LESSON
#24 (6 HOURS)
Theme. Common carotid artery. Vascular nervous bundle of the
neck. External
carotid artery (neck branches). Practical skills on senses organs preparations.
Head and neck division of vagus nerve and sympathetic trunk. Terminal branches of
external carotid artery: maxillary and superficial temporal arteries,
topography distribution of branches. Veins of the head.
Lymphatic
vessels and nodes of the head
A³m: Study the structural and topographical peculiarities
of carotid
arteries and branches.
Study
the structural and topographical peculiarities of lymphatic and venous drainage
of neck. To study the structure of lymphatic
system, separate organs, tributaries to thoracic
lymphatic trunk and to right lymphatic duct. Study the structural and topographical pecul³ar³t³es of autonomic nervous system, location of centres
and peripheral parts and main functions.
The profess³onal or³entat³on. Affection of aorta and its
branches is a severe pathology, often dangerous to patient's life and is not
infrequent in medical practice (pathology of vessels in atherosclerosis,
infectious diseases, congenital anomalies). The
diagnostic and medical manipulations on vessels cannot be executed without
knowing their normal anatomy. It is also impossible to determine a place of
localization of pathological process, relying on clinical signs.
Superior vena cava and brachiocephalic trunk are in complex relations
with organs of mediastinum surrounding them. Therefore disturbance of blood
flow in this vessels may be indicate not only of
disease of veins, but also of pathological process of organs of this area. In a
brain part of the head there is an anatomic unity of four layers of veins:
veins of soft covers of fornix, intraosteal veins,
veins of dura mater (venous sinuses), and also intracerebral veins. Therefore any infection of soft covers
of the head is dangerous in view of spread of infection to the cavity of skull.
Veins of the face form plexus, that anastomose with
veins of the cavity of skull and the orbits, and these anastomosis lack valves,
therefore there is a real danger of spreading odontogenous
inflammatory processes of jaws and paramaxillary soft
tissues on these anastomosis.
Knowledge
the organisation of the sympathetic part of the autonomic nervous system is the
base for understanding of neurophysiology and neuropathology. Anatomical peculiarities of the location of centres and peripheral
parts is necessary for neurological therapy and surgery in brain. If the
vagus nerve is damaged there is impairment of
function in the throat and the larynx: unilateral paralysis of the levator veli palatini
muscle causes the soft palate and the uvula to the displaced to the intact
side. The vocal cord on the affected side will remain immobile in the cadaver
position (recurrent laryngeal nerve palsy) as a result of paralysis of the
internal laryngeal muscles.
I.
Practical work – 9:00-12:00 am (4
hours)
1)
Methodology of
practical class.
Work 1. Dissection
of superficial
veins of neck.
The students under the direction
of teacher are making skin
cuts on the
left side of the neck
and midial section from the
chin to the
jugular notch of the manubrium.
Transverse section is made on
the level of superior margin
of neck. The cut along
the clavicle to the acromion
of scapula was made during
the previous lesson. Then cautiously (not damaging platisma) dissection is made
to the left
from the midial cut. After
that, the left platisma is
exposed and cut near the
base of mandible
and is pulled
to the side.
Now the anterior external
jugular vein and its branches
can be viewed.
Work 2.Dissection of
superficial vessels of face.
The students under the direction
of teacher are making skin
cuts on the
left side of the face:
midial-from the parietal bone to chin,
circular-along the orbits, nostrils and oral
cavity. Skin is carefully separated (not damaging mimetic muscle) dissected and pulled back
to auricle of the ear.
Then dissection of superficial vessels of face (facial artery and vein,
retromandibular vein, superficial temporal artery and theirs
branches) are made. take
the cuts on left part
of face. A skin cautiously exfoliate (to not to
damage mimetic muscles), prepare
and turn away to concha.
Prepare the superficial facial vessels
(facial artery and vein, retromandibular vein, superficial temporal artery and their tributaries).
Work 3 .Dissection the vessels of the neck. For better access to
vessels and nerves bundle of
neck teacher is suggests for
students to cut manubrium in
saggital plane and clavicle in
middle plane. The sternoclaudomastoid muscle is carefully
separated and turn away together
with part of manubrium and
clavicle. Then in anterior part
of neck the
students can find the neuro-vessel bundle which
on either sides of trachea
and pharynx. The dissection is done for
common and external carotid arteries, also for anterior branches
of external carotid artery (upper thyroid, lingual, facial and their branches)
Work
4. For preparation nerves near the base
of skull necessary to cut
and delete salivary gland. Delete the branch
of mandible from joint.
Work
5. Preparation vagus nerve, its
lower element. Track in to
input in the breast cavity
and preparation an upper laryngeal
nerve, which leaves from the
lower element.
Work 6.
Dissection of maxillary artery. For
better access to maxillary artery
the students have to carefully
(not damaging superficial vessels and nerves) cut
the zygomatic arch near its
root and connection with zygomatic bone. The zygomatic arch
together with masseter muscle are turned away
laterally and inferiorly. For this reason masseter
muscle is partially separated near the place
of its connection
to the angle
of mandible. Using a chisel, the caronoid process of mandible is
separated, and together with zygomatic
muscle is turn away superiorly.
