Vessels & Lymph, Head n Neck Flashcards
1
Q
How many brachiocephalic trunks are there?
A
1
2
Q
How many brachiocephalic veins are there?
A
2
Left brachiocephalic vein
Right brachiocephalic vein
3
Q
T/F the Left and Right common carotid arteries are the same length
A
F
Right common carotid artery is shorter bc it comes off of the Brachiocephalic trunk
The left comes off the left subclavian artery
4
Q
Which artery is often used, a piece of it is used for coronary bypass surgery
A
Internal thoracic artery (left)
5
Q
List the 8 branches from the aortic arch outward on the right side and know where they are
A
Dorsal scapular
Right costocervical trunk
Right thyrocervical trunk
Right internal thoracic a. + Right vertebral a.
Right subclavian a. + Right common carotid a.
Brachiocephalic trunk
Aortic arch
6
Q
List the 7 aortic branches from the aortic arch outward on the left side and know where they are
A
Left Dorsal scapular a. Left costocervical trunk Left thyrocervical trunk Left vertebral a. + Left internal thoracic a. Left subclavian a. Left common carotid a. Aortic arch
7
Q
Subclavian a. travels where?
A
both, come off brachiocephalic trunk, go lateral to the trachea, *passing btwn
anterior scalene and middle scalenes
8
Q
3 parts of the subclavian a.
A
1st Part: from where it breaks off of brachiocephalic trunk or aorta to medial border of ant. scalene
2nd Part: where it passes behind the ant. scalene
3rd Part: lateral border of ant. scalene to 1st rib, when it hits 1st rib it’s called the axillary a., then later it’s called the brachaii a., then it divides into the Brachial a. and Ulnar a.
9
Q
List the 5 branches off of Subclavian a.
A
VIT-CD….
Vertebral a
Internal thoracic a. (brings blood to thorax)
Thyrocervical trunk
Costocervical trunk
Dorsal scapular a. (brings blood to rhomboids)
10
Q
The thyrocervical trunk has its own 3 branches…..
A
1.) Inferior thyroid a. (travels w/ laryngeal n.)
Has 2 branches:
= Inf. laryngeal a.
= Ascending cervical a.
2.) Suprascapular a. (takes blood to scapula)
fyi part of subclavian triangle
3.) Transverse cervical a. (takes blood to trapezius)
fyi part of occipital triangle
11
Q
which trunk is particularly very short?
A
thyrocervical trunk
12
Q
Is the dorsal scapular a. a branch off of subclavian a.?
A
Yes
13
Q
Inferior thyroid a. travels with what nerve?
A
Laryngeal n.
14
Q
Costocervical Trunk has what 2 branches?
And they carry blood to where?
A
Deep cervical a. (muscles)
Supreme intercostal a. (1st & 2nd intercostal spaces)
15
Q
The internal thoracic artery branches into which 2 “terminal” arteries?
And these terminate where?
A
This is used clinically in heart surgery: bypass.
Carry blood to anterior chest wall and breast.
It branches into:
Superior epigastric a.
Musculophrenic a.
These terminate at the 6th intercostal space
16
Q
Vertebral a.
- ) Where does it travel
- ) Does the left Vertebral a. combine with the right one?
- ) What 2 things also does it eventually join?
A
1.) thru transverse foramina of C6-C1 (not C7)* so not All transverse foramina!
& thru foramen magnum
2.) Yes, they pass thru foramen magnum and then join e/o becoming the Basilar a.
3.) Cerebral Arterial Circle
& ICA to supply blood to brain
17
Q
Cerebral arterial circle
is also called
A
Circle of Willis
18
Q
Cerebral arterial circle provides “what” in case of obstruction?
A
collateral circulation
19
Q
Cerebral arterial circle is composed of what 11 arteries?
A
Anterior communicating L&R Anterior cerebral L&R Internal carotid L&R Posterior communicating (L&R) Posterior cerebral L&R Basilar
20
Q
What do each of the common carotid arteries branch off of?
A
Right = off brachiocephalic trunk Left = off of aorta
21
Q
Both common carotid arteries bifurcate as they pass what?
What is located at this bifurcation?
