head and neck vasculature

What is the origin of the subclavian artery (R&L)?

-Right subclavian from Right Brachiocephalic trunk

-Left subclavian artery from aortic arch

What is the course of the subclavian artery?

ascend through superior thoracic aperture to enter root of neck posterior to clavicle, arch over 1st rib, then change name to axillary artery, lateral to anterior scalene muscle

What does the subclavian artery supply?

Supplies the upper limbs, neck, and brain

What are the parts of the subclavian artery? (3) What muscle are they in reference to?

Parts: divided in three parts in reference to anterior scalene muscle

1st part: medial to anterior scalene

2nd part: posterior (deep) to anterior scalene

3rd part: lateral to anterior scalene

What are the branches of the subclavian artery?

1. Internal thoracic artery

2. Vertebral artery

3. Thyrocervical trunk

4. Cervicodorsal trunk (Transverse cervical artery)

5. Cervicocervical trunk

what is the origin of the internal thoracic branch of the subclavian artery?

arises from the anteroinferior aspect of the 1st part of the subclavian artery

what is the course of the internal thoracic branch of the subclavian artery?

1) descends into thorax posterior to clavicle and 1st costal cartilage

2) descends on each sides of sternum into the anterior wall of the thoracic cavity

3) gives rise to anterior intercostal arteries and vessels of the breast (known has internal mammary aa)

What does the Internal thoracic artery branch of the subclavian artery supply?

Supplies the anterior thoracic wall and breast

What is the origin of the vertebral artery branch of the subclavian artery?

from 1st part of subclavian

what is the course of the vertebral artery branch of the subclavian artery?

Course:

1. ascends through transverse foramina of cervical vertebrae (enters at C6)

2. comes out of transverse foramina of C1 (Atlas)

3. goes around lateral mass of Atlas

4. crosses posterior arch (on the groove of the C1)

5. then penetrates the posterior atlantooccipital membrane (at the level of the suboccipital triangle)

6. enters cranial cavity through FM

What does the vertebral artery branch of the subclavian artery supply?

Brain and spinal cord

what is the origin of the thyrocervical trunk branch of the subclavian artery?

arises from anterosuperior aspect of the 1st part of the subclavian a (near medial border of anterior scalene)

what is the course of the thyrocervical trunk branch of the subclavian artery?

immediately separates into 4 branches

What is the course of inferior thyroid artery branch of the subclavian artery?

thyrocervical trunk

What does the inferior thyroid artery branch of the subclavian artery supply?

Supplys

Larynx, trachea, esophagus, thyroid and parathyroid glands, and adjacent muscles

What is the course of the ascending cervical artery (terminal branch of thyrocervical trunk)?

inferior thyroid a.

What does the Ascending cervical artery (Terminal branch of thyrocervical trunk) supply?

lateral muscles of upper neck

what is the origin of the suprascapular artery?

thyrocervical trunk

what is the course of the suprascapular artery?

1) inferolaterally across anterior scalene muscle and phrenic nerve

2) posterior to clavicle

3) posterior aspect of scapula

What does the suprascapular artery supply?

Supply: muscles along posterior aspect of scapula

what is the origin of the cervicodorsal trunk?

thyrocervical trunk

what is the course of the cervicodorsal trunk?

crosses superficial to anterior scalene m. and 2-3 cm superior to clavicle

What does the Cervicodorsal trunk (Transverse cervical a.) supply?

vasa nervorum of brachial plexus, muscles along posterior aspect of scapula

What are the branches of the Cervicodorsal trunk (Transverse cervical a.) (2)

1. Superficial cervical artery (accompanies accessory n.: CN XI)

2. Dorsal scapular artery (posterior aspect of scapula)

what is the origin of the Costocervical trunk?

arises from posterior aspect of 2nd part of the subclavian a.

what is the course of the Costocervical trunk?

posterior to anterior scalene and goes superiorly before it divides

what are the branches of the Costocervical trunk? (2) What do they supply?