Now there is open access
to maxilar artery.
2)
Base level of
knowledge and sk³lls
1.
Skeleton of thoracis cage,
neck and skull.
2.
Muscles of the neck and head.
3.
Organs of the neck and head.
4.
Skeleton of thoracis cage,
neck and skull.
5.
Muscles of the neck and head.
6.
Organs of the neck and head.
7. Vessels of neck.
Illustrative materialss:
1. Demonstration corpse.
2.Study
corpse.
3.Skeleton.
Demonstrate on
preparations:
1. vagus nerve
2. sympathetic trunk
3. maxillary artery
4. external carotid artery
5. superficial temporal artery
6. jugular veins
3)
Show on the preparations:
Corpse
with prepared vessels of a head and neck: anterior group of branches of
external carotid artery (superior thyroid, lingual, facial arteries), their branches
and sites of a branching; posterior group of branches of external carotid
artery (sternocleidomastoid, occipital, auricularis
posterior arteries), their branches and sites of a branching, medial group -
ascending pharyngeal artery, its branches and sites of branching; final
branches - superficial temporal artery, maxillary artery, their branches and
sites of a branching.
1.
Studying the internal jugular vein pay attention to its topography in the
structure of vascular-nervous fascicle of the neck, its division into
intracranial and extracranial tributaries, their
connection.
2.
Name intracranial tributaries to internal jugular vein.
3.
Study extracranial tributaries to internal jugular
vein and their anastomosis.
4.
Studying external jugular vein, pay attention to its tributaries and places of
confluence.
5.
Study formation of anterior jugular vein and place of it confluence.
6. To know topography of subclavian vein and its
tributaries.
7.
Prepared corpse, lymphatic nodes in a site of head, neck, chest, abdominal
cavity, shoulder girdle and upper limb, pelvis and lower limb. Thoracic
lymphatic duct, left and right venous circulation.
8. Superior vena cava, left and right brachiocepalic veins, subclavian
vein, anterior jugular veins, external jugular vein and its tributaries (their
anastomosis), internal jugular vein with it extracranial
tributaries (anastomosis), sinuses of dura mater.
II. Seminar
discussion 12:30 am – 14:00 pm (2 hours)
1) Special attention should
be paid to the following questions:
1.
What parts of a
head and neck are supplied by external carotid artery?
2.
In which
triangle is the common carotid artery divided into external and internal?
3.
Show a place,
where the common carotid artery can be palpated.
4.
What is the
practical role of Pirogov's triangle?
5.
Where is the carotic sinus and glomus located?
6.
Into which
groups are the branches of external carotid artery devided?
7.
Which branches
belong to anterior group?
8.
Which branches
belong to medial group of external carotid artery?
9.
Which branches
belong to posterior group of external carotid artery?
10.
Topography and
region of supplying of lingual artery.
11.
Topography and
region of supplying of facial artery.
12.
Topography and region of
supplying of superior thyroid artery.
13.
Which vessels
form superior vena cava?
14.
. With what
organs does superior vena cava border?
15.
In what part of
mediastinum is superior vena cava located?
16.
Whence does
internal jugular vein collect blood?
17.
What does the
internal jugular vein continue?
18.
Where does the internal jugular vein begin?
19.
Which expansions has the internal
jugular vein?
20.
Describe topography of internal jugular vein in the structure
of vascular-nervous fascicle of neck.
21.
What intracranial tributaries of internal jugular vein do you
know ?
22.
What are diploid and emissar veins?
Where are they located? What do they drain?
23.
Where do diploid veins fall in?
24.
Whence do superior and inferior ophthalmic veins collect
blood? What are their anastomosis?
25.
How are veins of a labyrinth formed and where they run?
26.
Name extracranial tributaries of
internal jugular vein.
27.
Whence does the facial vein collect blood?
28.
Whence does the retromandibular
vein collect blood? It's anastomosis.
29.
Describe topography of pharyngeal and lingual veins.
30.
Whence does the superior thyroid vein collect blood?
31.
Whence does the external jugular vein collect blood?
32.
How are anterior jugular veins formed and where they run?
33.
Describe topography of subclavian
vein.
34.
Where does thoracic duct fall? What lymphatic trunks fall
into it?
35.
From what partes of a body does
thoracic duct collect
lymph?
36.
From what trunks is right lymphatic duct formed and where it pass?
37.
From what parts of a body does right lymphatic duct collect
lymph?
38.
What lymphatic nodes are distinguished in an area of neck?
Which nuclei does vagus nerve have? (name, function)
50. Which parts has the maxillary artery?
51. Branches and supplying area of first part of maxillary
artery.
52. Branches and supplying area of second part of
maxillary artery.
53. Branches and supplying area of third part of maxillary
artery.
