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Dr. Sami Zaqout Faculty of Medicine IUG
Arteries of the Head and Neck
Dr. Sami Zaqout Faculty of Medicine IUG
Common Carotid Artery
Dr. Sami Zaqout Faculty of Medicine IUG
Common Carotid Artery
Dr. Sami Zaqout Faculty of Medicine IUG
Carotid Sinus and Carotid Body
Dr. Sami Zaqout Faculty of Medicine IUG
Carotid Sinus Hypersensitivity
• 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.
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Common Carotid Artery
• Anterolaterally:
– Skin and fascia
– Sternocleidomastoid m
– Sternohyoid m
– Sternothyroid m
– Superior belly of omohyoid
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Common Carotid Artery
• Posteriorly:
– Transverse processes of the lower four cervical vertebrae
– Prevertebral muscles
– Sympathetic trunk
– Vertebral vessels
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Common Carotid Artery
• Medially:
– Larynx
– Pharynx
– Trachea
– Esophagus
– Lobe of the thyroid gland
• Laterally:
– Internal jugular vein
– Vagus nerve
Dr. Sami Zaqout Faculty of Medicine IUG
Taking the Carotid Pulse
• The bifurcation of the common carotid artery into the internal and external carotid arteries can be easily palpated just beneath the anterior border of the sternocleidomastoid muscle at the level of the superior border of the thyroid cartilage.
Dr. Sami Zaqout Faculty of Medicine IUG
Branches of the Common Carotid Artery
No branches.
Dr. Sami Zaqout Faculty of Medicine IUG
External Carotid Artery
• Begins at the level of the upper border of the thyroid cartilage and terminates in the substance of the parotid gland behind the neck of the mandible.
• Supplies structures in: – Neck – Face – Scalp – Tongue – maxilla
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the External Carotid Artery
Anterolaterally: – Anterior border of the
sternocleidomastoid.
– Skin and fascia
• Crossed by: – Hypoglossal nerve
– Posterior belly of the digastric m
– Stylohyoid m
• Within the parotid gland it is crossed by the facial nerve.
• The internal jugular vein first lies lateral to the artery and then posterior to it.
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the External Carotid Artery
Medially:
• Pharynx
• Internal carotid artery
• Stylopharyngeus m
• Glossopharyngeal nerve
• Pharyngeal branch of the vagus
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Branches of the External Carotid Artery
Dr. Sami Zaqout Faculty of Medicine IUG
Maxillary Artery
Branches supply:
• The upper jaw
• The lower jaw
• The muscles of mastication
• The nose
• The palate
• The meninges
Dr. Sami Zaqout Faculty of Medicine IUG
Internal Carotid Artery • Begins at the level of the upper border of the thyroid cartilage.
• Leaves the neck by passing into the cranial cavity through the carotid canal in the petrous part of the temporal bone.
• It then passes upward and forward in the cavernous venous sinus (without communicating with it).
• It then leaves the sinus and passes upward again medial to the anterior clinoid process of the sphenoid bone.
• It then inclines backward, lateral to the optic chiasma, and terminates by dividing into the anterior and the middle cerebral arteries.
• It supplies: – Brain
– Eye
– Forehead
– Part of the nose
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Carotid Artery in the Neck
Anterolaterally: Below the digastric
o Skin and fascia o Anterior border of the
sternocleidomastoid m o Hypoglossal nerve
Above the digastric o Stylohyoid m o Stylopharyngeus m o Glossopharyngeal nerve o Pharyngeal branch of the
vagus o Parotid gland o External carotid artery
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Carotid Artery in the Neck
Posteriorly:
• Sympathetic trunk
• Longus capitis m
• Transverse processes of the upper three cervical vertebrae
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Carotid Artery in the Neck
• Medially:
• Pharyngeal wall
• Superior laryngeal nerve
Laterally:
• Internal jugular vein
• Vagus nerve
Dr. Sami Zaqout Faculty of Medicine IUG
Arteriosclerosis of the Internal Carotid Artery
Dr. Sami Zaqout Faculty of Medicine IUG
Branches of the Internal Carotid Artery in The Neck
There are no branches
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Branches of the Internal Carotid Artery in The Skull
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Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout
Cortical arterial supply
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Subclavian Arteries – Right and Left
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Subclavian Arteries - Three Parts
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Subclavian Arteries - Branches
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Veins of the Head and Neck
Dr. Sami Zaqout Faculty of Medicine IUG
Veins of the Head and Neck
The veins of the brain, venous sinuses, diploic veins, and emissary veins
The veins of the scalp, face, and neck
Dr. Sami Zaqout Faculty of Medicine IUG
Veins of the Brain
• The veins of the brain are thin walled and have no valves.