A
C3
Carotid Body
22
Q
What are the Carotid Bodies and what 3 things do they do?
A
Chemoreceptors
- ) Measure Partial pressure of 02/CO2
- ) Ph
- ) Temperature
23
Q
Carotid Bodies send messages via what CN?
What type of message?
A
CN 9
SVA
24
Q
What are the chemoreceptors called that are scattered in the aortic arch?
What do they detect?
What nerve do they send messages thru?
A
Aortic bodies
They detect O2/CO2, Ph, Temp
CN X
25
What courses thru the neck in carotid sheath without branching?
Internal carotid a.
26
What travels thru carotid canal to enter skull?
| What part does it enter into next (and then exits)?
Internal carotid a.
| Cavernous Sinus
27
What is a localized dilation immediately after common carotid a. bifurcates?
Carotid sinus
28
What is the Carotid Sinus?
What does it do?
What nerve does is send messages thru?
What type of messages are they?
Baroreceptors
Senses Blood Pressure rises (i.e. dilation in the vessel).....so it signals for heart to slow down, vessels to dilate, and so causes blood pressure to fall.
Signals thru CN IX
GVA
29
Where is Carotid Sinus located?
| Where is Carotid Body located?
Internal Carotid a.
right after bifurcation (baroreceptor)
Common Carotid a.
at the bifurcation (chemoreceptor)
30
What are the 4 Internal Carotid a.'s branches that we need to know?
Opthalmic a. (branches: Ant Ethmoid a. + Post. Ethmoid a.)
Posterior communicating a.
Middle cerebral a. (largest branch)
Anterior cerebral a
31
What are the Opthalmic a.'s branches?
Anterior ethmoid a.
| Posterior ethmoid a.
32
What is significant about the Middle cerebral artery?
Largest branch of ICA
The little arteries that branch off it, Lenticulostriate arteries, is the most common location for a cerebrovascular occlusion....a stroke
33
Branches that come off of the Middle cerebral artery, and why are they significant?
Lenticulostriate arteries
| Most common location for a cerebrovascular occlusion....a stroke
34
What are the External Carotid a.'s 8 branches (need to know them in order).
```
Sensor Trees
Motion
Playing Around
Ancient Phoenixes
Old
Following
Like
So They
------
Some Like Following Old Ancient Prophets Maneuvering Ships
```
```
(superior, ends here)
Superficial temporal a.
Maxillary a.
Posterior auricular a.
Ascending pharyngeal a.
Occipital a.
Facial a.
Lingual a.
Superior thyroid a.
(inferior, starts here, right after common carotid bifurcates)
```
35
What 3 things does the Superior Thyroid a. supply blood to?
Superior larynx
Thyroid
SCM
36
What are the 3 branches of the Superior Thyroid a.?
Superior larynx
Glandular Branch
SCM branch
37
*Where exactly does the Lingual a. travel btwn?
| What does it cross and where?
*Btween hyoglossus / genioglossus muscles of tongue*
Crosses CN XII Hypoglossal at the Lingual a.'s proximal root (right where Lingual a. branches off the External carotid a.)
38
Where is the Lingual a. and Lingual v. in relation to the Lingual n.?
Why is this significant?
Lingual a. and vein are inferior to it
| One of few places in body where nerve, artery, vein w/ similar names do not all 3 travel together
39
Lingual artery's 5 jobs?
```
supply blood to
Tongue
Suprahyoid region
Sublingual gland
Palatine tonsils
Floor of mouth
```
40
What are the Lingual a.'s 4 branches?
Dorsal lingual a.
Sublingual a.
Deep lingual a.
Suprahyoid a.
41
Where does the Dorsal lingual a. supply blood to?
Base and Body of Tongue
Palatine tonsils
Epiglottis
42
Where does the Sublingual a. supply blood to?
```
Sublingual gland
Mylohyoid m.
Oral floor
Oral Cavity
Lingual gingiva of mandibular teeth
```
43
Which is the terminal branch of the branches of the Lingual a.?
Deep Lingual a.
44
Where does the Deep lingual branch supply blood to?
Anterior 1/3 of tongue (apex)
45
What are the 2 terminal branches of the External carotid a.?
| It branches off into 2 at the end up there.
