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Head and Neck > Blood vessels > Flashcards

Blood vessels Flashcards

1
Q

Major vessels in the neck

A

External jugular vein (can be seen above SCM)

Internal jugular vein
Common carotid artery

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2
Q

Common carotid and subclavian origins

A

R - arise from Brachiocephalic trunk on

L - arise from arch of aorta on left

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3
Q

What does the sublclavian artery then form?

A

Thyrocervical trunk
Vertebral artery

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4
Q

What does the thyrocervical artery form?

A

Inferior thyroid artery - close to recurrent laryngeal nerve

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5
Q

Where does the common carotid artery bifurcate into internal carotid and external?

A

Level of C4 or the superior border of thyroid cartilage

(internal stays within sheath, external exits)

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6
Q

What does the carotid artery form just before bifurcation?

A

Carotid sinus - baroreceptors for BP

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7
Q

Borders of carotid triangle

A

Superior - posterior belly of digastric muscle

Medial - superior belly of Omohyoid

Lateral - medial border of SCM

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8
Q

What occurs within carotid triangle?

A

Bifurcation of common carotid artery - important for surgery

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9
Q

Why is the carotid triangle important?

A

Artery:
Atherosclerosis
Carotid sinus massage
Central pulse

Access site for vagus and hypoglossal nerves
Access for central line
Contains IJV

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10
Q

Atherosclerosis and carotid artery problems

A

Bifurcation = common site for atherosclerosis
Narrowing of artery
Plaque rupture –> embolus to brain
Stroke or TIA
Can also cause transient loss of vision

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11
Q

What is transient loss of vision called?

A

Amaurosis Fugax

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12
Q

Treatment of plaque filled artery

A

Carotid endarterectomy - incision in neck and carotid, removal of plaque tissue, stitched back up

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13
Q

What is carotid sinus massage?

A

Pressure on carotid bodies
Increased baroreceptor feedback to slow heart down
Area to feel pulse also

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14
Q

IJV importance

A

Large central vein
Superficial
Easily accessible
Good site for central line - cannulate

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15
Q

Do the internal carotids branch in the neck?

A

NO

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16
Q

Course of internal carotid artieries

A

Enter base of skull via carotid canal (within petrous bone of temporal bone)
Horizontal and medially
S shaped bend to cavernous sinus
Supply intracranial structures

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17
Q

What do the vertebral arteries arise from?

A

Right and Left subclavian arteries

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18
Q

Course of vertebral arteries

A

Ascend up cervical vertebrae through transverse foramina
Enter base of skull via foramen magnum

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19
Q

What do the internal carotids and vertebral arteries supply?

A

Brain

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20
Q

Where is the carotid canal which allows internal carotid artery to enter skull?

A

Petrous part of temporal bone

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21
Q

What journey does the internal carotid take once entered skull?

A

Turns medially and horiontally
Makes S shaped bend
Moves through cavernous sinus

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22
Q

What is the cavernous sinus?

A

Venous type structure on upper surface of sphenoid bone

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23
Q

What structures run through cavernous sinus?

A

Internal carotid artery

Cranial nerve 3, 4, 6

2 branches of cranial nerve 5 (trigeminal - ophthalmic and maxillary)

24
Q

What is the first branch off the internal carotid artery?

A

Ophthalmic artery

25
Q

Branches of Ophthalmic artery

A

Central retinal artery - if occluded can have loss of vision

Supratrochlear artery
Supraorbital artery
(these two supply blood to scalp from ophthalmic)

26
Q

Other branches of internal carotid

A

Anterior cerebral
Middle cerebral
Posterior communicating

(all supply blood to brain)

27
Q

External carotids branches pneumonic

A

Some - Superior thyroid
Anatomists - ascending pharyngeal
Like - Lingual
Freaking - Facial
Out - Occipital
Poor - Posterior auricular
Medical - Maxillary
Students - Superficial temporal

