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1. Arteries, veins and lymphatic drainage of the head and neck. The epithelial

tissue. The development of blood vessels.

Posted in Head & Neck by Sahaja on December 1, 2008

1. Arteries, veins and lymphatic drainage of the head and neck. The epithelial tissue. The development of bloodvessels.

Anatomy: Arteries, veins and lymphatic drainage of the head and neck.

Arteries of Head & "eck

For this topic, you will need to discuss the branches of common carotid a, subclavian a, the veins that follow them, and

superficial and deep lymph nodes of the head and neck.

In this topic, if you have time, you may want to review infratemporal fossa, carotid triangle, scalenotracheal fossa,

scalenus hiatus & tent

Common Carotid a:

General Info:

Emerges from brachiocephalic a on R side, and aortic arch on L side

ascends in carotid sheath, w/ CN X, Int Jugular v and number of other structures (will discuss soon)

divides into int/ext carotid at superior border of thyroic cartilage

Has two receptors:

Carotid Body

located at the bifurcation of common carotid (Body = Bifurcation)

chemoreceptor = sensory receptor to detect levels of O2 & CO2

Or, remember that since it is located lower to the sinus, and closer to the lungs than the sinus – lungs =

O2,CO2

Carotid Sinus

located at the beginning of the int carotid a (Sinus = Internal carotid)

baroreceptor = detects blood pressure

Remember that it is the one closest to the head, so need to keep track of blood pressure in the head.

Int carotid a:

no branches in the neck,

ascends in carotid sheath w/ CN X and IJV

enters skull via carotid canal

only major branch to head and neck region is ophthalmic a – exits skull via optic canal

Ext Carotid a

emerges @ upper border of thyroid cartilage

runs in carotid sheath, then to neck of mandible

pierces the parotid glang, where it gives its 2 terminal branches = maxillary, and superficial temporal

8 main branches = Superior Thyroid, Lingual, Facial, Asc Pharyngeal, Greater Auricular, Occipital, Maxillary,

Superficial Temporal.

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NOTE: How to remember all the branches?

St. Louis FATSIS Apt to GO to Max Stein —- like fat people from St. Louis need to go to this famous weight

loss instructor, Max Stein. Sounds stupid, but hang on - it works.

Superior Thyroid a – St.

emerges at level of greater horn of hyoid bone

also in carotid sheath

branches = br. to infrahyoid m, br to SCM, sup laryngeal (which peirces the thyrohyoid membrane), br to

cricthyroid m, glands

Lingual a – Louis

emerges @ level of greater horn of hyoid bone

passes deep to hyoglossus m.

located w/in Pyrogov’s Triangle – Clinical note – by pushing at the location of triangle, can stop bleeding from

branches of lingual a

Borders:

ant = mylohyoid m

post = post digastric m

sup = hypoglossal n (CN XII)

floor = hyoglossus m

part of the Submandibular triangle (see salivary gland topic)

branches = suprahyoid a, dorsal lingual a, sublingual a, deep lingual a

supplies most of blood supply of tongue

Facial a – Fatsis

emerges just above lingual a, goes forward, deep to post digastric m & stylohyoid m

hooks around lower border of angle of mandible @ ant border of masseter (jsut deep to platysma)

run diagonally to the medial corner of the eye, running deep to zygomatic major & levator labii superiorus

major blood supply to face, terminates with angular a.

branches = FATSIS - is an abbreviation for facial and all its branches

F = facial

A = asc palatine

T = tonsillar

SI = Sup/Inf labial

S = submental

Asc Pharyngeal a - Apt

in carotid triangle

asc b/w int carotid & wall of pharynx

branches = pharyngeal, palatine, inf tympanic, meningeal branches

Greater (Posterior) Auricular a – G

arises just above post digastric –> deep to parotid –> runs superficial to styloid process

branches = stylomastoid, auricular, and occipital branches

Occipital a – O

emerges just above the hyoid bone –> passes deep to post digastric –> occipital groove –> on mastoid process

branches =

a to SCM – over CN XII, anatomosis w. SCM branch of sup thyroid a

decending br – has 2 branches

superficial – anatomosis w/ superficial br of transverse cervical a

deep – anatomosis w/ deep br of deep cervical a (from costocervical trunk of subclavian a

Maxillary a – Max

lies in infratemporal fossa

many many branches = How to remember them? DAAM I Bite SPAIDS.

