Dr. Sami Zaqout Faculty of Medicine IUGsite.iugaza.edu.ps/sizaqout/files/2012/03/The-Neck-II.pdfDr....

Dr. Sami Zaqout Faculty of Medicine IUG

Arteries of the Head and Neck


Common Carotid Artery


Carotid Sinus and Carotid Body


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.


Relations of the Common Carotid Artery

• Anterolaterally:

– Skin and fascia

– Sternocleidomastoid m

– Sternohyoid m

– Sternothyroid m

– Superior belly of omohyoid



• Posteriorly:

– Transverse processes of the lower four cervical vertebrae

– Prevertebral muscles

– Sympathetic trunk

– Vertebral vessels



• Medially:

– Larynx

– Pharynx

– Trachea

– Esophagus

– Lobe of the thyroid gland

• Laterally:

– Internal jugular vein

– Vagus nerve


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.


Branches of the Common Carotid Artery

No branches.


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


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.


Relations of the External Carotid Artery

Medially:

• Pharynx

• Internal carotid artery

• Stylopharyngeus m

• Glossopharyngeal nerve

• Pharyngeal branch of the vagus


Branches of the External Carotid Artery


Maxillary Artery

Branches supply:

• The upper jaw

• The lower jaw

• The muscles of mastication

• The nose

• The palate

• The meninges


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


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



Posteriorly:

• Sympathetic trunk

• Longus capitis m

• Transverse processes of the upper three cervical vertebrae



• Medially:

• Pharyngeal wall

• Superior laryngeal nerve

Laterally:

• Internal jugular vein

• Vagus nerve


Arteriosclerosis of the Internal Carotid Artery


Branches of the Internal Carotid Artery in The Neck

There are no branches


Branches of the Internal Carotid Artery in The Skull

Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout

Cortical arterial supply


Subclavian Arteries – Right and Left


Subclavian Arteries - Three Parts


Subclavian Arteries - Branches

Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout

Veins of the Head and Neck


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


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.

Dr. Sami Zaqout

Venous Sinuses


Diploic Veins and Emissary Veins


Veins of the Face and the Neck


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.


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



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.



Medially:

• Internal carotid artery

• 9th, 10th, 11th, and 12th cranial nerves

• Common carotid artery

• Vagus nerve


Tributaries of the Internal Jugular Vein


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.


Internal Jugular Vein Catheterization


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.


Subclavian Vein - Relations

Anteriorly:

– Clavicle

Posteriorly:

– Scalenus anterior muscle

– Phrenic nerve

Inferiorly:

– Upper surface of the first rib


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.


Anatomy of Subclavian Vein Catheterization


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


Infraclavicular Approach - Complications

• Pneumothorax

• Hemothorax

• Subclavian artery puncture

• Internal thoracic artery injury

• Diaphragmatic paralysis


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


Supraclavicular Approach - Complication

• Paralysis of the diaphragm

• Pneumothorax or hemothorax

• Brachial plexus injury

Lymph Drainage of the Head and Neck


• 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.



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



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



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



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



Retropharyngeal nodes:

• Nasal pharynx

• Auditory tube

• Vertebral column

Laryngeal nodes

• Larynx

Tracheal (paratracheal) nodes

• Neighboring structures, including the thyroid gland


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


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


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.


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

Dr. Sami Zaqout Faculty of Medicine IUGsite.iugaza.edu.ps/sizaqout/files/2012/03/The-Neck-II.pdfDr....

Documents

Transcript of Dr. Sami Zaqout Faculty of Medicine IUGsite.iugaza.edu.ps/sizaqout/files/2012/03/The-Neck-II.pdfDr....