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Head & Neck > Major Vessels > Flashcards

Major Vessels Flashcards

1
Q

What level does the common carotid artery bifurcate at? What is the clinical significance of this?

A

Superior border of thyroid cartilage (C4)

THEREFORE THE COMMON CAROTID ARTERY GIVES OFF NO BRANCHES IN THE NECK!!!

Carotid sinus in region of bifurcation —> carotid sinus massage to reduce BP (reversal of SVT) by activating baroreceptors

Common site of atheroma formation —> stenosis —> bruit
+ risk of rupturing clot —> embolism —> TIA (check for bruit before performing carotid sinus massage)

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2
Q

What are the main arteries branching off from the thyrocervical trunk?

A

Suprascapular artery —> scapular region

Transverse cervical artery —> neck

Ascending cervical artery —> neck

Inferior thyroid artery (posterior to common carotid artery) —> lower pole of thyroid gland

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3
Q

What are the major vessels of the head and neck?

A

Arteries arising from arch of the aorta:

RIGHT LEFT
Brachiocephalic trunk Left common carotid Left subclavian

  • brachiocephalic gives off right subclavian and right common carotid arteries
  • right subclavian artery gives off: internal thoracic, thyrocervical, and vertebral arteries
  • common carotid arteries split into internal and external carotid arteries (left and right)

Veins: left and right internal and external jugular veins

  • internal jugular vein deep to sternocleidomastoid, lateral to common carotid artery
  • external jugular vein superficial to sternocleidomastoid

note: JVP is the right internal jugular vein (indicates pressure in right atrium, as there are no valves so a column of blood can form)

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4
Q

Outline the course and branches of the maxillary artery.

A

Terminal branch of external carotid artery

Originates adjacent to the neck of the mandible and passes through the infratemporal fossa and into the pterygopalatine fossa

Branches:

  • posterior superior alveolar artery
  • infra-orbital artery
  • greater palatine artery
  • pharyngeal branch
  • sphenopalatine artery
  • artery of pterygoid region
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5
Q

What are the branches of the external carotid artery?

A
  • superior thyroid artery
  • lingual artery
  • facial artery
  • ascending pharyngeal artery
  • occipital artery
  • posterior auricular artery
  • superficial temporal artery (terminal branch)
  • maxillary artery (terminal branch)
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6
Q

What is the arterial blood supply of the scalp? Which arteries are branches of the internal carotid artery, and which are branches of the external carotid artery?

A

Anterior & Superior scalp: supraorbital & supratrochlear arteries
Posterior to ear: posterior auricular artery
Posterior scalp: occipital artery
Lateral scalp: superficial temporal artery

Internal carotid artery —> ophthalmic artery —>

  • –> supraorbital artery
  • –> supratrochlear artery

External carotid artery —>

  • –> superficial temporal artery
  • –> posterior auricular artery
  • –> occipital artery
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7
Q

What are the different layers of the scalp? Which layer contains the blood vessels supplying the scalp?

A

SCALP =

Skin
Connective tissue (dense) (contains vessels of scalp)
Aponeurosis (epicranial)
Loose connective tissue 
Periosteum

note: fluid collecting in the dense connective tissue layer tracks forward into the orbital region because:
- the epicranial aponeurosis is continuous with the temporal fascia attached to the zygomatic arches (therefore does not move into
subtemporal region)
- occipitalis muscle attached to occipital bone & mastoid process (therefore does not move into occipital region)
- frontalis muscle inserts into skin/subcutaneous tissue, not bone (therefore fluid can move into the upper eyelids)

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8
Q

What are some factors which mean that the scalp bleeds profusely? Can loss of blood supply to the scalp lead to necrosis of the underlying bone?

A

Walls of arteries are closely attached to the connective tissue (limited constriction)

Numerous anastomoses (therefore little point in compressing inferior parts of arteries to try and stem bleeding)

Occipitofrontalis has opposing pull which keeps lacerations involving the epicranial aponeurosis open

Scalp and skull blood supplies are different, so loss of the scalp does not lead to underlying bone necrosis

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9
Q

What is the venous drainage of the scalp? Which parts of the scalp does each vein drain?

