Major blood vessels of the head and neck

Question 1

What is the pneumonic to help remember the branches of the external carotid artery?

Answer 1

Some Lazy Fucker Asked Me Out Past Sunset

S- Superior thyroid artery
L - Lingual artery
F - Facial artery
A - Ascending pharyngeal artery
M - Maxillary artery
O - Occipital artery
P - Posterior auricular artery
S - Superior temporal artery

Question 2

What are the terminal branches of the ECA?

Answer 2

Maxillary and superior temporal artery

Question 3

What does the maxillary artery branch into?

Answer 3

Sphenopalatine and Miidle Meningeal artery

Question 4

What branches off the aortic arch?

Answer 4

ABC’s - Aortic arch has the brachiocephalic, LCCA and LS

Question 5

What does the brachiocephalic artery turn into?

Answer 5

Right subclavian and Right CCA

Question 6

What does the brachiocephalic artery turn into?

Answer 6

Right subclavian and Right CCA

Question 7

What are the branches of the subclavian arteries?

Answer 7

• internal thoracic
• costocervical
• thyrocervical
• vertebral arteries

Question 8

Where does the subclavian arteries branch?

Answer 8

base of neck

Question 9

Where do the vertebral arteries go?

Answer 9

enter in the transverse foramen fro C6-C1 then enter through the foramen magnum into the basilar artery which enters the circle of willis supplying the brain

Question 10

What are the branches of the thyrocervical?

Answer 10

inferior thyroid artery and suprascapular

Question 11

What is significant clinical point about the inferior thyroid artery?

Answer 11

important relationship to the recurrent laryngeal nerve branch of CNX (Vagus nerve)

Question 12

Where does the superior temporal artery run?

Answer 12

anteriorly to the ear to supply the lateral scalp

Question 13

What is the route of the internal carotid artery?

Answer 13

Passes through the carotid canal and runs through the petrous bone - when it emerges from the carotid canal it travels in the cavernous sinus

Question 14

What does the ICA branch into after the cavernous sinus?

Answer 14

• anterior cerebral artery
• middle cerebral artery
• opthalmic artery

Question 15

What does the opthalmic artery branch into?

Answer 15

the supraorbital, supratrochlear and the central retinal artery (does these after travelling through the optic canal)

Question 16

What is the cavernous sinus?

Answer 16

plexus of thin walled veins on the upper sphenoid surface

Question 17

What else travels through the cavernous sinus?

Answer 17

ICA, CN3,4,5ab,6

Question 18

Where does the common carotid artery split and what does it split into?

Answer 18

At C4 - level of the superior border of the thyroid cartilage - it splits into the internal and external carotid artery

Question 19

What does the external and internal carotid artery run in?

Answer 19

The ICA runs in the carotid sheath

Question 20

What does a carotid artery atheroma cause and where are they normal found?

Answer 20

causes stenosis of the artery, if this limits blood to the brain then its TIA - if the clot embolisms then its a stroke
Most common place is the bifurcation of the carotid artery

Question 21

What is the carotid sinus, where is it and what is in it?

Answer 21

• swelling of the bifurcation

- baroreceptors for detecting changes in arterial BP

Question 22

What is the carotid body?

Answer 22

where the peripheral chemoreceptors detect arterial o2

Question 23

What is a carotid sinus massage and what is its clinical purpose?

Answer 23

-alleviates supra ventricular tachycardia
increases parasympathetic outflow to the head and decreases sympathetic flow to the heart through the baroreceptors
-maintains blood pressure

Question 24

What is the clinical relevance of blood supply to the scalp?

Answer 24

The arteries are closely attached to connective tissue which limits constriction so you can get profuse bleeding as the arteries are held open

Question 25

What other reasons cause profuse bleeding in the brain?

Answer 25

There are LOTS of anastomoses which cause profuse bleeding -deep lacerations involving epicranial aponeurosis also cause this as there is the opposing pull of the occipitalfrontalis muscle

Question 26

NOTE

Answer 26

Blood supply to the skull is mostly the MMA so loss of SCALP ARTERIES WILL NOT LEAD TO BONE NECROSIS AS THERE IS A SEPARATE BLOOD SUPPLY

Question 27

What is the blood supply to the scalp?

Answer 27

ECA - posterior auricular occipital, superficial temporal | ICA - supratrochlear and supraorbital

Question 28

What is the blood supply to the face?

Answer 28

ECA - transvers facial, facial, angular, lateral nasal, maxillary ICA - supratrochlear and supraorbital

Question 29

What are the layers of the scalp?

Answer 29

``` S - subcutaneous tissues C - dense connective tissue - contains the blood vessels A - aponeurosis L - loose connective tissue P - periosteum ```

Question 30

What is the blood supply to the nasal septum?

Answer 30

Kiesselbach area - contains anastomoses of arteries

Question 31

What are the most important branches of the kiesselbach area?

Answer 31

- sphenopalatine (branch of the maxillary) | - anterior ethmoidal artery (branch of opthalamic)

Question 32

What is significant about the kiesselbach area?

Answer 32

most common site for nose bleeds (epistaxis)

Question 33

Where does the Medial meningeal artery travel?

Answer 33

Through foramen spinosum

Question 34

What is an important part of a craniotomy?

Answer 34

- gains access to the cranial cavity | - bone and scalp flap reflected inferiorly to preserve blood supply

Question 35

Where do the supraorbital and supratrochlear veins drain into?

Answer 35

they unite at medial angle of eye to form angular vein which drains into the facial vein

Question 36

What significant drains into the pterygopalatine plexus and what can be the complications of this?

Answer 36

Deep facial veins drain into pterygoid venous plexus - can cause infection from facial vein to spread to dural venous sinuses - near meninges layer so can infect that and cause meningitis

Question 37

What is a cavernous sinus thrombosis?

Answer 37

infection from any of the facial or scalp veins can cause thrombosis of the cavernous sinus - emissary veins between pterygopalatine and cavernous sinus also increase danger of this

Question 38

What is the danger triangle?

Answer 38

Area on the face around the nose where infection is easily spread (inside)

Question 39

Which vein is easiest to see in the neck?

Answer 39

EJV - IJV is hidden under SCM - easiest to see when head slightly turned

Question 40

What vein is used to measure JVP

Answer 40

right IJV - better indication of pressures in the RA

Question 41

How do you measure JVP?

Answer 41

pulsations of the IJV observed through muscle Measure in cmH20 Height from sternal angle +5cm