2021/7021MSC Oral Biology

Semester 1 2013

Laboratory Manual Anatomy of the Head and Neck Region Laboratory 5

Arterial supply, Venous drainage Lymphatic drainage

Laboratory 5: Arterial Supply, Venous and lymphatic Drainage Learning Objectives

Be able to identify the main arteries and veins of the head and neck as well as in the skull. Identify the main branches of the external carotid artery and its branches. Identify the blood vessels and nerves closely related to pharyngeal muscles. Know the blood supply of structures in the oral cavity. Be able to locate the major groups of lymph nodes in the head and neck and know the structures drained by each group.

Study the arrangement of structures in the neck using a cross section and appreciate the fascial arrangement of the neck.

Station 1

Arterial supply of the head and neck

The arterial supply to the head and neck arises from the common carotid arteries that divide into the internal and external carotid arteries. The internal carotid principally supplies the greater part of the cerebral hemisphere. External carotid gives off six branches as it extends upwards in the neck and head, terminating near the mandibular condyle by dividing into the maxillary and superficial temporal arteries . Blood supply to the brain

The internal carotid and vertebral arteries supply all blood to the brain. Identify these vessels on head and neck specimens and whole brains.
Where do these arteries arise? __________________________________________________________________________ __________________________________________________________________________ Are there differences between the left and right sides of the body? __________________________________________________________________________ __________________________________________________________________________ The internal carotid artery enters the cranial cavity by route of the carotid canal. The vertebral artery follows the spinal cord through the foramen magnum.

Fig 3.4 pg32, Head & Neck Anatomy for Dental Med icine (2010) Eric W. Baker Ed. Thieme Med ical Publishers Inc NY USA

In the space below, draw a simple tree diagram labelling the major branches of the external carotid artery. Identify an adjacent landmark for each branch to aid your recall of where to find the branches in the specimens.

Locate and examine the carotid canal and foramen magnum in the skull in both inferior and internal views.

Label the carotid canal and the jugular foramen on this diagram. Identify the specific vessel that passes through the carotid canal

What blood vessel/s does the vessel passing through the carotid canal connect or anastamose to?

In general, what does the vessel travelling in the carotid canal supply?

Fig 1.24 pg13, Head & Neck Anatomy for Dental Medic ine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

Why is the vertebral artery so named? (Hint: what structure does it pass through in the neck?)
__________________________________________________________________________ __________________________________________________________________________

Identify the cerebral arterial circle (Circle of Willis) on whole brain specimens.
The cerebral arterial circle is an example of an anastomosis. What does this term mean? __________________________________________________________________________ __________________________________________________________________________

What are the clinical implications of the cerebral arterial circle? __________________________________________________________________________ __________________________________________________________________________

Draw a picture of the cerebral arterial circle (Circle of Willis) and label each of the arteries that contribute to the circle.

Identify the anterior, middle and posterior cerebral arteries .

What depression does the anterior cerebral artery run in? __________________________________________________________________________ __________________________________________________________________________

Station 2 Maxillary artery:

See Figure 3.8 page 44 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA Identify the major branches of the maxillary artery (the three main branches and their subsequent branches) and identify the extent of their supply. See table 3.4 page 47 Head & Neck Anatomy for
Dental Medicine (2010) Eric W. Baker Ed. Thieme Medical Publishers Inc NY USA

DRAW a tree diagram identifying the major divisions/parts of maxillary artery .

State the main branches of each part

__________________________________________________________________________ __________________________________________________________________________ _______________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Pterygoid plexus of veins

Where, specifically is this plexus situated?

__________________________________________________________________________ __________________________________________________________________________

What is the clinical importance of valveless anastomoses between the facial vein, ophthalmic vein and pterygoid plexus of veins? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

What are the 3 communications between this plexus and the cavernous sinus?
__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Station 3

Neck
Identify the following structures in the anterior neck on the prosected specimens

o Common carotid artery o Internal jugular vein o Thyroid gland o Submandibular gland o Branches of the external carotid artery Superior thyroid artery Ascending pharyngeal artery
Lingual artery Facial artery Occipital artery Posterior auricular artery

Draw a lateral view of the face and sketch the branches of the external carotid artery, parotid gland and the facial nerve.