Branches

1. Superior (supreme) intercostal artery: supplies first two posterior intercostal spaces

2.Deep cervical artery: supplies posterior deep cervical muscles

What is the origin of the common carotid artery? (R&L)

Right common carotid artery from Right Brachiocephalic trunk

Left common carotid artery from aortic arch

What is the course of the common carotid artery?

ascends within the carotid sheath until superior border of thyroid cartilage where it divides

What does the common carotid artery supply?

supplies head and neck

What are the branches of the common carotid artery?

1. Internal carotid a.: no branches in the neck. Ascends in the carotid sheath

2. External carotid a.: numerous branches in the neck

What is the origin of the Internal carotid artery?

arise from and is a direct continuation of the common carotid artery

What is the course of the Internal carotid artery?

1. ascends through neck without branching

2. enters cranial cavity through carotid canal

3. runs anteriorly through cavernous sinus, where it divides

What does the Internal carotid artery supply?

brain and orbit

What are the Internal Carotid artery branches? (3)

1. Anterior cerebral artery

2.Middle cerebral artery

3.Ophthalmic artery

What is the course and supply of the Ophthalmic artery of the internal carotid artery?

Course: passes through optic canal and enters orbit

Supply: eyeball and extra-ocular muscles and structures

What artery is the carotid sinus found? What is its function?

slight dilation of the proximal part of the internal carotid a. It’s a baroreceptor and reacts to changes in blood pressure

What artery is the carotid body found? What is its function?

ovoid mass of tissue located on the medial side of the bifurcation of the common carotid. It’s a chemoreceptor and monitors O2 blood levels.

What is the origin of the External carotid artery?

arise from the common carotid artery

What is the course of the External carotid artery?

ascends posterosuperiorly to the condylar process of the mandible, where it divides in the two terminal branches

1. maxillary artery

2. superficial temporal artery

What does the External carotid artery supply?

most structures external to the cranium, with the exception of the orbit and part of the forehead. It also supplies deep structures of the cranium (e.g. middle meningeal a.)

What are the branches of the External Carotid Artery (ECA) (8)

Anterior (S-L-F)

1. Superior thyroid a.

2. Lingual a.

3. Facial a.

Medial ( M-A-P)

4. Ascending pharyngeal a.

Posterior (P-O-P)

5. Occipital a.

6. Posterior auricular a.

Terminal (T-S-M)

7. Superficial temporal a.

8. Maxillary a.

What is the course of the superior thyroid artery (anterior) of the external carotid artery?

runs anteroinferiorly deep to infrahyoid m

What does the superior thyroid artery (anterior) of the external carotid artery supply?

thyroid gland, infrahyoid mm. and SCM

What is the branch of the superior thyroid artery (anterior) of the external carotid artery?

1. Superior laryngeal a. (Supply: larynx)

What is the course of the lingual artery (anterior) of the external carotid artery?

1) runs superoanteriorly deep to hypoglossal n. (CN XII) and disappears under the hypoglossus m.

2) ascends towards tip of tounge

What does the lingual artery (anterior) of the external carotid artery supply? What are its branches

Supply: tongue

Branches:

1. Deep lingual a.

2.Sublingual aa.

What is the course of the facial artery (anterior) of the external carotid artery

Course

1. runs anteriorly (deep to posterior belly of digastric m. and stylohyoid m.)

2. hooks around the middle of the inferior border of mandible, emerging onto the face

3. diagonal course towards medial aspect of orbit

What does the facial artery (anterior) of the external carotid artery supply?

submandibular gland, muscles of facial expression, and face (lips, nose, and orbit)

What are the branches of the facial artery (anterior) of the external carotid artery? (3)

1. Ascending palatine a.

2. Tonsillar a.

3.Submental a

what is the course of the ascending pharyngeal artery (medial) of the external carotid artery?

ascends along pharynx deep (medial) to internal carotid a.

The ascending pharyngeal artery (medial) of the external carotid artery supplys what?

pharynx, prevertebral muscles, middle ear, and cranial meninges

what is the course of the occipital artery (posterior) of the external carotid artery?