28
Q

2 terminal branches of external carotid

A

Maxillary
Superficial temporal

29
Q

Superficial temporal artery problems

A

Giant cell arteritis/temporal arteritis

30
Q

GCA/Temporal arteritis symptoms

A

Frequent, severe headaches
Scalp tenderness - over temple especially
Jaw pain while eating/talking
Loss of vision/visual changes

31
Q

Importance of treatment with temporal arteritis

A

Patients can lose sight permanently so needs to be recognised and treated

32
Q

Blood supply to scalp

A

Internal carotid - supraoribital and supratrochlear

External - Superficial temporal, posterior auricular, occipital

33
Q

SCALP layers

A

Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Periosteum

SCALP

34
Q

Why does the scalp bleed?

A

Vessels within connective tissue layer

Artery walls are held open by connective tissue so cant constrict

Lots of anastomoses

Lacerations deep enough to involve aponeurosis of occipitofrontalis can pull cuts open

35
Q

Superficial arteries of face

A

Supraorbital and Supratrochlear - ICA branch

Facial artery - branches into angular artery, lateral nasal artery, superior and inferior labial artery

Superficial temporal artery - branches into transverse artery

36
Q

Maxillary artery supplies

A

Deeper facial structures

37
Q

Key branches maxillary artery

A

Middle meningeal - dura mater
Sphenopalatine - nasal septum

38
Q

Middle meningeal artery course

A

Enters skull via foramen spinosum

Splits into anterior and posterior middle meningeal

Anterior passes under Pterion of skull

(external to dura mater, in contact with skull as indents it)

39
Q

What is Pterion?

A

Area where lots of skull bones come together and skull thins

40
Q

How can middle meningeal artery rupture?

A

Skull can fracture (esp in Pteron region as is thinner)
Middle meningeal artery breaks and ruptures
Extradural haematoma forms on top of dura and below skull

(can be seen on CT as white area)

41
Q

What is extradural haemorrage?

A

Intracranial haemorrage - usually caused by fracture at site of pterion where anterior MMA runs

42
Q

Extradural haemorrhage treatment

A

Specialist neurosurgery
Craniotomy - open cranium and relieve pressure
Evacuate clot forming and stop bleeding

43
Q

Drainage of scalp to external jugular vein

A

Superficial temporal –> occipital vein –> retromandibular vein –> posterior auricular vein –> External jugular vein

44
Q

Drainage of scalp to internal jugular vein

A

Supraorbital and supratrochlear drain into facial vein

–> internal jugular vein

45
Q

End point for venous drainage

A

Subclavian vein

46
Q

other kind of drainage of scalp

A

Drains via emissary veins into dural venous sinuses within dura

Pools of venous blood

47
Q

venous drainage of face

A

Supraorbital –> Supratrochlear –>
Angular vein –>
Facial vein –>
Common facial vein –>
Internal jugular vein

(Some sharks attach fish cause fish is jummy)

48
Q

What drains into the cavernous sinus?

A

Superior and Inferior ophthalmic vein

49
Q

What drains into pterygoid venous plexus?

A

Facial vein
Deep facial veins

50
Q

Problem with dural venous sinuses/cavernous sinus

A

Risk of infection - communication between external and intracranial

51
Q

What connects the pterygoid venous plexus and the cavernous sinus?

A

venous network

52
Q

Danger triangle of face

A

Where facial vein drains backward into cavernous sinus
Infections here can easily spread

53
Q

Dural venous sinuses of head

A

Superior sagittal
Inferior sagittal
Cavernous
Sigmoid (to IJV)
Transverse

Sphenopalatine
Superior petrosal
Inferior petrosal

54
Q

Jugular venous pressure which vein?

A

Most easy to see external pulsating but want t =o use INTERNAL

55
Q

How to measure IJV jugular venous pressure?

A

Use RIGHT IJV
Patient tilted 45 degrees
Head turned to left slightly
Look for pulsations through SCM
Measure height from sternal angle and add 5cm

= right atrial pressure in cmH20

Head and Neck (26 decks)

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