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Semester 3 - Head and neck > 3. Major Blood Vessels of Head and Neck > Flashcards

3. Major Blood Vessels of Head and Neck Flashcards

1
Q

What are the 3 branches of the arch of the aorta?

A

◦ brachiocephalic trunk
◦ left common carotid artery
◦ left subclavian artery.

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2
Q

What are the branches of the brachiocephalic trunk?

A

bifurcates into the right common carotid artery and right subclavian artery

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3
Q

What are the 4 branches of the right subclavian artery?

A

vertebral, internal thoracic, thyrocervical trunk, costocervical trunk

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4
Q

What are the 4 branches of the thyrocervical artery?

A

Suprascapular, transverse and ascending cervical, inferior thyroid

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5
Q

What is the inferior thyroid artery a branch of and what does it supply?

A

thyrocervical trunk, supplies lower pole of thyroid gland

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6
Q

Which structure does the inferior thyroid artery run close to?

A

recurrent laryngeal nerve - have to be careful when doing thyroid surgery

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7
Q

What do the vertebral arteries originate from and what do they supply?

A

Originate from the subclavian arteries. Supply posterior neck and posterior parts of the brain (e.g. brainstem, cerebellum)

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8
Q

What is the path of the vertebral arteries and what do they join to form?

A

Ascend through transverse foramen of cervical vertebrae (except C7), enter cranium from foramen magnum, curve anteriorly around medulla and join to form basilar artery.

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9
Q

Which arteries from circle of willis?

A

Internal carotid artery anteriorly and basilar artery posteriorly

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10
Q

Where do the common carotid artery originate from?

A

right - Brachicephalic artery, behind the sternoclavicular joint,

left - directly from arch of aorta

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11
Q

What is the arrangement of neurovasculature in carotid sheath?

A

Common carotid medial, IJV lateral, Vagus nerve between and behind

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12
Q

Where does the common carotid artery most commonly bifricate?

A

Upper border of the thyroid cartilage (C4). - carotid sinus

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13
Q

Why is the internal carotid artery more bulbous at the bifurcation of the common carotid?

A

Carotid sinus (and carotid body)

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14
Q

What is the clinical importance of the carotid sinus?

A

Can alleviate supraventricular tachycardia i.e. carotid massage

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15
Q

What do the carotid sinus/body detect?

A

Sinus: changes in arterial BP - contain baroreceptors

Body: detect arterial O2

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16
Q

What does the common carotid artery bifricate into?

A

internal carotid artery

external carotid artery

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17
Q

How many branches does the internal carotid artery have in the neck?

A

None

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18
Q

Where does the ICA enter the skull?

A

Carotid canal in petrous part of temporal bone

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19
Q

What bone does the ICA sit on after entering rhe skull and what structure does it pass?

A

Sphenoid bone, passes cavernous sinus.

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20
Q

What is the cavernous sinus?

A

Plexus of thin walled veins at either side of sella turcica

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21
Q

What structures are found in the cavernous sinus

A 
◦ Internal Carotid artery
◦ CN III (Oculomotor)
◦ CN IV (Trochlear)
◦ CN VI (Abducens)
◦ 2 branches of CN V (Trigeminal) ( CN V1 ophthalmic and CN V2 maxillary)
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22
Q

What structure forms the superior border of the carotid triangle?

A

posterior belly of digastric muscle

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23
Q

What structure forms the medial/inferior border of the carotid triangle?

A

superior belly of omohyoid muscle

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24
Q

What structure forms the lateral border of the carotid triangle?

A

medial border of SCM

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25
Q

what is the importance of the carotid triangle?

A
  • Bifurcation of the common carotid occurs within
    the carotid triangle
  • Contains clinically important artery - carotid
    ◦ Atherosclerosis
    ◦ Carotid sinus massage
    ◦ Central pulse
  • Access site for vagus and hypoglossal nerves
  • Contains internal jugular vein
    ◦ Access site for central line placement
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26
Q

what is the bifurcation of common carotid a common site of?

A

atherosclerosis

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27
Q

describe what happens in atherosclerosis of bifurcation of common carotid

A

◦ Causes the artery to narrow (stenose)
◦ Plaque rupture can release an embolus which can travel to the brain
◦ Can cause a stroke or TIA depending on the size
◦ Can also course transient loss of vision (Amaurosis
Fugax)

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28
Q

what is Carotid endarterectomy

A

◦ Incision in to the neck and the carotid

◦ Removal of plaque tissue and stitched back up

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29
Q

describe the carotid sinus massage

A

◦ Pressure at the site of the carotid bodies

◦ Increased baroreceptor activity feedback to the heart to slow down

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30
Q

which vein is a good site for central venous line?

A

IJV -
Large central vein
Superficial
Easily accessible

31
Q

What is the ophthalmic artery a branch of?

A

internal carotid artery

32
Q

What are 3 major branches of the ophthalmic artery?

A

Supraorbital, supratrochlear, central retinal artery

33
Q

what is the first branch of ICA?

A

ophthalmic

34
Q

what other branches of ICA provide arterial blood to brain?

A

◦ Anterior cerebral artery
◦ Middle cerebral artery
◦ Posterior communicating artery

35
Q

How many branches does the ECA have and what mnemonic is used to remember them?

A 
8
Some
Anatomists
Like
Freaking
Out
Poor
Medical
Students
36
Q

what are the branches of the ECA

A 
Some – Superior thyroid
Anatomists – Ascending pharyngeal
Like - Lingual
Freaking - Facial
Out - Occipital
Poor – Posterior auricular
Medical - Maxillary
Students – Superficial Temporal
37
Q

what are symptoms of Giant cell arteritis (GCA) / Temporal arteritis?

