- On the right side it arises from the brachiocephalic trunk, on the left it comes from the arch of the aorta. - On the right side it originates at the level of the right sternoclavicular joint. On the left it originates in the superior mediastinum and extends up past the left sternoclavicular joint. - Extends posteriorly and upwards. - Both CCA terminate becoming the external and internal carotid arteries at the upper border of the thyroid cartilage (C3-C4) - Gives no branches other branches in the neck. Internal Carotid Artery- - Originates as a terminal branch of the CCA at the superior border of the thyroid gland in the neck (C3-C4) - Gives no branches in the neck - Passes through carotid canal into cranial cavity - Gives following branches: o Anterior Cerebral Artery o Middle Cerebral Artery o Posterior communicating branch with Circle of Willis o Ophthalmic Artery - Has two special features at origin of ICA: o Carotid Sinus localized dilation, innervated by glosspharyngeal and sympathetic fbres acts as a baroreceptor to control BP. o Carotid Body Small, reddish-brown structure found at bifurcation of CCA, innervated by glossopharyngeal and vagus, which acts a chemoreceptor (O2 and CO2) Ophthalmic Artery- - Important branch of ICA in the cranial cavity. - Passes through the optic canal with CN II - Has nine branches in the orbit: o Lacrimal Artery o Central Artery of the Retina (travels within CN II) o Posterior Ciliary Arteries (Long and Short) o Supratrochlear Artery o Supraorbital Artery o Anterior Ethmoidal Artery o Posterior Ethmoidal Artery o Medial Palpebral Artery o Dorsal Nasal Artery External Carotid Artery- - Originates from bifurication of CCA at C3-C4 level. - Starts medial to ICA but will pass backwards and laterally. - Terminates by entering the parotid gland and bifurcating into Maxillary and Superfcial Temporal Arteries. - Gives the following branches o Superior Thyroid Artery (Anterior) Supplies upper 1/3 of lobe, upper of isthmus o Ascending Pharyngeal Artery (Medial) Pharynx, Meninges o Facial Artery (Anterior) Cervical Part Tonsilar Glandular Submental Ascending Palantine Facial Part Inferior Labial Superior Labial Lateral Nasal Angular o Lingual Artery (Anterior) Tongue, suprahyoid muscles, palantine tonsil o Posterior Auricular Artery (Posterior) External ear, scalp o Occipital Artery (Posterior) Scalp, lateral neck o Maxillary o Superfcial Temporal Artery Gives Transverse Facial Artery Maxillary Artery - Terminal branch of the ECA. - Divided into three parts each with its own branches: o Mandibular Part Deep Auricular Artery Anterior Tympanic Artery Middle Meningeal Artery Accessory Meningeal Artery Inferior Alveolar Artery o Pterygoid Part Buccal Artery Masseteric Artery Pterygoid Artery Deep Temporal Artery o Pterygo-Palantine Part Posterior Superior Alveolar Artery Infraorbital Pharyngeal Artery Artery to pterygoid canal Great Palantine Artery Sphenopalantine Artery Subclavian Artery - Right subclavian originates from brachiocephalic trunk, located behind the right sternoclavicular joint. Left is a branch of he the aortic arch. Both will continue down arm as Axillary Artery. - Divided into three parts by the Scalanius Anterior muscle o Ist Part Vertebral Artery Thyrocervical Trunk Transverse Cervical Artery Suprascapular Artery Inferior Thyroid (Travels with recurrent laryngeal n.) Internal Thoracic Artery o 2 nd Part Costocervical Trunk Superior Intercostal Artery Deep Cervical Artery o 3 rd Part Dorsal Scapular Artery - Clinical Correlations: o Scalenius Anterior Syndrome hypertrophy (possibly from tuberculosis) of SA muscle will cause compression of the 2nd part of subclavian artery o Subclavian Steal Syndrome - Stenosis or blockage of the proximal subclavian artery on one side will cause blood fow to be stolen from the brains blood supply. Blood intended for the brain will instead pass up through the internal carotids and pass in a retrograde fashion back down the vertebral artery to supply the occluded subclavian/axillary artery. Obviously though, this is not good for the brain! o As well the subclavian artery is in close proximity to the trunks of the brachial plexus and may pathologically cause compression of these nerves. Vertebral Artery Branch of 1 st part of the subclavian artery - 1st part o Passes from its origin to the transverse foramen of C6 - 2nd part o Passes upwards through the transverse foramen of C6 to C1 - 3rd part o Traverses laterally across the superior border of the posterior arch of the atlas. o In the suboccipital triangle - 4th part o Enters the cranial vault VIA the foramen magnum. o Left and right vertebral arteries join to terminate as the basilar artery. o Branches from basilar artery: Posterior Cerebral Artery Superior Cerebellar Artery Signifcance: Oculomotor Nerve (CN III) runs through these two before passing into the middle cranial fossa, and can be damaged if vessels hemorrhage or have an aneurysm. o Branches from 4th part: Anterior Spinal Artery Posterior Spinal Artery Meningeal Branches Medullary Branches Posterior Inferior Cerebellar Artery Venous Drainage of Head and Neck Dural Venous Sinuses - Endothelium lined spaces found between the periosteal and meningeal layers of dura mater. - Drainage site for most veins from the brain. - Superior Sagittal Sinus o Formed in convex attached border of falx cerebri o Extends from crista galli to external occipital protuberence o Ends at the confuence of the sinuses o Receives the superior cerebral veins o Majority of arachnoid granulations are found in this sinus. - Inferior Sagittal Sinus o Runs along free border of falx cerebri o Empties into straight sinus - Straight Sinus o Formed by inferior