)

 Trochlear nerve (CN IV)

 Trigeminal nerve (CN V): ophthalmic (V1), maxillary (V2)

55
Q

Which structure within the cavernous sinus is vulnerable to injury? Give 3 potential causes of damage?

A

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

56
Q

List the deep veins in the head that connects with the facial vein? How do they connect to Cavernous sinus?

A
  • Ophthalmic veins
  • Infraorbital vein
  • Deep facial vein

All these channels have interconnections with intracranial Cavernous sinus directly or via emissary veins&raquo_space; cavernous sinus

57
Q

Location of Pterygoid venous plexus?

A

lies in the infratemporal fossa between the pterygoid muscles

58
Q

What does the Pterygoid venous plexus drain?

A

Drains nasal cavity & paranasal sinuses, nasopharynx, oral cavity, teeth, muscles of mastication

59
Q

Describe how the superior and inferior opthalmic veins from the orbit go to the cavernous sinus?

A

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)

60
Q

What veins do the pterygoid plexus receive? Which veins does it connect with anteriorly, posteriorly and superiorly?

A

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)
61
Q

What do emissary veins pass through in the cranium? What do they connect?

A

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)

62
Q

Which veins joins to form the superior opthalmic veins?

A

Confluence of supratrochlear, supraorbital and angular veins

63
Q

Describe one pathway for intracranial metastasis to other parts of the body?

A

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

64
Q

Sequence of drainage of superficial nodes?

A

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)

65
Q

List the 5 groups of superficial lymph nodes of the head?

A

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

66
Q

Course of superficial cervical lymph nodes? receive lymph from where?

A

 Along external jugular vein
 Receive lymphatic drainage from posterior, posterolateral scalp
 Drain to deep cervical nodes

67
Q

Course and drainage of Deep cervical nodes? How are these nodes divided anatomically?

A

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)

MBBS II HNNS (57 decks)

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