• They consist of the cerebral veins, the cerebellar veins, and the veins of the brainstem, all of which drain into the neighboring venous sinuses.
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Venous Sinuses
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Diploic Veins and Emissary Veins
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Veins of the Face and the Neck
Dr. Sami Zaqout Faculty of Medicine IUG
Internal jugular vein • The internal jugular vein is a large vein that receives blood from:
– Brain
– Face
– Neck
• It starts as a continuation of the sigmoid sinus and leaves the skull through the jugular foramen.
• It then descends through the neck in the carotid sheath lateral to the vagus nerve and the internal and common carotid arteries.
• It 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.
• The vein has a dilatation at its upper end called the superior bulb and another near its termination called the inferior bulb.
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Jugular Vein
Anterolaterally: • Skin and fascia • Sternocleidomastoid m • Parotid salivary gland
• Stylohyoid m • Posterior belly of the digastric m • Spinal part of the accessory
nerve
• Sternothyroid m • Sternohyoid m • Omohyoid m
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Jugular Vein
Posteriorly: • Transverse processes of the
cervical vertebrae • Levator scapulae • Scalenus medius • Scalenus anterior • Cervical plexus • Phrenic nerve • Thyrocervical trunk • Vertebral vein • First part of the subclavian
artery. • On the left side it passes in
front of the thoracic duct.
Dr. Sami Zaqout Faculty of Medicine IUG
Relations of the Internal Jugular Vein
Medially:
• Internal carotid artery
• 9th, 10th, 11th, and 12th cranial nerves
• Common carotid artery
• Vagus nerve
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Tributaries of the Internal Jugular Vein
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Penetrating Wounds of the Internal Jugular Vein
• Air embolism is a serious complication of a lacerated wall of the internal jugular vein.
• Because the wall of this large vein contains little smooth muscle, its injury is not followed by contraction and retraction
• The adventitia of the vein wall is attached to the deep fascia of the carotid sheath, which hinders the collapse of the vein.
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Internal Jugular Vein Catheterization
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Subclavian Vein • The subclavian vein is a continuation of the axillary vein at the
outer border of the first rib
• It joins the internal jugular vein to form the brachiocephalic vein
• It receives the external jugular vein
• It often receives the thoracic duct on the left side and the right lymphatic duct on the right.
Dr. Sami Zaqout Faculty of Medicine IUG
Subclavian Vein - Relations
Anteriorly:
– Clavicle
Posteriorly:
– Scalenus anterior muscle
– Phrenic nerve
Inferiorly:
– Upper surface of the first rib
Dr. Sami Zaqout Faculty of Medicine IUG
Subclavian Vein Thrombosis
• Spontaneous thrombosis occasionally occurs after excessive and unaccustomed use of the arm at the shoulder joint.
• Secondary thrombosis is a common complication of an indwelling venous catheter.
• Rarely, the condition may follow a radical mastectomy with a block dissection of the lymph nodes of the axilla.
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Anatomy of Subclavian Vein Catheterization
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Infraclavicular Approach
• The needle is pointed upward and posteriorly toward the middle of the suprasternal notch.
Skin
Superficial fascia
Pectoralis major muscle (clavicular head)
Clavipectoral fascia and subclavius muscle
Wall of subclavian vein
Dr. Sami Zaqout Faculty of Medicine IUG
Infraclavicular Approach - Complications
• Pneumothorax
• Hemothorax
• Subclavian artery puncture
• Internal thoracic artery injury
• Diaphragmatic paralysis
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Supraclavicular Approach
• The needle is directed downward in the direction of the opposite nipple.