divided into 3 parts by lat pterygoid m

Part 1 = Mandibular = DAAM I - 5 branches

Deep auricular a

Ant tympanic a

Acc meningeal a

Middle meningeal a – can be shown in practical exam

Inf alveolar a – can be shown in practical exam


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Part 2 – Pterygoid = Bite (Bite = muscle of mastication) – 5 branches

lat & med pterygoid a

massteric a

buccal a

deep temporal

Part 3 – Pterygopalatine = SPAIDS – 7 branches

Sup (post/mid) alveolar a

Pharyngeal a

A. of pterygoid canal

Infraorbital a

Desc Palatine a

Sphenopalatine a

Superficial Temporal a

terminal branch

emerges on face b/w TMJ and ear

runs w/ auriculotemporal n, sup temporal v

branches = transverse facial a (b/w zyg arch & parotid duct), frontal/parietal br

transv. facial a gives blood supply to parotid gland, duct, masseter and skin of face

Subclavian a

br of Brachiocephalic trunk on R, arises from arch of aorta on L

Pathway: enters neck behind the sternoclavicular joint –> runs towards the apex of pleura along the mediastinal

surface –> over the apex –> turns forward and down along sternocostal surface of apex –> exits neck to enter thorax

@ scalenus hiatus w/ brachial plexus

has 3 divisions, separated by ant scalene m.

"OTE = to remember the # of branches – its opposite of part # – i.e. Part 1 has 3 branches, Part 2 has 2 branches, and

Part 3 has 1 branch (sometimes)

123=321

Thoracic part = medial to ant scalene m - 3 branches, b/w trachea and ant scalene m

Vertebral a – has a med/sup path –> goes thru transverse foramen of C6-C1 –> thru post occipital membrane –>

foramen magnum

Int Thoracic a - runs along the inside of thoracic wall

1st 6 ant intercostal a

sup epigastric – medistinal, thymic, sternal br

musculophrenic – gives the ant intercostal arteries 7-10

Thyrocervical trunk – 3 branches again

Transverse cervical a – under SCM –> occipital triangle –> runs below trapezius m

Suprascapular a - runs parallel to clavicle w/ a/v/n — anatomosis w/ circumflex scapular a

Inf thyroid a – asc along thyroid gland and anatomosis w/ asc cervical a

Muscular part = behind ant scalene m. – 2 branches, = Costocervical trunk

Supreme IC a – gives 1st 2 post IC a

Deep cervical a – blood supply to deep m of back, asc along levator scapulae m.

Cervial part = lat to ant scalene m – 1 branch, sometimes

dorsal scapular a - only present if suprascapular a is missing

usually no branches here

Veins of Head & "eck

Veins mostly follow the arteries, so there is no need to go into each branch. Also, veins have an extremely variable branching

pattern, so your body may be different from what is laid out here. We’ve seen a body with 2 Ext Jugular v!

To learn veins of any area – just draw the picture a bunch of times. Hell, draw it on the exam.


3 of 12 1/31/2010 9:57 AM

Here’s an “in general” flow pattern of the veins:

Supraorbital v + Supratrochlear v = angular v at the corner of the eye

angular v + deep facial v = facial v

Maxillary v + Superficial temporal v = Retromandibular v

ant branches of Retromandibular v + Facial v —> flows into IJV, w/ a bunch of other v

post branches of Retromandibular v + Post Auricular v = EJV

Ant Jugular —> flows into EJV

Subclavian v collect veins that follow the arteries that branch off subclavian a

Subclavian v + IJV = Brachiocephalic v —- called angulus venosus, also where major lymph ducts of the the body

drain into

EJV can flow into Subclavian v OR IJV OR angulus venosus itself (the intersection of the 2 veins)

Other vein info, specifics: Doubt you have to know this, but rather give u extra info, than not at all.