Station 4

Venous drainage of the head and neck

The external jugular vein and the anterior jugular vein are the two superficial veins of the neck region. The external jugular vein originates from just behind the mandible's angle, and is formed by the union of the posterior auricular vein, and the posterior division of the retromandibular vein. The retromandibular vein is formed within the parotid gland from the superficial temporal, and the maxillary veins . The external jugular vein, upon formation descends through the superficial region of the neck obliquely across the sternocleidomastoid muscle. It then pierces the deep fascia of the neck and drains into the subclavian vein just above the clavicle in the posterior triangle of the neck.
Identify the following in specimens: External jugular vein Anterior jugular veins Superficial temporal vein Maxillary vein Retromandibular vein

Fig3.17 pg50, Head & Neck Anatomy for Dental Med icine (2010) Eric W. Baker Ed . Thieme Medical Publishers Inc NY USA

Deep veins
The internal jugular vein is the main trunk of the deep veins of the neck. The internal jugular vein drains the brain, face, and neck. The internal jugular vein originates at the jugular foramen as the continuation of the sigmoid sinus of the skull. Then the internal jugular vein descends in the carotid sheath (with common carotid artery & vagus nerve) and joins the subclavian vein to form the brachiocephalic vein.

Locate the mid sagittal sinus, the transverse sinus, the occipital emissary vein, the mastoid emissary vein, the condylar emissary veins on the diagram on previous page. Emissary veins, after passing through the bony canal (after which they are named) communicate with the dural sinuses.
What is meant by the term dural sinus? __________________________________________________________________________ The internal jugular vein has several tributaries within the deep region of the neck. o Facial Vein (& labial and angular veins); Lingual Vein; Superior & Middle Thyroid Veins

Using your understanding of the deep veins of the head, particularly the pterygoid venous plexus, the cavernous sinus and the deep facial veins and their interconnection, describe how an infection can spread from an infective focus on the upper lip to the cavernous sinus (see Figure 3.20 and text on page 53 Head & Neck Anatomy for Dental Medicine (2010) Eric W. Baker Ed . Thieme Medical
Publishers Inc NY USA or page 911 Figure 7.10

________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Skull Identify the location of the following o cavernous sinus o superior sagittal sinus o transverse sinus o sigmoid sinus

o Complete the labels on the diagram of the occipital view of venous structures.
Fig3.21 pg53, Head & Neck Anatomy for
Dental Medic ine (2010) Eric W. Baker Ed . Thieme Med ical Pub lishers Inc NY USA

Briefly state how these veins drain to the internal jugular vein. Where is the blood draining from?

What else drains into the cavernous sinus?

Station 5
Lymphatics of Head and Neck

Using the diagrams and models study the lymphatic drainage of the head and neck.

Fig1 2.5 pg269, Head & Neck Anatomy for Dental Med icine (2010) Eric W. Baker Ed . Thieme Med ical Publishers Inc NY USA

Know the location of following nodes: o Submental o Submandibular o Preauricular (Parotid) o Post auricular (Mastoid) o Occipital o Retropharyngeal nodes o Deep cervical nodes
Complete the following table clearly identifying the region/s drained by the lymph nodes (see Table 20.1 page 330-331 in Textbook of Head & Neck Anatomy 4th Edn Hiat JL and Gartner LP Wolters Kluwer Lippincott Williams and Wilkins Philadelphia PA. See also page 269 in Head & Neck
Anatomy for Dental Medicine (2010) Eric W. Baker Ed . Thieme Medical Publishers Inc NY USA)

Nodes Submental

Drainage area

Submandibular

Preauricular (Parotid)

Post auricular (Mastoid)

Occipital

Retropharyngeal nodes

Deep cervical nodes.