A

Anterior scalp: supratrochlear and supraorbital veins
Lateral scalp: superficial temporal veins
Posterior to ear: posterior auricular vein
Posterior scalp: occipital vein

Superficial veins accompany arteries:

  • superficial temporal vein
  • occipital vein
  • posterior auricular vein

Supraorbital and supratrochlear veins join at medial angle of eye —> angular vein —> facial vein

Some deep parts of scalp in temporal region have veins draining into the pterygoid venous plexus

note: veins of the scalp —> diploic veins —> emissary veins —> dural venous sinus (veins are valveless, so infection of scalp can spread to meninges)

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10
Q

How is the blood supply preserved when the cranial cavity needs to be accessed?

A

Craniotomy = bone and scalp flap reflected inferiorly

Superficial temporal artery and middle meningeal artery kept intact

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11
Q

What is the main arterial supply of the skull and dura mater?

A

Middle meningeal artery (branch of maxillary artery)

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11
Q

Outline the arterial blood supply to the brain.

A

Left and right vertebral arteries (from left and right subclavian arteries) ascend through the transverse foramina of the cervical vertebrae (6)

—–> enter cranial cavity through foramen magnum —> fuse to form the basilar trunk —> posterior cerebral arteries

Internal carotid arteries enter the skull through carotid canals

—> anterior and middle cerebral arteries, ophthalmic artery, posterior communicating artery

Vertebral arteries and internal carotid arteries connect to form the cerebral arterial circle (of Willis):

  • anterior communicating artery connects left and right anterior cerebral a arteries
  • two posterior communicating arteries (left and right?) connect internal carotid arteries to posterior cerebral artery
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12
Q

Outline the venous drainage of the brain.

A

Cerebral and cerebellum veins drain into dural venous sinuses = endothelium-lined spaces between periosteal and meningeal layers of the dura (form at dural septae)

Includes:

  • superior and inferior sagittal sinuses
  • sigmoid sinus
  • transverse sinus
  • confluence of sinuses
  • cavernous sinus
    etc.

Dural venous sinuses drain into the internal jugular veins

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13
Q

Outline the superficial arterial supply of the face. Which arteries are branches of the internal carotid artery, and which are branches of the external carotid arteries?

A

Internal carotid artery —> ophthalmic artery

  • –> supraorbital artery
  • –> supratrochlear artery

External carotid artery —>

  • –> angular artery
  • –> lateral nasal artery
  • –> superior and inferior labial arteries
  • –> facial artery
  • –> maxillary artery
  • –> transverse facial artery

note: pulse of facial artery can be felt at inferior border of the mandible, anterior to the masseter muscle

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14
Q

Outline the venous drainage of the face.

A

Facial vein communicates with:

  • ophthalmic veins at medial angle of eye (via angular vein) —> cavernous sinus
  • pterygoid venous plexus (via deep facial veins)

Therefore infection can spread to intracranial sinuses (veins are valveless so infection can go backwards) e.g. thrombophlebitis of facial vein can travel to intracranial venous system

Supraorbital & supratrochlear veins —> angular vein —> superior & inferior labial veins —> facial vein —> common facial vein

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15
Q

What are the contents of the cavernous sinus?

A

Cavernous sinus = plexus of extremely thin-walled veins on upper surface of sphenoid bone

O TOM CAT

  • oculomotor nerve (CNIII)
  • trochlear nerve (CNIV)
  • ophthalmic branch of trigeminal nerve (CNV1)
  • maxillary branch of trigeminal nerve (CNV2)
  • internal carotid artery
  • abducent nerve (CNVI)
  • trochlear nerve (CNIV)

+ pituitary gland?

16
Q

What is the danger triangle of the face, and what is its clinical significance?

A

Site where infection of the face can spread from the facial vein to the cavernous sinus (and other dural venous sinuses), causing meningitis/brain abscesses/thrombosis)

Triangle constructed from corners of the mouth and the bridge of the nose.

17
Q

What is a lymphatic system? What areas of the body do not have lymphatics present? Why is the lymphatic system important?