54. Which arteries supply teeth of the upper jaw?
55. Which arteries supply the mucosa of maxillary sinus?
56. Branches and supplying area of superficial temporal
artery.
57. What
intracranial tributaries of internal jugular vein do you know
?
58. What
are diploid and emissar veins? Where are they
located? What do they drain?
59. Whence
do superior and inferior ophthalmic veins collect blood? What are their anastomosis?
60. How
are veins of a labyrinth formed and where they empty?
61. Name
extracranial tributaries of internal jugular vein.
62. Whence
does the facial vein collect blood?
63. Whence
does the retromandibular vein collect blood?
64. What
lymphatic nodes are
distinguished in an area of head?
²²². Independent students work – 14:15pm – 15:00 pm
1)
Situational TASK.
1. The
wound of a hairy part of a head is accompanied by profuse bleeding. What
anatomic peculiarities of vessels of soft tissues of a brain
part of a head determines significant bleeding in such wounds?
2. For uncovering
the bones of a skull fornix the radial sections in the temporal area are made.
What is this direction of sections determined by?
3 Patient
with a trauma in temporal area and fracture of zygomatic
bone has signs of intracranial hemorrage. What artery
is injured most likely ?
4.
Patient has profuse bleeding from branches of maxillary artery. Since this
artery, owing to deep bedding on the face is inaccessible to bandaging,
there was a necessity to tie up external carotid artery within carotid triangle.
What topographical reference point should be used to distinguish external
carotid artery from internal one in this site?
5. In normal conditions venous blood outflows from the face
toward internal jugular vein. Patient has purulent inflammation of soft tissues
of the face. Their considerable edema caused compression of facial vein and
retrograde (reciprocal) direction of venous outflow. Infection of what venous
sinus is possible in these conditions?
6.
Patient has thymoma (the tumour
of thymus) causing compression of a trunk of superior vena cava. Congestion in
tributaries of vein is clinically manifested in cyanosis, edema and expansion
of subcutaneous venous net. In what areas of a body will these symptoms be
observed in this case?
7.
“Syndrome of superior vena cava ” is connected with
compression of a vessel by neighbouring organs. In
what organs the pathological process may be clinically manifested by signs of
congestion in tributaries of superior vena cava?
8.
Surgical intervention on the parotid gland for purulent parotititis
is complex as may become the cause of disturbance of integrity of vessels and
nerves. Is there a danger of injuring large vein? If yes,
then which?
9.
In vestibule of the nose and on the skin of external nose the furuncules (purulent inflammation of hair follicle) may
develop which are dangerous because may carry infection by venous ways to brain
sinuses with formation of thrombosis. It is usually very unfavourable
course. List venous vessels and plexus, on which the infection in a cavity of a
skull may expand.
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test
evaluations and constructive questions (the instructor has tests &
situational tasks).
Student should know:
1. Latin terminology
2. Anatomy and
topography of Common carotid artery system.
3. Anatomy and
topography of External carotid artery system.
Correct answers for tests and situational tasks:
1. Arterial vessels are in subcutaneous fat and their adventition grows strongly together with connective
intersections, which connect skin with tendinous
helmet. The vessels are in normal condition, their lumen gapes.
2. The direction of all arterial trunks in a brain part of the head is
radial (as well as that of nervous trunks), therefore
at such sections integrity of neurovascular fascicles is preserved as much as
possible.
3. A. meningea
media.
4. External carotid artery on a
neck has artain amount of branches, unlike internal,
that has no branches on a neck; external carotid artery goes forward and
medially and lays more superficially, than internal
carotid artery, that goes laterally and deep.
5. Cavernous sinus (superficial veins of the
face - ophthalmic veins - cavernous sinus).
6. In
the face, neck, upper part of torso and upper limbs.
7. Pathological process in
thymus, right lung, ascending aorta.
8. Yes; retromandibular
vein, which passes through parotid gland.
9. à) vein of the nose – superior ophthalmic vein –
cavernous sinus; á) external nasal
veins - facial vein – pterygoid plexus - veins of dura mater - veins of a cavity of skull; â) external nasal veins -
facial vein - pterygoid plexus - orbital veins –
cavernous sinus.
References:
à) basic
1. Atlas
of Human Anatomy/ Frank H. Netter,- 5 edition, - 2011 by Saunders, an Imprint of Elsevior Inc.
3.
Materials preparation
for lectures
4.
Materials preparation
for practical
classes
b) additional
2.
F.H. Netter. Atlas of Human Anatomy. – C³ba Pharmaceut³cals D³v³s³on, 1994. – 514 p.
3.
Syneln³kov R.D. The atlas of
anatomy of the man. ²n
4-th volumes. -: Med³c³na, 1991.
4.
Reminetskyy B.Y., Fedonyuk Y.I. Human anatomy. Notes. 136 p.
5.
Lectures.
Methodical instructions have been prepared by: Assistant Prof. Gavlich O. B.
The instruction was discussed
and confirmed at the department meeting
12.06.2013. Protocol number 11