1) ascends posteriorly parallel to posterior belly of digastric m.

2) it divides in posterior part of scalp

The Occipital artery (posterior) of the external carotid artery supplys what?

posterior portion of scalp

what is the course of posterior auricular artery (posterior) of the external carotid artery?

ascends posteriorly between external acoustic meatus opening and mastoid process

The posterior auricular artery (posterior) of the external carotid artery supply what?

parotid gland, facial nerve, and structures in temporal bone, auricle, and small part of scalp posterior to auricle

what is the course of superficial temporal artery (terminal) of the external carotid artery?

1) arises from terminal bifurcation of ECA

2) emerges on face between TMJ and auricle

3) om scalp it divides into frontal and parietal branches

The superficial temportal artery (terminal) of the external carotid artery supply what?

frontolateral part of scalp

What is the branch of the superficial temporal artery? What is its course and what is it supplied by?

1. Transverse facial artery

Course: projects anteriorly within parotid gland and superficial to masseter muscle

Supply: parotid gland and duct, masseter muscle, and skin of face. Anastomoses with facial artery

What is the course of the artery (terminal) of the external carotid artery?

1) runs anteriorly through infratemporal fossa

2) crosses lateral pterygoid m.

3) goes through pterygomaxillary fissure and into pterygopalatine fossa

What does the maxillay artery (terminal) of the external carotid artery supply what?

TMJ, infratemporal fossa structures, meninges and calvaria, maxillary and mandibular teeth, structures of nasal cavity, and some aspects of the orbit

What are the maxillay artery branches in the INFRATEMPORAL FOSSA?

1. middle meningeal

2. muscular branches

3. Inferior alveolar

4. posterior superior alveolar (PSA)

What is the course of the middle meningeal (Maxillary artery branches) in the infratemporal fossa?

ascends to enter cranial cavity through foramen spinosum

What is the middle meningeal (Maxillary artery branches) in the infratemporal fossa supplied by?

dura mater and calvaria, trigeminal ganglion, facial n. and geniculate ganglion

What is the course of the muscular branches Maxillary artery branches in the infratemporal fossa?

go to muscles of mastication and the buccinator

What is the muscular branches Maxillary artery branches in the infratemporal fossa supplied by?

muscles of mastication and buccinator

What is the course of Inferior alveolar (Maxillary artery branches) in INFRATEMPORAL FOSSA supplied by?

1) descends to enter the mandible via mandibular foramen

2) goes anteriorly within the body if mandible

3) emerges through mental foramen

4) becoming the mental a

What is the Inferior alveolar (Maxillary artery branches) in INFRATEMPORAL FOSSA supplied by?

mandible, mandibular teeth, chin, and mylohyoid muscle

What is the course of the posterior superior alveolar (PSA) Maxillary artery branches in the infratemporal fossa?

descends on maxilla’s infratemporal surface

What is the posterior superior alveolar (PSA) Maxillary artery branches in the infratemporal fossa supplied by?

Supply: maxillary molar and premolar teeth, adjacent gingiva, and mucous membrane of maxillary sinus

what are the maxillary artery branches in PTERYGOPALATINE FOSSA?

1. Infraorbital artery

- Anterior/ Middle superior alveolar arteries

2. Descending palatine artery

- Greater/ Lesser palatine artery

3. Sphenopalatine artery

What is the course of the infraorbital artery of the maxillary artery branches in PTERYGOPALATINE FOSSA?

Course:

1. enters orbit via inferior orbital fissure

2. runs on inferior wall (floor) of orbit

3. emerges in the face through infraorbital foramen

What is the Infraorbital artery of the maxillary artery branches in PTERYGOPALATINE FOSSA supplied by?

Supply: inferior oblique and rectus mm., lacrimal sac, maxillary canines and incisors teeth, and infra-orbital region of face

What are the branches of the Infraorbital artery? (2) What are they suppled by?