A

System of vessels and lymphoid organs that drain tissue fluid from the extracellular component to the circulatory (venous) system

Absent in the CNS, eyeballs, inner ear, avascular planes of cartilage, bone

  • major constituent of immune system
  • fluid balance/determination of cell volume (blockage —> lymphoedema)
  • absorbs/transports fats from digestive system
  • conduit for spread of infection/cancer (primary and secondary)
  • assists capillaries in returning plasma proteins (which leak into the ECF)
  • assists transport of cellular debris which does not use the circulatory system
18
Q

What is lymph composed of? What function does it serve? How much is produced per day?

A

Transudative fluid, alkaline, transparent, yellowish (although this depends on the location in the body)

  • 96% water (exerts an osmotic effect)
  • 4% solutes: electrolytes (osmotic effect), 2%-6% proteins (oncotic effect), 5%-15% lipids, glucose
  • cells (mainly lymphocytes)

Lymph formed when water leaves blood and enters the extracellular compartment (via Starling’s forces) - ~10% of blood volume which passes through the tissues returns via lymphatics, not venous system

Bathes all cells of the body (most widely distributed tissue in body)

Low pressure; movement driven by breathing and muscle contraction.

3-4l of lymph produced per day (at rest) = ~120ml/hr flow (100ml through thoracic duct, 20ml through right lymphatic duct)

note: chyle = lymph produced by small intestines

19
Q

What are the components of a lymph channel? How does lymph drain in general?

A

Lymphatic capillaries (microscopic) —> Lymphatic vessels (lymphangions) —> Lymph node —> Collecting trunks —> Lymphatic ducts (right lymph duct or thoracic duct) —> Subclavian vein

Afferent lymphatics —> Follicles (of lymph node) —> Efferent lymphatics

Superficial lymph vessels drain the skin and follow venous drainage
Superficial lymph vessels drain into deep lymph vessels
Deep lymph vessels tend to accompany arteries (except head and neck deep lymphatics, which follow veins)

20
Q

What are the main organs of the lymphatic system?

A 
Tonsils 
Lymph nodes & lymphatic vessels 
Thymus 
Spleen 
Peyer's patches 
Appendix 
Bone marrow
21
Q

What quadrant of the body does the right lymphatic duct drain? Where does the right lymphatic duct drain into the venous system?

A

Drainage of upper right quadrant (right side of face, neck, and thorax, and right arm)

Enters venous system at right venous angle (union of right internal jugular vein and right subclavian vein)

22
Q

What quadrant of the body does the thoracic lymphatic duct drain? Where does the thoracic lymphatic duct drain into the venous system?

A

Drains all three quadrants of the body apart from the right side of the head, neck, and thorax, and the right arm (right lymphatic duct)

Enters venous system via left venous angle (union of left internal jugular vein and left subclavian vein)

note: thoracic duct originates from cisterna chyli in the abdomen (dilatation of duct due to entry of chyle) and ascends through the aortic hiatus of the diaphragm
note: thoracic duct runs just right of the midline until T5 (sternal angle/mediastinum), then it crosses to the left side above T5

23
Q

Contrast the different ways of classifying different lymph nodes.

A

Regional v.s. Terminal:

  • regional lymph nodes drain specific anatomical regions
  • terminal lymph nodes are the point of confluence of lymph drainage of many regional lymph nodes

Horizontal v.s. Vertical:

  • horizontal: clusters of lymph nodes which occur on a horizontal plane (irrespective of depth; can be high, intermediate, or low)
  • vertical: lymph nodes which occur on a vertical plane (following the course of the internal jugular vein; difficult to palpate due to depth)
24
Q

What are the important lymph nodes to palpate during an examination of the head and neck? What areas do these drain?

A

Occipital (drains back of scalp)
Superficial cervical (+ deep cervical?)
Anterior cervical chain
Posterior cervical chain
Supraclavicular
Posterior auricular (drains posterior temporoparietal region, upper ear, back of ear canal)
Preauricular (drains areas supplied by superficial temporal artery - anterior parietal scalp and anterior surface of ear)
Parotid(?) (drains scalp over parotid gland, eyelids, parotid gland, auricle, external auditory meatus)
Submental
Submandibular

25
Q

How are the lymph nodes of the head and neck arranged?