If only peripheral lymph node groups are affected, then it is likely that the disease process is local to the nodes affected.
Which groups of nodes drain which areas of the face bilaterally? __________________________________________________________________________ __________________________________________________________________________

Jugulofacial venous junction receives lymphatics from the head (obliquely inferiorly) and redirects them vertically inferiorly into the neck.

Thus if this group of nodes is enlarged then it may indicate a disease process in the head, oral or facial regions. If, the other central group (nodes occurring at the venous junctions) the jugulosubclavian is enlarged then this could reflect even more extensive disease processes.

What is the significance of the left jugulosubclavian venous junction, with regard to the lymphatic system drainage of the body? (ie which regions drain here)
__________________________________________________________________________ __________________________________________________________________________

What is the significance of the right jugulosubclavian venous junction, with regard to the lymphatic system drainage of the body? (ie which regions drain here)

__________________________________________________________________________ _________________________________________________________________________

Where do the deep cervical lymph nodes drain to?

__________________________________________________________________________ __________________________________________________________________________

What are the structures that constitute Waldeyer's ring? And where do they drain?
__________________________________________________________________________ __________________________________________________________________________

Lymphatic drainage from the teeth is directed to which groups of lymph nodes? __________________________________________________________________________ __________________________________________________________________________

REVIEW

If you wanted to anaesthetise the nerves that innervate the upper teeth which nerves would you need to target (note the possible variations):

If you wanted to anaesthetise the nerves that innervate the lower teeth which nerves would you need to target (note the possible variations):

Revise the bony features of the hard palate.

If you wanted to anaesthetise the nerves that innervate the hard palate which nerves would you need to target?

Describe the source of motor, sensory and special sensory innervation to the tongue. Be specific as to which nerve innervates which tongue region. You may wish to draw a summary diagram.

What structures does the vagus nerve innervate in the neck?

What does the recurrent laryngeal nerve innervate?

What nerve innervates the gingivae of the mandible? And the maxilla?

An infection in the loose connective tissue layer of the scalp may result in meningitis, briefly explain how the infection may pass into the skull to the meninges.

The occipitofrontalis muscle bellies prevents scalp infection passing into the neck.

Infections of the oral cavity may enter the retropharyngeal space between the buccopharyngeal fascia covering the pharynx and oesophagus and the alar fascia.

If the alar fascia is penetrated by the infection, and enters the space between the alar fascia anterior to the pre-vertebral fascia it may travel into the _______________________, where it can be life threaten

What are the signs and symptoms arising from Ludwigs angina?

How might you contract Ludwigs angina?

Identify the key treatments needed to treat this condition.

Identify and label on the diagram provided: o Skin o Superficial fascia (Platysma) o Arrangement of the deep fascia of the neck.

o Label the following on the diagram o Carotid sheath v What structures lie inside the carotid sheath? o Pretracheal fascia o Buccopharyngeal fascia o Prevertebral fascia o Trachea o Oesophagus o Retropharyngeal space

Explain the advantages of these deep cervical fasciae.

Floor of the mouth and tongue Revise the intrinsic and extrinsic muscles of the tongue.

Revise the embryological development of the tongue from the branchial arches.

Understand the nerve supply to the tongue (appreciate the anterior 2/3 and posterior 1/3 supply is different, due to its embryological development):

o Sensory -

o Taste o Motor -

 How do the taste fibres from CN 7 reach the anterior 2/3 of the tongue?

Draw a diagram to describe the general sensory and taste innervation of the tongue.

Hyoglossus: o Study the diagrams or specimens which show the relationships of this muscle to the submandibular gland/duct, lingual and hypoglossal nerves and lingual artery.

State the path taken by the parasympathetic (secretomotor) fibres to reach the submandibular/sublingual and parotid glands.