Skin
Superficial fascia and platysma
Investing layer of deep cervical fascia
Wall of the subclavian vein
Dr. Sami Zaqout Faculty of Medicine IUG
Supraclavicular Approach - Complication
• Paralysis of the diaphragm
• Pneumothorax or hemothorax
• Brachial plexus injury
Lymph Drainage of the Head and Neck
Dr. Sami Zaqout Faculty of Medicine IUG
• Lymph nodes of the head and neck are arranged:
As a regional collar that extends from below the chin to the back of the head.
As a deep vertical terminal group that is embedded in the carotid sheath in the neck.
Lymph Drainage of the Head and Neck
Dr. Sami Zaqout Faculty of Medicine IUG
Re
gio
nal
No
de
s
Occipital nodes
Retroauricular (mastoid) nodes
Parotid nodes
Buccal (facial) nodes
Submandibular nodes
Submental nodes
Anterior cervical nodes
Superficial cervical nodes
Retropharyngeal nodes
Laryngeal nodes
Tracheal (paratracheal) nodes
Dr. Sami Zaqout Faculty of Medicine IUG
Lymph Drainage of the Head and Neck
Occipital nodes • Back of the scalp
Retroauricular (mastoid) nodes • Scalp above the ear • Auricle • External auditory meatus
Parotid nodes • Scalp above the parotid gland • Eyelids • Parotid gland • Auricle • External auditory meatus
Buccal (facial) nodes
Dr. Sami Zaqout Faculty of Medicine IUG
Lymph Drainage of the Head and Neck
Submandibular nodes
• Front of the scalp
• Nose
• Cheek
• Upper lip and lower lip (except the central part)
• Upper teeth and lower teeth (except the lower incisors)
• Anterior two thirds of the tongue (except the tip)
• Floor of the mouth and vestibule; and the gums
• Frontal, maxillary, and ethmoid sinuses
Dr. Sami Zaqout Faculty of Medicine IUG
Lymph Drainage of the Head and Neck
Submental nodes • Tip of the tongue • Floor of the anterior part of the mouth • Incisor teeth • Centeral part of the lower lip • Skin over the chin
Anterior cervical nodes • Skin and superficial tissues of the front of the neck
Superficial cervical nodes • Skin over the angle of the jaw • Skin over the lower part of the parotid gland • Lobe of the ear
Dr. Sami Zaqout Faculty of Medicine IUG
Lymph Drainage of the Head and Neck
Retropharyngeal nodes:
• Nasal pharynx
• Auditory tube
• Vertebral column
Laryngeal nodes
• Larynx
Tracheal (paratracheal) nodes
• Neighboring structures, including the thyroid gland
Dr. Sami Zaqout Faculty of Medicine IUG
Deep Cervical Nodes
• Form a vertical chain along the course of the internal jugular vein within the carotid sheath.
• Receive lymph from all the groups of regional nodes.
• The efferent lymph vessels from the deep cervical lymph nodes join to form the jugular trunk, which drains into the thoracic duct or the right lymphatic duct
Dr. Sami Zaqout Faculty of Medicine IUG
Deep Cervical Nodes
The jugulodigastric node
• Located below and behind the angle of the jaw
• Mainly concerned with drainage of the tonsil and the tongue
The jugulo-omohyoid node
• Situated close to the omohyoid muscle
• Mainly associated with drainage of the tongue
Dr. Sami Zaqout Faculty of Medicine IUG
Examination of the Deep Cervical Lymph Nodes
• After the identification of enlarged lymph nodes, possible sites of infection or neoplastic growth should be examined, including the face, scalp, tongue, mouth, tonsil, and pharynx.
Dr. Sami Zaqout Faculty of Medicine IUG
Carcinoma Metastases in the Deep Cervical Lymph Node
• In the head and neck, all the lymph ultimately drains into the deep cervical group of nodes.
• Secondary carcinomatous deposits in these nodes are common.
Primary growth may be easy to find.
Primary growth may be small and overlooked.
Dr. Sami Zaqout IUG Faculty of Medicine