Chapter 2 Blood vessels of Head and Neck Flashcards
(114 cards)
1
Q
Describe features of arteries
A
- Oxygenated blood
- Arteries usually have a smaller diameter than veins
- Thicker wall means arteries are paler in colour (dark colour of veins is due to contained blood being partly visible through thin wall).
- Blood flows in arteries under pressure from the heart
- Apart from the origins of aorta & pulmonary artery, arteries do not have & do not need valves.
- Large and medium sized arteries are named
- Smaller arteries are usually described as “branches of…”
- Arteries are often accompanied by a vein or veins.
- Veins are usually more superficial so that slow venous return is not compressed by overlying artery.
- Artery & accompanying vein oftne have similar veins
2
Q
Describe the two types of nerves associated with arteries
A
Muscle contraction (vasomotor) - penetrate wall, mostly sympathetic (accompanied by sensory fibres)
Hitchhikers
- Remain outside adventitia (outer layer of wall)
- Can be parasympathetic, sympathetic, sensory or a combination
3
Q
Small lymph vessels form a plexus on the walls of many large arteries.
A
True
4
Q
Define anastomosis
A
Anastomosis is a join between two vessels that allows by passing of the usual route - means that they can influence/feed into each others territories.
5
Q
Describe arterial anastomosis
A
Connection between two arteries rather than the usual pattern of arteries of decreasing size emptying into network of capillaries & from there into a network or veins of increasing size.
6
Q
What can arterial anastomosis mean?
A
- One artery opening directly into another
- Two arteries coming together to form a single artery e.g. Vertebral arteries forming the basilar artery inside skull
- Two arteries linked by a small connecting artery
7
Q
Define ‘arterio-venous anastomosis’
A
E.g. in skin where the capillary bed may be partly bypassed. Play a role in thermoregulation
8
Q
Define ‘veno-venous anastomosis’
A
Dorsal venous arch of the foot (improved venous return under gravity)
9
Q
‘Lymph vessels’ have numerous anastomoses - facilitate return of lymph.
A
True
10
Q
Define ‘endothelium’
A
A single layer of flattened epithelial cells which forms the innermost lining of all vessels - blood and lymph.
11
Q
Arch of the aorta is at the level of ?
A
Manubriosternal joint
12
Q
Define manubriosternal joint
A
This is the joint between the upper two bones of the three which form the sternum. The upper is the manubrium & the middle one is the body of the manubrium.
13
Q
Why is manubriosternal joint useful?
A
This joint is an useful surface landmark as it can be usually be palpated externally as a horizontal ridge - called the sternal angle.
14
Q
Which branches and arteries branch/arise from the arch of aorta?
A
Braciocephalic trunk, left common carotid and left subclavian artery
15
Q
Brachiocephalic trunk divides at level of right sternoclavicular joint into _____________________.
A
Right common carotid and subclavian.
16
Q
Both common carotids divide at level of top of thyroid cartilage of larynx into __________________.
A
Internal and external carotids.
17
Q
Carotids are on either side of trachea, thyroid gland, larynx, pharynx and deep to sternocleidomastoid.
A
True
18
Q
What is the carotid sheath?
A
It encloses both common and internal carotids (medial) along with internal jugular (anterior or anterolateral) and vagus (posterior).
19
Q
What is ansa cervicalis?
A
A nerve loop arising from cervical spinal nerves and supplying muscles of anterolateral neck is in or just anterior to the carotid sheath.
20
Q
Sympathetic trunk is anterior to carotid sheath and ansa cervicalis.
A
False, it is posterior to ansa cervicalis and carotid sheath.
21
Q
Carotid sheath consists of?
A
A sheet of dense fascia enclosed in looser adjacent fascia.
22
Q
List branches of external carotid artery
A
- Superior thyroid artery
- Lingual artery
- Facial artery
- Ascending pharangeal artery
- Occipital artery
- Posterior auricular artery
23
Q
Which landmarks to use to identify branches of external carotid artery?
A
- Sternocleidomastoid
- Infrahyoid muscles
- Digastric
- Styloid muscles
- Submandibular gland
- Thyroid gland
24
Q
Superior thyroid artery arises ___ to SCM, crosses the anterior triangle (______), and runs ___ to infrahyoid muscles (________) to supply thyroid gland (thyroid gland is also supplied with a pair of _______________ - a branch of subclavian artery).
