L7: Blood vessels of the head and neck

Question 1

Why are the vessels of the neck important?

Answer 1

• major vessels supplying and draining the brain
• access route (exposed so easy route to get to body’s blood supply)
• important in clinical examination (carotid pulse/jugular venous pressure)

Question 2

What are most of the vessels in the neck covered by?

Answer 2

SCM

Question 3

What are the major blood vessels under the SCM?

Answer 3

Right to left

common carotid artery/internal jugular vein/external jugular vein

Question 4

Which blood vessel overlies the SCM?

Answer 4

External jugular vein

Question 5

What vessels branch off the right subclavian artery?

Answer 5

• vertebral artery which ascends
• thyrocervical trunk splits into 2, one being the inferior thyroid artery
• internal thoracic artery which supply the chest wall

Question 6

What nerve does the inferior thyroid artery lie near?

Answer 6

Recurrent laryngeal nerve (surgeons have to be careful of when doing thyroid surgery)

Question 7

What is the course of the right common carotid artery?

Answer 7

Ascends upwards until it reaches the carotid sinus, where the baroreceptors sit, and it then bifurcates to form the right internal and external carotid arteries.

Question 8

What level does the bifurcation of the common carotid artery occur?

Answer 8

Superior border of the thyroid cartilage (C4) (Adam’s apple)

Question 9

What is the internal thoracic artery also known as?

Answer 9

Internal mammary artery, often use this in reconstructive surgery

Question 10

What is the importance of the carotid triangle?

Answer 10

• bifurcation of the common carotid occurs within the triangle
• important clinically for surgery

Question 11

Where is atherosclerosis likely to occur?

Answer 11

Bifurcation of the common carotid artery (around site of internal carotid)

• causes vessel to narrow
• risk of plaque rupturing sending an embolus up to brain causing a stroke/TIA/amaurosis fugax (transient loss of vision in the eye)

Question 12

What is a TIA?

Answer 12

Transient ischaemic attack

Question 13

How do you treat atherosclerosis at the bifurcation of the carotid artery?

Answer 13

Carotid endarterectomy
-incision into the carotid triangle (neck and carotid)
-remove plaque tissue and stitch back up
Reduces risk of stroke

Question 14

What does transient mean?

Answer 14

For a short time (not long lasting)

Question 15

What could you do to the carotid sinus if a patient is tachycardic?

Answer 15

Massage the carotid sinus to slow down the heart rate.

• pressure at site of carotid bodies
• increased baroreceptor feedback to heart to slow down
• can determine pulse here

Question 16

What is the importance of the internal jugular vein in the carotid triangle?

Answer 16

-cannulate it to give drugs/fluid directly as it is a large central vein that is superficial and easily accessible, so is a good place for central venous line