Transcript 17. Major Vessels of the Head & Neck

MAJOR VESSELS OF THE
HEAD & NECK
Dr. Zeenat Zaidi
Arteries of the Head & Neck
 Common carotid arteries
 Subclavian arteries
Common Carotid Artery
• Is a paired structure
• The left and right common
carotid arteries follow the
same course with the
exception of their origin.
• Right common carotid artery
originates in the neck from
the brachio-cephalic artery
behind the right
sternoclavicular joint
• Left common carotid artery
arises in the superior
mediastinum from the arch of
the aorta
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• The common carotid artery runs
upward through the neck under
cover of the anterior border of the
sternocleidomastoid muscle
• At the upper border of the thyroid
cartilage, it divides into the
external and internal carotid
arteries
The common carotid artery is
embedded in a connective tissue
sheath, called the carotid sheath,
throughout its course and is
closely related to the internal
jugular vein and vagus nerve
Carotid Sinus
• a localized dilatation at the
point of division of the common
carotid artery
• has thinner tunica media of the
sinus is than elsewhere, but
relatively thick adventitia, and
contains numerous nerve
endings derived from the
glossopharyngeal nerve
• serves as a reflex pressoreceptor
mechanism: A rise in blood
pressure causes a slowing of the
heart rate and vasodilatation of
the arterioles
• In cases of carotid sinus
hypersensitivity, pressure on
one or both carotid sinuses can
cause excessive slowing of the
heart rate, a fall in blood
pressure, and cerebral ischemia
with fainting
Carotid Body
• a small structure that lies
posterior to the point of
bifurcation of the
common carotid artery
• is innervated by the
glossopharyngeal nerve.
• is a chemoreceptor,
being sensitive to excess
carbon dioxide and
reduced oxygen tension
in the blood. Such a
stimulus reflexly
produces a rise in blood
pressure and heart rate
and an increase in
respiratory movements.
Relations
• Anterolaterally: skin, fascia,
sternocleidomastoid, sternohyoid,
sternothyroid, superior belly of the
omohyoid
• Posteriorly: transverse processes of
the lower four cervical vertebrae,
prevertebral muscles, sympathetic
trunk. In the lower part of the neck
are the vertebral vessels.
• Medially: larynx and pharynx and,
below these, the trachea and
esophagus. lobe of the thyroid
gland.
• Laterally: internal jugular vein and,
posterolaterally, vagus nerve
• Apart from the two
terminal branches, the
common carotid artery
gives off no branches.
External Carotid Artery
• One of the terminal branches of the
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common carotid artery
Supplies structures in the neck, face, and
scalp; it also supplies the tongue and the
maxilla.
Begins at the level of the upper border of
the thyroid cartilage
Terminates in the substance of the parotid
gland behind the neck of the mandible by
dividing into the superficial temporal and
maxillary arteries.
Close to its origin, the artery emerges from
undercover of the sternocleidomastoid
muscle, where its pulsations can be felt.
At first, lies medial to the internal carotid
artery, later passes backward and lateral to
it.
It is crossed by the posterior belly of the
digastric and the stylohyoid
• Anterolaterally:
Relations
• Overlapped at its beginning by the
anterior border of the
sternocleidomastoid.
• Above this level, covered by skin
and fascia. Crossed by hypoglossal
nerve, posterior belly of the
digastric and stylohyoid muscles.
• Within the parotid gland, it is
crossed by the facial nerve.
• Internal jugular vein first lies lateral
to the artery and then posterior to
it.
• Medially:
• Wall of the pharynx and internal
carotid artery.
• Stylopharyngeus muscle,
glossopharyngeal nerve, and
pharyngeal branch of the vagus
pass between the external and
internal carotid arteries
Branches
• Superior thyroid artery:
• curves downward to the
upper pole of the thyroid
gland
• accompanied by the
external laryngeal nerve
• Ascending pharyngeal
artery:
• ascends along and
supplies the pharyngeal
wall
• Lingual artery:
• loops upward and
forward and supplies the
tongue
• Facial artery
• Loops upward close to the outer
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surface of the pharynx and the
tonsil
Lies deep to the submandibular
salivary gland and
Emerges and bends around the
lower border of the mandible. It
then ascends over the face close to
the anterior border of the masseter
muscle
Then ascends around the lateral
margin of the mouth and
terminates at the medial angle of
the eye
Supplies tonsil, submandibular
gland & muscles and skin of the
face.
Facial
artery
• Occipital artery:
• Supplies the back of the scalp
• Posterior auricular artery:
• Supplies the auricle and the
scalp
• Superficial temporal artery:
• Ascends over the zygomatic
arch, (where it may be palpated
just in front of the auricle).