Superficial temporal a. (superior)
| Maxillary a. (inferior)
46
*Sublingual a. brings blood to the sublingual gland, but not the what?
*not to the Submandibular gland, which is supplied by a branch of the facial a. (Submental a.)
47
How to stop a bleeding tongue?
squeeze tongue posterior to laceration, to occlude branches of Lingual a. (Dorsal lingual a.)
48
What 3 things does the Facial a. supply blood to?
Face
| including LIPS and SUBMANDIBULAR GLAND
49
What are the Facial a.'s 2 branches?
Cervical branches
| Facial branches
50
What's the pathway of the Facial a.?
| Where does it become twisty?
Passes along submandibular gland, then
| Passes in a v. tortuous way over body of mandible where the Masseter m. is
51
List branches of Facial a.:
CERVICAL PORTION
Ascending palatine a.
Tonsilar a.
Submental a
```
FACIAL PORTION
Superior labial a.
Inferior labial a.
Angular a.
Lateral (dorsal) nasal a.
```
52
What does the Ascending palatine supply blood to?
pharyngeal wall
palatine tonsil
soft palate
pharyngotympanic tube
53
What does the Tonsillar branch supply blood to?
palatine tonsils
54
*What does the Submental a. supply blood to?
*Oral floor
Chin
Submandibular gland
55
*What does the Inferior labial a. supply blood to?
*lower lip
56
*What does the Superior labial a. supply blood to?
*upper lip &
| nasal septum
57
What does the Angular a. supply blood to?
nasal root
| this is 1 of 2 terminal branches
58
What does the Lateral (dorsal) nasal a. supply blood to?
outside of nose
| this is 1 of 2 terminal branches
59
What is the smallest branch of the External carotid a.?
Ascending pharyngeal a.
60
What supplies blood to the pharyngeal wall and tonsils?
Ascending pharyngeal a.
61
What are the 4 branches of the Ascending pharyngeal a.?
Pharyngeal branches (3-4)
Palatine a.
Interior tympanic a.
Posterior meningeal a.
62
What does the Pharyngeal branch supply blood to:
Stylopharyngeus m.
Middle constrictor m.
Inferior constrictor m.
63
What does the Palatine a. supply blood to:
Superior constrictor m.
Palatine tonsil
Soft palate
Auditory tube
64
What does the Occipital a. supply blood to?
Pharynx
| Suboccipital triangle
65
What does the Posterior auricular a. supply blood to?
back of scalp
66
Is the Superficial temporal a., a terminal branch of the external carotid artery?
Yes, it's 1 of the 2 terminal branches of the external carotid artery. (the other is the Maxillary a.)
67
What does the Superficial temporal a. supply blood to:
the skin over frontal and temporal parts of scalp
68
What does the Dorsal lingual a. supply blood to:
posterior 1/3 of tongue
69
What's special about the Maxillary a.?
| What does it supply blood to?
It's 1 of the 2 terminal branches of the ExCarotidArtery
(the other is the Superficial temporal a.)
Supplies the:
Meninges
Maxilla
Mandible (fyi there is no Mandibular a.)
70
All teeth are supplied by direct or indirect branches of which artery?
Maxillary artery
71
What does the Maxillary a. travel thru?
Pterygomaxillary fissure and fossa
72
What's the terminal branch of the Lingual a.?
Deep lingual a.
73
What are the Maxillary a.'s 3 regions?
Mandibular, 1st part
Pterygoid, 2nd part
Pterygopalatine, 3rd part
74
*List the branches for Maxillary a. part 1: Mandibular Part
| doesn't need to be in order
Mandibular Part:
```
Deep auricular a.
Anterior tympanic a.
Middle meningeal a.
Accessory meningeal a.
Inferior alveolar a. (+Mylohyoid,Incisive,Mental branches)
```
75
*List the branches for Maxillary a. part 2: Pterygoid Part
| doesn't need to be in order
Pterygoid Part:
Deep temporal branches (ant. & post.)
Pterygoid branches
Masseteric a.
Buccal (or buccinator a.)
76
*List the branches for Maxillary a. part 3: Pterygopalatine Pt
doesn't need to be in order
Pterygopalatine Part:
Posterior superior alveolar a.