A

Outer circle: peri-cervical collar from chin to occiput (bilaterally)

  • submental nodes
  • submandibular nodes
  • occipital nodes
  • preauricular nodes
  • posterior auricular (mastoid) nodes
  • superficial parotid nodes

Inner circle: deep to deep investing layer of cervical fascia (surround internal jugular vein)

  • infrahyoid nodes
  • prelaryngeal nodes
  • pretracheal nodes

Paratracheal nodes: either side of trachea, oesophagus, and recurrent laryngeal nerves

Retropharyngeal nodes: posterior to pharynx, anterior to prevertebral fascia (in the retropharyngeal space)

Innermost circle (Waldeyer’s ring): surrounds upper airway/alimentary passages (MALT)

  • pharyngeal (adenoid) tonsil (unpaired; behind soft palatine) —> deep cervical & retropharyngeal nodes
  • palatine tonsils (paired; back of mouth) & lingual tonsils (paired; root of tongue) —> jugulo-digastric nodes
  • tubal tonsils (paired) drain Eustachian tubes
  • lateral bands of lymphoid tissue (paired)
26
Q

How are the superior and inferior deep cervical lymph nodes separated?

A

Superior deep cervical lymph nodes: above angle between lower body of mandible and the anterior border of the sternomastoid muscle
e.g. jugulo-digastric/tonsillar nodes

Omohyoid crosses over internal jugular vein

Inferior deep cervical lymph nodes: below the angle between the sternomastoid and the clavicle
e.g. jugulo-omohyoid/lingual node

+ supraclavicular nodes in posterior triangle of the neck (behind posterior border of sternomastoid)

27
Q

Give some examples of diseases of the lymphatic system.

A

Lymphadenitis = infection of lymph nodes themselves

Lymphangitis = inflammation of lymph nodes

Lymphoedema = chronic pooling of lymph in tissues

Lymphocytosis = high lymphocyte count due to infection, lymphoma, autoimmune disorders

Lymphoma = cancer of the lymph system

  • Hodgkin’s disease
  • Non-Hodgkin’s disease (usually malignant)
28
Q

What significant anatomical landmarks are found at the sternal angle? What points does this imaginary line run through?

A

Runs through manubriosternal joint anteriorly and intervertebral disc of T4/T5 posteriorly

  • division between superior and inferior mediastinum
  • the upper margin of the heart
  • beginning and end of curvature of arch of aorta
  • approximate level of 2nd pair of costal cartilages
  • passage of thoracic duct from right to left (behind oesophagus)
  • tracheal bifurcation (carina)
  • ligamentum arteriosum
  • branching of left recurrent laryngeal nerve from left vagus nerve and its looping of around the ligamentum arteriosum and the aortic arch
    (right recurrent laryngeal nerve branches off right vagus nerve at level of right subclavian artery)
29
Q

Where can the pulse of the common carotid artery be palpated?

A

Press against anterior tubercle of transverse process of C6

Point of bifurcation at C4/upper border of thyroid cartilage (visible here?)

30
Q

Where can the pulse of the facial artery be palpated?

A

Inferior border of mandible

note: when lacerated requires compression on both sides of mandible due to multiple anastomoses with other arteries of the face

31
Q

What blood vessels supply the skin of the forehead above the eyes?

A

Internal carotid artery —> supra-orbital & supratrochlear arteries

External carotid artery —> superficial temporal & maxillary arteries

32
Q

What are the contents of the parotid gland?

A

Facial nerve

External carotid artery and its branches:

  • maxillary artery and vein
  • superficial temporal artery and vein
33
Q

What cranial nerves supply the carotid body and carotid sinus? What is the difference between the carotid body and carotid sinus?

A

Glossopharyngeal nerve (CNIX) and vagus nerve (CNX)

Carotid sinus:

  • baroreceptor
  • at dilatation of arterial wall of internal carotid artery, just superior to bifurcation of external and internal carotid arteries

Carotid body:

  • peripheral chemoreceptor (changes in pO2 of blood)
  • bifurcation of external and internal carotid arteries (medial side)
34
Q

Why is it necessary for the inferior thyroid artery to be torturous?

A

As the thyroid moves, the blood vessels are able to elongate to prevent rupturing

(same as stomach expansion with splenic artery)

35
Q

Which cranial nerves are in close relation to the cavernous sinus?

A

Oculomotor nerve (CNIII)

Trochlear nerve (CNIV)

Abducens nerve (CNVI)

Head & Neck (12 decks)

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