• Accompanied by the
auriculotemporal nerve
• supplies the scalp.
• Maxillary artery:
• Runs forward medial to the
neck of the mandible and
enters the pterygopalatine
fossa of the skull.
Superficial
Temporal a.
Posterior
auricular a.
Occipital
artery
Internal Carotid Artery
• Begins at the bifurcation of the common carotid
artery at the level of the upper border of the thyroid
cartilage
• Supplies brain, eye, forehead, and part of nose.
• Ascends in the neck embedded in the carotid
sheath with the internal jugular vein and vagus
nerve.
• At first it lies superficially; it then passes deep to
the parotid salivary gland
• Leaves the neck by passing into the cranial cavity
through the carotid canal in the petrous part of the
temporal bone.
• Passes upward and forward in the cavernous
venous sinus
• Leaves the sinus and passes upward again medial
to the anterior clinoid process of the sphenoid
bone.
• Inclines backward, lateral to the optic chiasma, and
terminates by dividing into the anterior and the
middle cerebral arteries.
Relations
• Anterolaterally:
• Below the digastric : skin, fascia, anterior
border of the sternomastoid, and
hypoglossal nerve
• Above the digastric: stylohyoid and
stylopharyngeus muscles,
glossopharyngeal nerve, pharyngeal
branch of vagus, parotid gland, and
external carotid artery
• Posteriorly: sympathetic trunk ,
longus capitis muscle, and transverse
processes of upper three cervical
vertebrae
• Medially: pharyngeal wall and
superior laryngeal nerve
• Laterally: internal jugular vein and
vagus nerve
Subclavian Artery
Right Subclavian Artery
• Arises from the brachiocephalic artery,
behind the right sternoclavicular joint
• Arches upward and laterally over the pleura
and between the scalenus anterior and
medius muscles.
• At the outer border of the first rib, it
becomes the axillary artery.
Left Subclavian Artery
• Arises from the arch of the aorta in the
thorax.
• Ascends to the root of the neck and then
arches laterally in a manner similar to that of
the right subclavian artery
The scalenus anterior muscle
passes anterior to the artery on each
side and divides it into three parts.
First Part of the Subclavian Artery
 Extends from the origin
of the subclavian artery
to the medial border of
the scalenus anterior
muscle
 Branches
 Vertebral artery
 Thyrocervical trunk
 Internal thoracic
artery.
• The vertebral artery:
• Ascends in the neck through
the foramina in the transverse
processes of the upper six
cervical vertebrae
• Passes medially above the
posterior arch of the atlas and
then ascends through the
foramen magnum into the
skull
• On reaching the anterior
surface of the medulla
oblongata of the brain at the
level of the lower border of
the pons, it joins the vessel of
the opposite side to form the
basilar artery.
• Branches in the neck: Spinal
and muscular arteries
• The thyrocervical trunk is a
short trunk that gives off
three terminal branches
• The inferior thyroid artery
ascends to the posterior
surface of the thyroid gland,
where it is closely related to the
recurrent laryngeal nerve. It
supplies the thyroid and the
inferior parathyroid glands.
• The superficial cervical artery is
a small branch that crosses the
brachial plexus
• The suprascapular artery runs
laterally over the brachial
plexus and follows the
suprascapular nerve onto the
back of the scapula
 The internal thoracic
artery:
 Descends into the thorax
behind the first costal
cartilage and in front of
the pleura
 Descends vertically one
fingerbreadth lateral to
the sternum
 In the sixth intercostal
space, it divides into the
superior epigastric and the
musculophrenic arteries.
Second Part of the Subclavian Artery
• Lies behind the scalenus
anterior muscle
Branches
• The costocervical trunk runs
backward over the dome of
the pleura and divides into
the superior intercostal
artery, which supplies the
first and the second
intercostal spaces, and the
deep cervical artery, which
supplies the deep muscles of
the neck.
Third Part of the Subclavian Artery
• Extends from the lateral
border of the scalenus
anterior muscle to the lateral
border of the first rib, where
it becomes the axillary artery.
• Is closely related to the
nerves of the brachial plexus.
Branches
• Usually has no branches.
Occasionally, superficial
cervical and suprascapular
arteries, or both arise from
this part.
Veins of the Head & Neck
 May be divided into:
 Veins of the brain, venous
sinuses, diploic veins, and
emissary veins
 Veins of the scalp, face, and
neck
Facial Vein
• Formed at the medial angle of
the eye by the union of the
supraorbital and supratrochlear
veins.