Infraorbital a. (+ASA a. and sometimes also MSA a.)
Pharyngeal a.
Artery of pterygoid canal
Descending palatine a. (+Greater Palatine,Lesser Palatine,)
Sphenopalatine/Nasopalatine a. (+Post Nasal branches, Post Septal branches)
77
Deep auricular a. supplies blood to what?
TMJ
| so does Ant. tympanic a.
78
Anterior tympanic a. supplies blood to what?
TMJ
| so does Deep auricular a.
79
Inferior alveolar a. has branches that branch off at what point?
MAX artery 1ST PART
opposite the 1st Premolars
but on the diagram looks like it divides btwn the 2nd & 1st premolars
fyi the branches are:
Mylohyoid a.
Incisive (dental) a.
Mental a.
80
What are the Inferior alveolar a.'s 3 branches?
| MAX artery 1ST PART
Mylohyoid a.
Incisive (dental) a.
Mental a.
81
What does the Mylohyoid a. supply blood to?
| MAX artery 1ST PART
mylohyoid m.
82
What does the Incisive (dental) a. supply blood to?
| MAX artery 1ST PART
anterior mandibular teeth, 1st PreM on--mesially
83
What does the Mental a. supply blood to?
| MAX artery 1ST PART
Mental foramen
Chin
Labial gingiva of mandibular anterior teeth
84
Where does the Inferior alveolar a. travel thru?
| MAX artery 1ST PART
mandibular canal
85
What does the Inferior alveolar a. supply blood to?
| MAX artery 1ST PART
1. via mental a.=> BUCCAL GINGIVA OF ALL MANDIBLE
Labial gingiva of ANTERIOR MANDIBLE
and chin
2. ALL MANDIBULAR TEETH
via Inf alveolar (itself)=> post. mand teeth to 2nd PreM
via Incisive a.(its branch)=> 1st PreM on-
fyi Inf alveolar's other branch, mylohyoid a. & mental a.
86
What does the Accessory meningeal a. supply blood to?
meninges
87
What does the Middle meningeal a. supply blood to?
meninges
88
What 2 arteries supply blood to the meninges?
Accessory meningeal a.
| Middle meningeal a.
89
What does the Maxillary a. 2nd Part supply blood to?
Muscles of Mastication + Buccinator
Pterygoid branches = (M & L pterygoids m.
Deep temporal branches = (Ant & Post temporal m.
Masseteric a. = (Masseter m.
Buccal/Buccinator a. = (Buccinator m.
90
What does the PSA a. (Posterior superior alveolar a.) supply blood to?
Maxillary molars & premolars
+ corresponding buccal gingiva
Maxillary sinus
91
What does the Infraorbital a. supply blood to?
its branch, ASA a. (Anterior superior alveolar a. and sometimes also MSA, Middle superior alveolar a.)
These supply blood to Max Incisors + Canines, their corresponding buccal gingiva and Maxillary sinus
92
What does the Descending palatine a. supply blood to?
Greater palatine a. (mucosa of hard palate posterior to the maxillary canine)
Lesser palatine a. (soft palate and palatine tonsil)
93
Where does the Sphenopalatine/Nasopalatine a. travel thru and what are its branches?
What does it supply blood to?
Branch of Maxillary. Travels thru incisive foramen (just like nasopalatine nerve)
Supplies blood to:
Wall of nasal cavity
Nosebleeds: aka *Epitaxis
Bleeding may be arterial or venous
Can cause severe nasopharyngeal bleeding
Stop it via Ligation of artery in the Pterygopalatine Fossa
Branches:
Posterior lateral nasal branches
Posterior septal branches....to nasal septum, mucosa of hard palate anterior to max canine....and this branch anastomoses w Greater palatine artery.
94
What artery sits right under the pterion?
Middle meningeal a.
Trauma at pterion ruptures this artery
Causes Epidural hematoma
95
Middle meningeal a., what does it supply blood to?
| What does it travel thru?