A
Deep, anterior to SCM, deep, attached to inferior surface of hyoid bone, inferior thyroid arteries from thyrocervical trunk
25
Lingual artery passes deep to ______________ and to submandibular gland. Then medial to posterior border of ________ (a muscle at the side of the root of the tongue ) and into _______.
intermediate tendon of digastric muscle, hyoglossus, postero-inferior tongue.
26
Facial artery loops posterior to _____ and crosses ________ to run obliquely across face to ________.
Submandibular gland, body of mandible, medial corner of eye.
27
Branches of facial artery include?
Tonsilar artery, submental artery and inferior and superior labial arteries.
28
Facial artery supplies?
Soft palate, tonsils, submandibular and sublingual glands plus adjacent muscles and superficial face.
29
Variations of facial artery include:
Lingual and facial arteries often arising as a common trunk with the superior thyroid artery.
30
Describe ascending pharangeal artery
Small posterior branch arising near origin of external carotid.
31
Ascending pharyngeal artery passes deep to?
Styloid msucles
32
Ascending pharyngeal artery has an extracranial branch that supplies?
Upper pharynx, temporomandibular joint, tympanic cavity
33
Ascending pharyngeal artery also has an intracranial branch which passes through _____ to supply ____.
foramen mangum, meninges
34
Occipital artery runs deep to ________, passes behind mastoid to supply _______ and ____________.
Posterior belly of digastric, sternocleidomastoid, muscles of skin of occiput
35
Occipital artery grooves ______________ medial to mastoid/digastric notch.
Temporal bone
36
Posterior auricular artery has a posterior branch which arises above ___________ and supplies __________.
posterior belly of digastric, auricle and occipital region
37
How do you distinguish ascending pharyngeal artery?
Arises well below posterior belly of digastric and close to origin of external carotid.
38
How do you distinguish occipital branch/artery?
Passes deep to posterior belly of digastric, usually has a branch to SCM (usually a stump), can also be located posterior to external ear where it is fairly superficial.
39
How do you distinguish posterior auricular artery
Above level of posterior belly of digastric
40
External carotid divides in parotid gland to form?
Two terminal branches - superficial temporal and maxillary arteries.
41
What other structures pass through the parotid?
Retromandibular vein and facial nerve.
42
Which landmark muscles to help you identify branches of the superficial temporal artery:
Orbicularis oculi - extensive thin muscle surrounding eye, temporalis
43
Important branches of superficial temporal artery?
- Transverse facial artery
| - Zygomatico-orbital artery
44
Transverse facial artery arises from ________ and passes ______.
Superficial temporal artery, passes below zygomatic arch and passes anteriorly to parotid and duct.
45
Zygomatico-orbital artery arises from ________ and passes to __________ (________).
Arises from the superficial temporal artery above zygomatic arch, passes to orbicularis oculi (muscle of facial expression)
46
Superficial temporal artery then divides into anterior and posterior branches that supply?
Scalp, eye, temporalis muscle
47
Temporalis muscle is also supplied by the?
Deep temporal arteries
48
Landmark muscles to help identify branches of maxillary artery:
- Temporalis
- Masseter
- Lateral & medial pterygoid muscles- deep muscles involved in TMJ movement
- Parotid gland and duct
- Temporomandibular joint (TMJ)
49
Maxillary artery passes medial to _____, then either superficial or deep to the ________ and into _____.
neck of mandible, lower head of lateral pterygoid, pterygopalatine fossa
50
List important branches of maxillary artery:
- Deep auricular artery
- Anterior tympanic artery
- Middle meningeal artery
- Inferior alveolar artery
- Posterior superior alveolar/dental artery
- Infraorbital artery
51
Deep auricular artery supplies?
External ear, exterior tympanic membrane, TMJ
52
Anterior tympanic artery supplies
Internal tympanic membrane and middle ear. Often arises as a single trunk with deep auricular artery
53
Middle meningeal artery passes through?
Foramen spinosum
54
Inferior alveolar artery to mandible branches to mylohyoid artery which supplies?
Mylohyoid muscle arises before inferior alveolar artery enters mandibular foramen.
55
Inferior alveolar artery passes through?
Passes through mandibular canal within the bone of the mandible giving off branches to bone and to each of the mandibular teeth.
56
At level of the first premolar, inferior alveolar artery divides into two terminal branches:
Incisor branch and mental branch
57
Incisor branch of inferior alveolar artery supplies?