sagittal sinus and great cerebral vein o Runs between connection of falx cerebri and tentorium cerebelli. o Ends in confuence of the sinuses - Occipital Sinus o Found in the attached border of the falx cerebelli o Communicates inferiorly with internal vertebral venous plexus o Communicates superiorly with confuence of sinuses - Confuence of the Sinuses o Meeting place of superior sagittal, occipital and inferior sagittal sinuses o Drains bilaterally into transverse sinuses. - Temporal Sinuses o Bilateral sinuses that are found in the attached posterolateral borders of the tentorium cerebelli. o Drain the convluence of the sinuses and become the left and right sigmoid sinus. - Sigmoid Sinus o Continuation of Temporal Sinus o Follows an S shaped path in the posterior cranial fossa o Becomes the internal jugular vein as it exits the jugular foramen - Cavernous Sinus o Large venous plexus located on each side of sella turcica. o Receives blood from superior and inferior ophthalmic veins, superfcial middle cerebral vein, and the sphenoparietal sinuses. o Communication between right and left cavernous sinuses via intercavernous sinuses. o Drains through superior and inferior petrosal sinuses. o Communicates inferiorly via emissary veins with basilar and pterygoid plexuses o Has nerves and arteries passing through it. Ophthalmic Nerve CN III, IV, V2, VI ICA - Superior and Inferior Petrosal Sinuses o The superior petrosal sinus lies in the anterolateral attached margin of the tentorium cerebelli. o The superior petrosal sinus drains the cavernous sinus into the transverse sinus before it becomes the sigmoid sinus o The inferior petrosal sinus runs in a groove between the petrous part of the temporal bone and the basilar part of the occipital bone o The inferior petrosal sinus drains the cavernous sinus into the bulb of the IJV (It is the frst tributary of the IJV) o A connection exists between the inferior petrosal sinus and the internal vertebral plexus Veins that Communicate with the Sinuses - Emissary Veins o Emissary veins are connection between the dural venous sinuses and the outside of the cranium. o Have no valves, but fow is usually away from brain. o Retrograde blood fow can be a pathway for infection. o Most are small and unnamed, however there are a few larger ones Frontal emissary vein in children. Connects superior sagittal sinus and nasal cavity through foramen cecum. Parietal emissary vein. Connects superior sagittal sinus with scalp through bilateral parietal foramen. Mastoid emissary vein connects sigmoid sinus to occipital or posterior auricular vein through mastoid foramen. Posterior condylar emissary vein connects sigmoid sinus to the suboccipital venous plexus. - Superior Ophthalmic Vein o The facial vein is connected to he cavernous sinus via the superior ophthalmic vein. Although it would typically drain away from the brain, infection may pass in a retrograde manor. - Inferior Ophthalmic Vein and Deep Facial Veins o These vein ofer a connection between the face and the pterygoid plexus of veins (inferior to cavernous sinus, but still connected via emissary veins) o - The valveless venous connection between the facial vein, the superior ophthalmic, inferior ophthalmic and the deep facial veins are the reasons that the triangle over the nose is called the dangerous area of the face. (Possible route of infection) - For the same reason, the loose areolar tissue layer of the scalp is known as the dangerous layer of the scalp due to its valveless emissary veins. Veins of the Scalp, Face and Neck - Scalp o The veins of the scalp coincide with the similarly named arteries. o Anteriorly the scalp is drained by the supraorbital and supratrochlear veins (IJV) o As you progress laterally there is: Superfcial Temporal (EJV) Posterior Auricular (EJV) Occipital (IJV) - Facial Vein o The facial vein is a continuation of the angular vein, which communicates with the supraorbital and supratrochlear veins at the medial aspect of the eye. o It continues down to drain the face and nose before joining with the anterior division of the retromandibular vein to form the common facial vein. o The common facial vein is a tributary of the internal jugular vein. - Retromandibular Vein o Formed by the union of the superfcial temporal vein and the maxillary vein (within the parotid gland) o The retromandibular vein then divides into an anterior division and posterior division. o The posterior division joins the posterior auricular vein and becomes the external jugular vein o The anterior division joins the facial vein and drains into the internal jugular vein as the common facial vein. - External Jugular Vein o Formed by the union of the posterior division of the retromandibular and posterior auricular veins. o Drains directly into subclavian vein. o Tributaries: Retromandibular Vein Posterior Auricular Vein Transverse Cervical Vein Suprascapular Vein Anterior Jugular Vein - Internal Jugular Vein o A continuation of the sigmoid sinus as it passes through the jugular foramen o Descends in carotid sheath o Terminates behind medial end of clavicle by joining with subclavian vein to form brachiocephalic trunk. o Tributaries: Inferior Petrosal Sinus Common Facial Vein Lingual Vein Pharyngeal Vein Superior Thyroid Vein Middle Thyroid Vein Occipital Vein - Pterygopalantine Venous Plexus o Located between the temporalis muscle and the pterygoid muscles in the pterygopalantine fossa. o Acts as common drainage points for veins that accompany the branches of the maxillary artery. o Has communication via emissary veins with the cavernous sinus o Also has communication with the inferior ophthalmic and deep facial veins (dangerous triangle of face)