= ECA then Max a. then Middle meningeal a
= Supplies blood to meninges & calvaria
= Travels thru Foramen Spinosum
= Head trauma at pterion ruptures this
96
Venous drainage of the head
No valves*
Venous drainage is highly variable
Infections from superficial face can spread to cavernous sinus...can then cause:
Inflammation of eyelids, conjunctiva
Paralysis of cranial nerves
97
How many brachiocephalic arteries are there?
| How many brachiocephalic veins are there?
1
| 2
98
Veins in head n neck that are identical (names) to arteries:
*Which veins are not identical name to an artery:
```
Superficial temporal v.
Posterior auricular v.
Maxillary v.
Pharyngeal v.
Facial v.
Lingual v.
Superior thyroid v.
Internal thoracic v.
Vertebral v.
External jugular v.
Subclavian v.
```
*DIFFERENT:
Internal jugular v. (counterpart to carotid a.'s)
Right/Left brachiocephalic v.
(yes, there's a brachiocephalic a., but it's singular, not a left and a right)
99
*The sigmoid sinus becomes the what?
*Internal jugular v.
100
* Which veins have a direct connection to the cavernous sinus?
* What nerves are embedded in lateral wall of cavernous sinus?
* What just goes thru it?
* Superior petrosal sinus
* Inferior petrosal sinus =aka= venous sinus (to Transverse sinus, Sigmoid sinus, IJV)
* Superior opthalmic vv.
* Inferior opthalmic vv.
* Emissary v.
POE. Edgar Allen Poe is outside of a cave.
```
Petrosal Sinuses (Superior & Inferior/Dural venous)
Opthalmic Sinuses (Superior & Inferior)
Emissary Veins
```
*CN III,
CN IV,
CN V1,
CN V2
*ICA,
CN VI
101
* What are the direct connections to the cavernous sinus?
| * What are the direct connections to the pterygoid plexus?
Maxillary artery has lots of branches. It's vein equivalent is the Pterygoid plexus (and not really the Maxillary vein which doesn't have many branches)
102
* What is the the pterygoid plexus?
| * Where is it located?
A venous plexus of considerable size, formed by tributaries of maxillary v.
It is situated between the temporalis muscle and lateral pterygoid muscle, and partly between the two pterygoid muscles.
103
* The pterygoid plexus lies btwn what 2 muscles?
| * It parallels what 2 things?
Temporalis m.
Lateral pterygoid m.
(partly btwn the two pterygoid m.'s)
Parallels 2nd & 3rd parts of Maxillary a.
104
What is the job of the Emissary v.?
make direct connection btwn
Pterygoid plexus &
Cavernous sinus
There are lots of emissary veins
105
What veins have a direct connection to the Pterygoid plexus?
Maxillary v.
| Deep facial v.
106
Cavernous sinus Syndrome is caused by?
Thrombosis. A blood clot traveling thru veins gets stuck in cavernous sinus.
107
Cavernous sinus Syndrome's clinical manifestations are?
Opthalmoplegia (paralysis of the muscles within or surrounding the eye)
Paralysis of nerves of Cavernous sinus
Venous congestion leading to periorbital edema
Exophthalmos (eyes protruding outward)
108
Danger triangle
Possible, rare, retrograde infections from the nasal area that spread through Inferior opthalmic v. to cavernous sinus.
Thrombosis in the cavernous sinus may be fatal.
109
On one side of neck...
How many carotid a.'s?
How many jugular v's?
2
internal & external
3
external jugular v.
anterior jugular v.
interior jugular v.
110
What 2 veins join to form the External jugular vein?
| Where does this occur?
Posterior auricular vein
Posterior retromandibular vein
These join in the Parotid gland to form the External jugular vein
111
External jugular vein, after it's already formed from the 2 veins joining e/o, has 3 veins that drain into it:
Anterior jugular v.
Transverse cervical v.
Suprascapular v.
112
External jugular vein travels down neck thru _____ and superficial to ______ ?
It then drains into what?
Investing deep cervical fascia
SCM
Subclavian v., which then drains into Brachiocephalic v.
113
Jugular venous pulse
Can be seen in the clinic
Difficult to see in obese people
Can be large and tortuous when exposed to prolonged periods of raised intrathoracic pressure
114
Where is a catheter often inserted because of its easy access?
External jugular v.