Supratrochlear v = begins as a collection of veins connected to the frontal branches of superficial temporal v

Supraorbital v = begins also in the forehead, where it connects w/ branches from supratrochlear, superfical temporal

v, and middle temporal v, a branch of it passes through supraorbital notch to anatomose w/ superior ophthalmic v

Together, these 2 v. drain ant part of scalp and forehead

Facial v = runs from medial angle of eye and inf border of orbit, starting from angular v, is much straighter than than

facial a

receives pterygoid venous plexus (via deep facial v), sup/inf labial v

branch of it anatomose w/ superior ophthalmic v

drains ant scalp, forehead, eyelids, ext nose, ant cheek, lips, chin, submandibular gland

Superficial temporal v = receives a number of v of scalp/zygomatic arch, runs thru parotid gland

drains side of scalp, superficial aspect of temporalis m, ext ear

Retromandibular v = formed by union of superficial temporal & maxillary v

is post to ramus of mandible, goes thru parotid gland, has ext carotid a behind and facial n in front of it

drains masseter m, and parotid gland

Lymph Drainage of Head & "eck

The head and the neck, each have a set of superficial & deep lymph nodes and vessels. The superficial lymph nodes and

vessels run with veins, deep lymph nodes and vessels run with arteries. All lymph from head and neck drains into deep

cervical lymph nodes, that run w/ IJV.

Superficial lymph nodes of Head:

In general, the face, scalp, and ear –> drains into occipital, retroauricular, parotid, buccal, submandibular,

submental, superficial cervical l.n.

lat face, including eyelids –> parotid l.n. –> deep cervical l.n

upper lip, lat lower lip –> submandibular l.n.

chin, central lower lip –> submental l.n.

Deep lymph nodes of Head:

middle ear –> retropharyngeal & upper deep cervical l.n.

nasal cavity/ pasanasal sinuses –> submandibular, retropharyngeal, upper deep cervical l.n.

tongue –> submental, submandibular, upper/lower deep cervical l.n.

larynx –> upper/lower deep cervical l.n.

pharynx –> retropharyngeal, upper/lower deep cervical l.n.

thyroid –> lower deep cervical, prelaryngeal l.n., pretracheal l.n., paratracheal l.n.

Superficial cervical lymph nodes:

lie along the ext jugular v in posterior triangle & along ant jugular v in anterior triangle

drain into deep cervical nodes

Deep cervical lymph nodes:


4 of 12 1/31/2010 9:57 AM

Superior

lie along int jugular v, in carotid triangle of neck

receive: lymph from back of head and neck, tongue, palate, nasal cavity, larynx, pharynx, trachea, thryroid

gland, & esophagus

efferent vessels that join those of the inf deep cervical nodes to from jugular trunk –> thoracic duct on L, and

angulus venosus on R

Inferior

lie on the IJV, near subclavian v

receive lymph from ant jugular, transverse cervical, axillary nodes

Histology: The epithelial tissue.

Epithelium = sheets of cells that cover external surfaces of the body, line internal cavities, form various organs,glands and

ducts. Remember that it is avascular - no blood vessels!

Epithelium can be classified in 3 ways: functionally, # of cell layers, & structure of surface cells

Functional groups:

Lining epith – formation of barrier on surface of body, ex/ skin, inner stomach

Glandular epith – production/secretion of substances to extra cellular territory in high amt

Sensory epith – for special sensations, ex/ taste buds, olfactory

Epithelium has what is called functional polarity = basically, this means that different sides of the cells have different

functions.

Basal side:

attached to basement membrane = basement lamina + reticular fibers

has hemidesmosomes

protein, polysaccharides rich layer

Lateral side:

intracellular junctions = tight, adherent, desmosomes

Apical side:

microvilli – inc surface absorption

kinocilia – move substances across apical surface

stereocilia – sensory function, absorption

Cell-Cell Junctions

Occluding/Tight Jxns: impermeable and allow epithelia cells to functions as a barrier

form primary intercellular diffusion barriers b/w adjacent cells

located @ most apical part

Proteins:

occludins - maintain barrier b/w cells, @ apical/lateral domains, not in all tight jxns

claudins - form backbone of each strand, form extracellular H2O channels for ions and small molecules

JAM (Junctional adhesions molecule) – immunoglobulin, w/ claudins, interactions b/w endothelium &

monocytes

Anchoring Junctions: mechanical stability to epithelium, by linking cytoskeleton of 1 cell to adjacent cell.

interact w/ both actin & intermediate filaments

lateral cell surface, basal domain

signal transductions capability, cell-cell recognition, cell differentiation, morphogenesis

Zonula adherens – interact w/ network of actin filaments inside cell, lateral adhesion