Canines and incisors and surrounding bone and finally anastomoses with contralateral artery (from the opposite side).
58
Mental branch of inferior alveolar artery passes through the _____ to supply ________.
mental foramen, chin
59
Inferior alveolar veins are small and drain either through the ________ to the ______ or posteriorly through the ________ to the _________.
mental foramen, facial artery, mandibular foramen, pterygoid venous plexus
60
Inferior alveolar artery and branches and inferior alveolar veins and tributaries closely accompany inferior alveolar nerve and its branches.
True
61
Infraorbital artery enters orbit through ______ and gives rise to branches including __________.
Inferior orbital fissure, superior alveolar/dental arteries.
62
Maxillary branches accompanying nerves arising from pterygopalatine ganglion (supply nose, orbit, maxilla).
True
63
Describe middle meningeal artery
This is closely associated with the auricular temporal nerve at its origin & sometimes often passes between 2 roots of auriculotemporal nerve.
Passes through foramen spinosum.
64
Features in neck relating to internal carotid artery include:
- Unbranched in neck
| - carotid sinus and carotid body
65
Describe carotid sinus
Dilation at origin of internal carotid - contains nerve endings in wall - pressure receptor
66
Describe carotid body
(outside artery wall) - chemoreceptor - oxygen levels
67
Through the skull, internal carotid artery passes through
Carotid canal and foramen lacerum
68
Within skull, internal carotid artery passes through the ______ and joins the ________ which supplies brain. Circle also receives blood from ______.
Cavernous sinus, arterial Circle of Willis, vertebral arteries.
69
Ophthalmic artery arises near _________ and accompanies _____ through canal.
Cranial opening of optic canal, optic nerve
70
Ophthalmic artery supplies _____, _____ and _____.
Orbit, eye, forehead,
71
What arteries supply orbit, eye and forehead?
Ophthalmic artery, supraorbital and supratrochlear arteries.
72
Supraorbital and supratrochlear arteries arise from the ophthalmic artery in the orbit above the eyeball, pass across the _____________ and ________.
upper rim of the orbit to supply skin and muscles of forehead.
73
Branches of subclavian artery include:
- Vertebral arteries
- Internal thoracic arteries
- Thyrocervical trunk
- Costocervical trunk
74
Describe vertebral artery
First branch of subclavian artery, deep, posterior and ascending. Passes through transverse foramina of cervical vertebra 1-6. Passes through foramen magnum to participate in Circle of Willis.
75
Describe internal thoracic artery
Inferior and descending, supplies thorax
76
Branches of thyrocervical trunk include?
Inferior thyroid artery to thyroid and neck.
77
Describe costocervical trunk
Just lateral to thyrocervical trunk, branches to thorax and neck.
78
Describe general features of veins
- Deoxygenated blood, low pressure
- Contains 80% of body's blood
- Thin walled
- venous return is assisted by: Gravity, muscle in vein walls, external pressure (from contraction of adjacent viscera, movement of adjacent viscera, suction e.g. blood pulled into thorax during inspiration
- Valves - pockets of vessel lining - usually in pairs
- Many anastomoses.
79
List tributaries of superior vena cava
- Brachiocephalic veins
- Inferior thyroid veins
- Vertebral veins
- Internal thoracic veins
80
Describe brachiocephalic veins
- One on either side, unlike single arterial brachiocephalic trunk. Formed from subclavian and internal jugular veins
81
Tributaries of brachiocephalic veins include:
- Inferior thyroid veins
- Vertebral veins
- Internal thoracic veins
82
Inferior thyroid veins drain?
Drains small vessels within the thyroid as well as some of the vessels in the adjacent larynx, trachea and oesophagus
83
Describe vertebral veins
Starts as internal vertebral venous plexus within the vertebral canal. Branches of the plexus leave the vertebral canal above the atlas and form a vein on either side which passes down through the transverse foramina of the first six cervical vertebra (there is only a small accessory vein through the 7th foramen). The vertebral veins collect some of the blood from dural sinuses (the rest mostly goes into internal jugulars.
84
Internal jugular veins collects blood from?
Cranial dural sinuses, facial, lingual, pharangeal, superior and middle thyroid veins.
85
Internal jugular veins passes through?
Passes through jugular foramen into carotid sheath.