A

◦ Frequent, severe headaches
◦ Scalp tenderness particularly over the temple
◦ Jaw pain while eating/talking
◦ Loss of vision/visual changes

38
Q

without treatment, what can Temporal arteritis lead to?

A

Without treatment patients can permanently lose their eye sight

39
Q

What is temporal arteritis?

A

Inflammation of superficial temporal artery (1/8 branch of external carotid)

40
Q

Which blood vessels supply the scalp?

A

ICA: supraorbital, supratrochlear.
ECA: Superficial temporal, posterior auricular, occipital.

They have rich anastamoses

41
Q

Name the layers of the scalp? (Hint : acronym SCALP)

A 
skin
connective tissue
aponeurosis
loose areolar tissue
periosteum
42
Q

In which layer of the scalp are the vessels located?

A

Dense connective tissue layer

43
Q

Why does the scalp bleed heavily when cut?

A

◦ Artery walls held open by connective tissue and so cant constrict
◦ Lots of anastomoses
◦ Lacerations deep enough to involve the epicranial aponeurosis of occipitofrontalis can pull cuts open

44
Q

What are the superficial arteries of the face?

A

from ICA:
Supraorbital art.
Supratrochlear art.

from ECA:
Transverse facial art.
Angular art.
Lateral nasal art.
Maxillary art.
Superior & Inferior
Labial art.
Facial art.
45
Q

What are the branches of the facial artery?

A

Submental, Inferior labial, Superior labial, Lateral nasal, Angular artery

46
Q

What are 2 major branches of the maxillary artery?

A

◦ Middle Meningeal art.

◦ Sphenopalatine art.

47
Q

what is the maxillary artery branch of?

A

ECA

48
Q

what does the maxillary artery supply?

A

deeper facial structures

49
Q

Through what structure does the middle meningeal artery enter the skull?

A

Foramen spinosum

50
Q

The middle meningeal artery splits into anterior and posterior branches - what area of the skull does the anterior pass under?

A

Pterion

51
Q

What part of the skull does the middle meningeal artery supply?

A

Dura mater of skull

52
Q

Why is it easy to rupture the medial meningeal artery?

A

Anterior branch runs under PTERION -thin area of bone so fracture at this site can rupture MMA.

53
Q

Rupture of the MMA (due to fracture of pterion) can lead to what life threatening condition?

A

Intracranial haemorrhage - called an extradural haemorrhage. - periosteal dura ripped away from bone and fill with blood
Needs surgical treatment. Puts pressure on brain

54
Q

what is extradural haemorrhage management?

A

◦ Needs specialist neurosurgical treatment
◦ Craniotomy – opening of the cranium to relieve the pressure
◦ Evacuate the clot forming and stop the bleeding

55
Q

Which arteries contribute to blood supply to the nasal septum?

A

Septal branch of sphenopalatine artery, Anterior/Posterior ethmoidal arteries, septal branch of superior labial artery

56
Q

What is the Kiesselbach area?

A

Area in anterioinferior nasal septum where arteries anastamoses. Common site for nose bleeds

57
Q

where do brain structures drain into?

A

dural venous sinus

58
Q

where does the scalp drain into and how?

A

Scalp drains via emissary veins through the skull into dural venous sinuses

59
Q

Because the scalp drains into dural venous sinuses, what does this lead of a risk of?

A

Infection ie meningitis

60
Q

describe the venous drainage of scalp via external jugular vein

A

superficial temporal vein comes down and joins with occipital vein to form retromandibular vein which joins with posterior auricular vein to form external jugular vein that drains into subclavian vein

61
Q

describe superficial venous drainage of the face

A

supraorbital and supratrochlear veins Unite at the medial angle of the eye to from the angular veins and drain into the facial vein which forms common facial vein, which drains into the internal jugular vein

62
Q

The cavernous sinus is connected to ……… ……… plexus?

A

pterygoid plexus

63
Q

Where is the pterygoid plexus located?

A

Infratemporal fossa

64
Q

Which veins drain into the pterygoid plexus?

A

Paired veins of the branches of the maxiallary artery e.g. middle meningeal veins, sphenopalatine veins, etc.

65
Q

Where does the pterygoid plexus drain?

A

Maxillary vein, which joins with the superficial temporal vein to form the retromandibular vein which drains into the external jugular vein

66
Q

Where is the cavernous sinus located?

A

Either side of sella turcica

67
Q

Which veins drain into the cavernous sinus?

A

Paired veins of the branches of the ICA artery e.g. superior and inferior ophthalmic veins, etc.

68
Q

what is the association of facial veins and cavernous sinus??

A

Drainage of some structures into the cavernous sinus

Risk of infection to the intracranial cavity as directly connected

69
Q

Where does the cavernous sinus drain?

A

Drain via superior and inferior petrosal sinuses into the the transverse sinus and sigmoid sinus which continue as the internal jugular vein

70
Q

Do veins of the face have valves?

A

No

71
Q

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

A

The region where the facial vein can drain backwards into the cavernous sinus
Infections in that area can spread via the facial vein and ultimately end up in the dural venous sinuses.

Could cause cavernous sinus thrombosis, meningitis or brain abscess

72
Q

Which IJV gives indication of pressure in right atrium?

A

Right, has direct connection to right atrium. Left IJV joins with subclavian vein

73
Q

how is jugular venous pressure measured?

A

Patient at 45 degrees
Head turned slightly to the left IJV mostly hidden by
sternocleidomastoid
Look for pulsations through the muscle
Measure the height from the sternal angle and add 5cm, gives an estimate of the right atrial pressure in cmH2O

Semester 3 - Head and neck (17 decks)

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