• Connected through the
ophthalmic veins with the
cavernous sinus.
• Descends down the face with
the facial artery and passes
around the lateral side of the
mouth.
• Crosses the mandible, is joined
by the anterior division of the
retromandibular vein, and
drains into the internal jugular
vein.
Superficial Temporal Vein
• Formed on the side of
the scalp
• Follows the superficial
temporal artery and the
auriculotemporal nerve
• Enters the parotid
salivary gland, where it
joins the maxillary vein
to form the
retromandibular vein.
Maxillary Vein
• Formed in the infratemporal fossa
from the pterygoid venous plexus
• Joins the superficial temporal vein
to form the retromandibular vein.
Retromandibular Vein
• Formed by the union of the
superficial temporal and the
maxillary veins
• On leaving the parotid salivary
gland, divides into an anterior
branch, which joins the facial
vein, and a posterior branch,
which joins the posterior auricular
vein to form the external jugular
vein.
External Jugular Vein
• Formed behind the angle of the jaw
by the union of the posterior
auricular vein with the posterior
division of the retromandibular vein
• Passes straight down the neck in the
superficial fascia, deep to platysma
• Lies superficial to the
sternocleidomastoid muscle
throughout its course, crossing it
diagonally as it descends.
• Reaching the lower part of the neck,
superior to the clavicle and
immediately posterior to the
sternocleidomastoid muscle, it
pierces the investing layer of
cervical fascia, and enters the
subclavian vein behind the middle
of the clavicle..
Tributaries
• Posterior external
jugular vein from the
back of the scalp and
neck
• Transverse cervical vein
from the skin and the
fascia over the
posterior triangle
• Suprascapular vein
from the back of the
scapula
Anterior jugular vein
• Begins below the chin from
veins draining the lower lip
and mental region
• Descends in the front of the
neck close to the midline
• Just above the sternum, is
joined to the opposite vein
by the jugular arch.
• Joins the external jugular
vein deep to the
sternocleidomastoid muscle
Internal Jugular Vein
• A large vein that receives blood
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from the brain, face, and neck
Starts as a continuation of the
sigmoid sinus and leaves the skull
through the jugular foramen.
Descends through the neck in the
carotid sheath lateral to the vagus
nerve and the internal and
common carotid arteries.
Ends by joining the subclavian vein
behind the medial end of the
clavicle to form the
brachiocephalic vein
Throughout its course, it is closely
related to the deep cervical lymph
nodes.
• Has a dilatation at its upper end
called the superior bulb and
another near its termination
called the inferior bulb. Directly
above the inferior bulb is a
bicuspid valve.
Relations
• Anterolaterally: skin, fascia,
sternocleidomastoid, and parotid
salivary gland.
• Lower part is covered by sternothyroid,
sternohyoid, and omohyoid muscles
• Upper part crossed by stylohyoid,
posterior belly of the digastric, and
spinal part of accessory nerve.
• The chain of deep cervical lymph
nodes runs alongside the vein.
• Posteriorly: transverse processes of the
cervical vertebrae, levator scapulae,
scalenus medius, scalenus anterior,
cervical plexus, phrenic nerve,
thyrocervical trunk, vertebral vein, and
first part of the subclavian artery . On
the left side it passes in front of the
thoracic duct.
Medially: Above lie the
internal carotid artery and
9th, 10th, 11th, and 12th
cranial nerves. Below lie the
common carotid artery and
the vagus nerve
Tributaries
 Inferior petrosal sinus
 Facial vein
 Pharyngeal veins
 Lingual vein
 Superior thyroid vein
 Middle thyroid vein
Subclavian Vein
• Continuation of the axillary vein at
the outer border of the first rib
• Joins the internal jugular vein to
form the brachiocephalic vein
• Receives the external jugular vein
• In addition, it receives the thoracic
duct on the left side and the right
lymphatic duct on the right.
Relations
• Anteriorly: The clavicle
• Posteriorly: The scalenus anterior
muscle and the phrenic nerve
• Inferiorly: The upper surface of the
first rib
Internal Jugular Vein
Catheterization
• The internal jugular vein is remarkably
constant in position.
• In the posterior approach, the tip of the
needle and the catheter are introduced into
the vein about two fingerbreadths above
the clavicle at the posterior border of the
sternocleidomastoid muscle
• In the anterior approach, with the patient's
head turned to the opposite side, the
triangle formed by the sternal and clavicular
heads of the sternocleidomastoid muscle
and the medial end of the clavicle are
identified. A shallow skin depression usually
overlies the triangle. The needle and
catheter are inserted into the vein at the
apex of the triangle in a caudal direction