Macula adherens (desmosomes) - interact w/ network of intermediate flaments

Communication Junctions (Gap): direct communications b/w adjacent cells by diffusion of small molecules

epithelia, smooth m, cardiac m, and nerves

open communication – quicker exchange of ions, regulatory molecules, small metabolites

easier to coordinate activity

Proteins = connexons, in 6 subunits of 2 = connexin


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Apical Modifications:

Microvilli

small, non motile projections that cover all absorptive cells in SI and prox convoluted tubules in kidney

proteins = villin, actin filaments, fimbrin, fascin, myosin I in core, and spectrin & myosin II in base

sit on intermed filaments

Kino cilia

motile structures that are found in uterin tubes, uterus, repiratory system

move substances across a surface

dark line @ apical surface

2 microtubules in center, surrounded by 9 doublets of microtubles, w/ dynein, & nexin

Sterocilia

long, non motile branched microvilli of sorts that cover cells in epididymis & vas deferens

absprption!

Proteins: actin filaments, erzin, fimbrin in core, and alpha -actinin in base

Classification by layers

Simple – one layer of cells only, attached directly to basement membrane

Stratified – multiple layers of cells

Pseudostratified – one layer of cells, all attached to basement membrane, but have varying heights, so appear

stratified

Classification by morphology

squamous - flat cells

Simple squamous -

called mesothelium on the outside surfaces of lungs, heart, digestive organ == i.e. where-ever there is

pleura, pericardium, or peritoneum, there is mesothelium anatomically – Histo wise, this is called a serosa

covering.

called endothelium on the internal surface of arteries, lymph vessels, and internal surface of heart

Stratified squamous –

keratinized – top cells are dead & have no nuclei, are instead filled w/ keratin protein – located in

external areas of body ex/ skin

non-keratinized – live surfaces, all cells of epithelium alive – located in areas exposed to outside

elements, but not on external areas of body ex/ oral mucosa, pharynx, vagina, anal canal, esophagus.

Cuboidal – height = width

Simple cuboidal – excretory ducts, like prox convoluted tubules of kidney, very common in glands

Stratified cuboidal – not as common, ducts of salivary glands and pancreas

Columnar – height > width

Simple columnar – characteristic of digestive organs, like in stomach and gallbladder, SI, LI – tend to have

microvilli

Stratified columnar – limited in body, ducts again

Transitional Epithelium = Urothelium

located in urinary system, like bladder and ureter, and minor/major calices – NOT IN URETHRA

Cell Types:

Umbrella cells – binucleated, is dome shaped when urinary structures are empty, flat when full

Piriform cells – in the middle

Basal cells - single layer on bottom , right above BM

Embryology: The development of blood vessels

Blood vessels develop in two ways:

vasculo genesis – vessels arise from the combination of blood islands aka angioblasts – mainly dorsal aorta, &

cardinal veins

angiogenesis – vessels arise from existing vessels


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Development of arteries

Aortic sac develops from distal part of truncus arteriosus

sac gives a set of aortic arches, one to each pharyngeal arch

arches terminate in two (R&L) dorsal aortas

aorticopulmonary septum divides outflow part of truncus arterious into ventral aorta & pulmonary trunk

dorsal aorta b/w 3rd and 4th arch disappears (carotid duct)

R dorsal aorta disappears b/w 7th segmental aorta and L dorsal aorta

heart is pushed into thoracic cavity by folding of embryo

because of the heart movement – this is why recurrent laryngeal a is in diff location in R & L side

Aortic Arches:

Arch I = part of maxillary a, by day 27

Arch II = part of stapedial a & hyoid a

Arch III = part of R &L common carotid a, R&L int carotid a

Arch IV = part of R subclavian a, and part of aortic arch on L

Arch V = disappears

Arch VI = part of R &L pulmonary a, ductus arteriosus – connection b/w pul a & arch of aorta, is

ligamentum arteriosum in non fetal life

Dorsal Aorta

R & L dorsal aortae combines into dorsal aorta.

from dorsal aorta, originates posterolateral a, lateral a, and ventral a

Posterolateral a = a to upper and lower limb, IC, lumbar and lateral sacral arteries

Lateral a = renal, suprarenal, and gonadal arteries *NOTE = paired visceral arteries of abdominal aorta

Ventral a

Vitelline a = celiac, superior mesenteric, inf mesenteric a *NOTE = unpaired visceral arteries of abdominal

aorta

Umbilical a = part of Int Iliac, superior vescical arteries, run in medial umbilical ligaments. = PELVIS