Branches:

1. Anterior superior alveolar artery

2. Middle superior alveolar artery

Supply: incisors and canines teeth, respectively

What is the course of the descending palatine artery of the maxillary artery branches in

PTERYGOPALATINE FOSSA?

descends to the palate and divides

What is the descending palatine artery of the maxillary artery branches in

PTERYGOPALATINE FOSSA supplied by?

greater and lesser palatine arteries supply the palate

What are the branches of the descending palatine artery? What do they supply?

Greater and lesser palatine artery

Supply: mucosa and glands of hard and soft palate

What is the course of the Sphenopalatine artery (terminal a. of maxillary a.) of the maxillary artery branches in PTERYGOPALATINE FOSSA?

through sphenopalatine foramen

What is the Sphenopalatine artery (terminal a. of maxillary a.) of the maxillary artery branches in PTERYGOPALATINE FOSSA supplied by?

walls and septum of nasal cavity, frontal, ethmoidal, sphenoid, and maxillary sinuses

What vein drains the anterior part of the scalp?

1. Supra-orbital vein

2. Supratrochlear vein

What vein drains the scalp anterior to the auricles?

Superficial temporal vein

What vein drains the scalp posterior to auricles?

Posterior auricular vein

What vein drains the posterior part of the scalp and ends deep in the IJV?

Occipital vein

What is the origin of the facial vein?

medial aspect of orbit from superior and inferior ophthalmic vein.

CLINCAL RELIVANCE!

Infection in the face can spread to the cranial cavity through what vein?

Facial Vein

Superior ophthalmic vein runs on the roof of orbit > goes through the superior orbital fissure > enters the cavernous sinus.

What is the course of the Facial vein? What does it drain?

course: descends posteriorly and inferiorly until > lower border of mandible > runs posteriorly to join the common trunk on IJV

Drains superficial aspect of face

What are the superficial jugular veins?

1. Anterior jugular vein

2. External jugular vein

What is the origin of the anterior jugular vein?

at the hyoid bone level from confluence of superficial submandibular veins

What is the course of the anterior jugular vein?

descends between anterior median line of neck and anterior border of SCM > at root of neck it turns laterally and posterior (deep) to SCM > ends in the EJV or subclavian vein

What is the jugular venous arch?

where R & L anterior jugular veins join superior to the manubrium, in the suprasternal space

What is the course of the External jugular vein?

descends from angle of mandible superior to SCM and deep to platysma > pierces investing layer of deep cervical fascia > ends in subclavian vein

What does the External jugular vein drain?

most of scalp and side of face

What are the tributaries of the external jugular vein?

1. Posterior auricular vein

2. Retromandibular vein

- Superficial temporal vein

- Maxillary vein

3. Pterygoid venous plexus

What is the course of the posterior auricular vein of the external jugular vein?

part of scalp between auricles and superior to mastoid process (superficial to SCM)

What is the course of the retromandibular vein of the external jugular vein?

1)runs posterior to ramus of mandible, within the substance of the parotid gland

2) emerges from the inferior pole of the parotid gland and divides in anterior and posterior branches

what are the tributaries of the retromandibular vein?

superficial temporal vein and maxillary vein

what is the course of the superficial temporal vein?

1) from part of scalp anterior to auricles

2) descends to infratemporal region to meet the maxillary vein

what is the course of the maxillary vein?

1) drains the pterygoid venous plexus in the infratemporal regions

2) runs posteriorly to join superficial temporal vein

What is the location of the Pterygoid venous plexus of the external jugular vein? What is its connection? What is the clinical relevance associated?

location: infratemporal fossa (under temporalis muscle and around pterygoid muslce

Connections: Anteriorly to facial v. Superiorly to cavernous sinus. Posteriorly with EJV via maxillary v. ****Potential for infection spread among those areas

What is the origin and course of the Internal jugular vein?

Origin: jugular foramen in the posterior cranial fossa

Course: descends through the neck in carotid sheath deep to SCM > joins subclavian vein (posterior to sternal end of clavicle)