Right side is most direct to SVC
Inserted when patient inspires, when valves are open
Inserted 1/2 way btwn cricoid cartilage & clavicle
115
Retromandibular vein forms half of what vein?
| Posterior auricular v. forms the other half.
External jugular v.
116
Where is the Retromandibular vein formed?
| What 2 veins join together to form it?
Parotid gland
| Superficial temporal v. + Maxillary v.
117
*What vein has an anterior and a posterior division to it?
Why is this vein important to a dentist?
Retromandibular v.
It's right next to the mandible
118
*What is so unusual about the Retromandibular vein?
* Its anterior division joins the Facial v. to form the Common facial v, which goes into the *IJV
* Its posterior division joins the Posterior auricular v. which goes into the *EJV
This way there's a form of anastomosis, a back-up way for blood to get back to heart
119
Which is bigger?
Internal jugular v.
or
External jugular v.
Internal jugular v. (IJV) is MUCH BIGGER
Facial v. is also big and then it joins into IJV
120
IJV
1. is continuous with what vein?
2. Travels w/in what?
3. Unites with _____ to form the _____.
1. Sigmoid v
2. Carotid sheath
3. Subclavian v., Brachiocephalic v.
121
What veins drain into the IJV?
```
Superficial temporal v.
Facial occipital v.
Lingual v.
Pharyngeal v.
Superior thyroid v.
Middle thyroid v.
```
122
What's the basic pathway of venous drainage from the teeth/gingiva?
=Veins of the teeth and gingiva follow the arteries
=Inferior alveolar v. and anterior/posterior superior alveolar v (ASA, PSA)
=Primarily drain, some via facial v., into the pterygoid plexus
=Maxillary v.
=Retromandibular v.
=EJV
note: venous blood can easily go from pterygoid sinus up to the cavernous sinus via emissary v.
123
Thoracic duct drains what?
| From where in the body?
Lymph
| Lower 1/2 of body + Upper left quadrant
124
All lymph in the body drains into what 2 ducts?
Right lymphatic duct
| Thoracic duct
125
Lymph from right foot would get back into bloodstream via which lymphatic duct?
Thoracic duct
126
Lymph from teeth, tongue, head, could go into either lymphatic duct? T/F
T either one.
Right lymphatic duct
or
Thoracic duct
127
There are 4 sets of lymph nodes we need to know bc they drain lymph from the teeth, gums, head, etc..
Which are they?
Submental nodes
Submandibular nodes
Pre-auricular/Parotid nodes
Deep cervical nodes
128
What part of lips' lymph drains into the submandibular lymph nodes?
All of lips
| except for medial part of lower lip
129
What part of lips' lymph drains into the submental lymph nodes?
What else drains into these lymph nodes?
What is unique about these nodes' drainage?
Medial part of lower lip only (All else is drained by submandibular nodes)
Below and posterior to the chin
Tip of tongue
Anterior mandibular teeth & gingiva
* **Some of this will then drain first into the submandibular nodes and then into the deep cervical nodes
* **And some will drain directly into the deep cervical nodes
130
Submandibular nodes
```
=Located btwn submandibular salivary gland & the mandible
=Drain:
Medial corner of orbit
External nose
Paranasal sinuses
Medial cheek
Upper lip & Laterals of lower lip
Anterior 2/3 of tongue
All teeth and gingiva
(but not Anterior mandibular teeth, so same as lips)
=Drain into deep cervical nodes
```
131
Pre-auricular/Parotid Nodes
```
=Located anterior to the ear
=Drain:
Most of eyelids
Part of external nose
Lateral cheek
=Drain into deep cervical nodes
```
132
Deep Cervical Nodes
=Located from base of skull to the root of neck, along the inferior jugular v.
=Drains: Lymph from Submental nodes, Submandibular nodes, Parotid nodes, & posterior 1/3 of tongue
=Join to form jugular lymph trunk
=Drains into either Thoracic duct (upper left quad)
or the Right Lymphatic duct (lower 1/2 & upper right quad)
133
What is the most common cause of swollen submandibular lymph nodes?
Acute infection of the teeth
fyi, swollen lymph nodes are also commonly enlarged bc of pathologic condition of scalp, face, maxillary sinus, or mouth