Coronary a – from 2 sources

angioblasts formed elsewhere and sent over the heart surface

from epicardium – some of its epithelial cells will become mesenchymal cells due to some reaction from underlying

mesenchyme

new mesenchyme and neural crest cells create smooth m cells in these arteries

endothelial cells from these arteries push into aorta

Development of Veins

develop mainly from three pairs of veins = vitelline v, umbilical v, and cardinal v —> empty blood into sinus

venosus

vitelline v = carry blood from yolk sac

become hepatocardiac part of IVC, hepatic v &sinusoids, ductus venosus, portal v, inf mesenteric v, sup

mesenteric v, splenic v

form plexus around duodenum and pass thru septum transversum, pushing into liver to form sinusoids

the duodenal plexus becomes the portal v

umbilical v = from chorionic villi and carries O2 blood to embryo

pass on each side of liver, some connect to sinusoids

only L umbilical v remains to carry blood from placenta to liver — becomes ligamentum teres of liver, and

ductus venosus, to become ligamentum venosum in life.

cardinal v = drains embryo itself

Ant =drain cephalic part of embryo intially–> SVC, int jugular v, L brachiocephalic v

Post = drain rest of embryo initially –> part of IVC, R common iliac v

Subcardinal v = drain kidneys –> renal v, part of IVC, gonadal v

Sacrocardinal = drain lower limb –> sacrocardinal part of IVC, L common iliac v

Supracardinal v = drain body wall via IC v (takes over fxn of post cardinal v) –>part of IVC, IC v, azygos


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system

Anim = Development of Aorta, Pulmonary Trunk, and Interventricular Septum

Anim = Aortic Arch Vessels

Possibly related posts: (automatically generated)

First-Ever Recording of Blood Vessel Development During the Formation of an…

Tagged with: carotid body, carotid sinus, columnar eptihelium, cuboidal epithelium, development of arteries, development of

veins, dorsal aorta, endothelium, epithelium, external carotid, gap junctions, keratinized v. nonkeratinized, kinocilia, lymph

drainage of head and neck, macula adherens, mesothelium, microvilli, pseudostratified epithelium, pyragov's triangle,

squamous, sterocilia, subclavian a, urothelium, veins of head and neck, zonula occludens

3 comments

2. The somatosensory and somatomotor innervation of the head and neck. The cells of the connective tissue. The

development of the neurocranium. »

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Abigail said, on February 2, 2009 at 1:17 AM

just a little correction, the stomach is the foregut and is supplie by the ciliac artery and not the superior mesenteric,

superior mesenteric is for the mid gut…….apart from that, this is the best anatomy summary anywhere……..good job

guys

Reply

1.

dr.omprakash said, on May 10, 2009 at 4:14 PM

simply superb and really educative and very much important not to forget this tips , thanks for giving us this.

Reply

2.

Dr. Aman Biswas said, on January 10, 2010 at 10:49 AM

May God bless you for superb hardwork done.It will help many.Good luck

Reply

3.

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About This Site:

This site was made for the Anatomy, Histology, Embryology class in 2nd yr, 1st semester at the University of Debrecen. All

theoretical topics are listed as described on the website of the Anatomy department.

We combined Practical class notes, Moore, Board Review Series textbooks of Gross Anatomy and Embryology, Langman’s,

DiFiore’s, as well as the Lab manual for Histology at Semmelweiss. We believe it to be all inclusive of the material you will

need for your test. We made them for ourselves, but since people asked for them, and emailing them seemed next to

impossible, we decided to post them here.

On the left are the newest topics we’ve added.

To see all the topics we’ve done so far, scroll down and click on the Category you would like to see: Head & "eck,

Thorax, Abdomen, & Pelvis.

Added a search box in the sidebar, so you can search for the item you want.

But the best way to find the topic that you want?

Scroll down and click on the “Link to Topics” Page. There is the list of all topics. If a link to your topic of choice

exists, we’ve started/finished it, else we’re working on it. There! That’s easier, isn’t it?

We’ve added pictures, links, and animations where we have found them.

Hope this helps you, and GOOD LUCK!

(P.s. If you find mistakes, or want to add info, or find something we missed, please comment below the post in question, and

we will fix or add it. )

We are adding more info by the day, so check back in with us!

Created by Sahaja Parsa and Anne H.

contact: sahaja.parsa[at]gmail.com


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