86
Describe subclavian vein
Crosses the superior surface of rib 1, anterior to the attachment for scalenus anterior.
87
List tributaries of subclavian vein
External jugular and anterior jugular veins.
88
Describe external jugular veins
Formed by confluence of posterior branch of retromandibular vein with posterior auricular vein. Crosses superficial/lateral surface of sternocleidomastoid to drain into subclavian vein.
89
Describe anterior jugular veins
Arise near hyoid from confluence of small veins in the submandibular region. Pass deep to SCM to join external jugular or subclavian vein.
90
Scalp drained by _______ which join with the short _______ to form the ________ in the parotid.
Superficial temporal veins, maxillary vein, retromandibular vein
91
Maxillary vein drains?
Drains the pterygoid venous plexus
92
Maxillary vein runs ______ and accompanies ______.
Medial to neck of mandible, maxillary artery
93
Retromandibular vein divides into
An anterior branch and posterior branch.
94
Anterior branch of retromandibular vein unites with the __________ which drains into the _______.
Common facial vein, internal jugular
95
Posterior branch of retromandibular vein joins with the ________ to form the _________ (this is very superficial and is often visible as an oblique ridge down the side of the neck lateral to sternocleidomastoid - may be duplicated).
Posterior auricular vein, external jugular
96
Define 'pterygoid venous plexus'
A deep network of fine veins between temporalis and pterygoid muscles. This plexus is almost always missing from prosections.
97
Pterygoid venous plexus receives blood from many of the adjacent larger deep veins including:
Sphenopalatine, deep temporal, pterygoid, masseteric, buccal, dental, palatine and meningeal veins. Also small veins from posterior maxillary and mandibular teeth.
98
Blood from the pterygoid venous plexus may drain into any one of the three possible venous structures:
the maxillary vein, the deep facial vein and the cavernous sinus.
99
Deep facial vein connects what with what?
Pterygoid venous plexus with the common facial vein.
100
Deep facial vein passes deep to the _____ and across the _________ to drain into the ___________ above its junction with the anterior branch of the ___________. Also drains _________________.
zygomatic arch, superficial surface of buccinator, common facial vein, retromandibular vein.
Also drains buccinator, zygomaticus major, and masseter.
101
The pterygoid venous plexus is a route of communication of possible infection between face and intracranial structures via ________. The plexus is also connected to the cavernous sinus via ______ through the skull via ____________ and/or foramen _____.
deep facial vein, emissary veins, sphenoid emissary foramen, ovale.
102
Common facial vein is formed by?
Confluence of supraorbital and supratrochlear veins.
103
Describe common facial vein running passage
Runs obliquely across face from medial corner of eye.
104
Location of common facial vein
Located lateral to mandible and submandibular gland.
105
Where does common facial vein join the anterior branch of retromandibular vein?
Just posterior to mandible.
106
Describe venous drainage of common facial vein
Drains from anterior maxilla (via the deep facial vein) and anterior mandible (via mental foramen) is to the facial vein. Posterior drainage of posterior maxilla and mandible is to the pterygoid venous plexus.
107
Describe facial vein relationship
Posterior to facial artery and more direct (less wavy)
108
Describe occipital vein relationship
Arises from the posterior network of veins of the scalp, drains into either vertebral or posterior auricular vein.
109
Describe posterior auricular vein relationships
Posterior auricular vein unites with posterior branch of retromandibular vein near angle of mandible to form external jugular.
110
Describe cranial dural venous sinuses
- Venous spaces within dura, no valves, no muscle
- Collect blood from brain and cranial bones
- Mostly drain into internal jugular (also communicate with vertebral veins). Includes cavernous sinuses
111
Describe cavernous sinus (paired)
A pair of the venous plexus each about 2cm long in middle cranial fossa just lateral to pituitary. Consist of interconnecting endothelial lined venous spaces.
112
Superior sagittal sinus runs in dura beneath sagittal suture
True
113
Cavernous sinuses are connected to?
Connected to dural sinuses, veins of brains and ophthalmic veins as well as pterygoid venous plexus via emissary veins through bone of skull. Cavernous sinus is usually missing from prosections.
114
The internal carotid with its sympathetic nerve plexus, the abducent, trochlear and oculomotor cranial nerves all pass through the sinus (nerves are separated from blood by endothelium). Ophthalmic and maxillary divisions of trigeminal are in lateral wall.
True
