Arteries of the head and neck

From the aortic arch, the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery branch off in sequence, carrying blood to the head and neck, upper limbs, and the anterior wall of the chest and abdomen.

The brachiocephalic trunk (truncus brachiocephalicus) departs from the aortic arch at the level of the cartilage of the second right rib; in front of it is the right brachiocephalic vein, behind it is the trachea. Heading upward and to the right, the brachiocephalic trunk does not give off any branches and only at the level of the right sternoclavicular joint does it divide into two terminal branches - the right common carotid and right subclavian arteries.

The right common carotid artery (a.carotis communis dextra) is a branch of the brachiocephalic trunk, and the left common carotid artery (a.carotis communis sinistra) comes directly from the aortic arch and is usually 20-25 mm longer than the right one. The common carotid artery lies behind the thoracic and no-cleidomastoid and omohyoid muscles and the covering middle fascia of the neck. The artery runs vertically upward in front of the transverse processes of the cervical vertebrae, without giving off branches along the way.

Outside the common carotid artery is the internal jugular vein, and behind the artery and this vein is the vagus nerve; inside - first the trachea and esophagus, and above - the larynx, pharynx, thyroid and parathyroid glands. At the level of the upper edge of the thyroid cartilage, each common carotid artery divides into the external and internal carotid arteries, which have approximately the same diameter. This place is called the bifurcation of the common carotid artery. A small expansion at the beginning of the external carotid artery is called the carotid sinus (sinus caroticus). In this place, the outer shell of the artery is thickened, it contains many elastic fibers and nerve endings. The middle shell is less developed than in other places of this artery. In the area of the bifurcation of the common carotid artery there is a body 2.5 mm long and 1.5 mm thick - the carotid glomus (intercarotid glomus; glomus caroticum), containing a dense capillary network and many nerve endings (chemoreceptors).

The external carotid artery (a.carotis externa) is one of the two terminal branches of the common carotid artery. It separates from the common carotid artery within the carotid triangle at the level of the upper edge of the thyroid cartilage. Initially, the external carotid artery is located medial to the internal carotid artery, and then lateral to it. The sternocleidomastoid muscle adjoins the initial part of the external carotid artery on the outside, and in the area of the carotid triangle - the superficial plate of the cervical fascia and the subcutaneous muscle of the neck. Located medially from the stylohyoid muscle and the posterior belly of the digastric muscle, the external carotid artery at the level of the neck of the mandible (in the thickness of the parotid gland) divides into its terminal branches - the superficial temporal and maxillary arteries. Along its path, the external carotid artery gives off a number of branches that depart from it in several directions. The anterior group of branches consists of the superior thyroid, lingual and facial arteries. The posterior group of branches includes the sternocleidomastoid, occipital and posterior auricular arteries; the ascending pharyngeal artery is directed medially.

External carotid artery

The internal carotid artery (a.carotis interna) supplies blood to the brain and the organ of vision. The internal carotid artery is divided into the cervical, petrosal, cavernous and cerebral parts. This artery does not give off branches on the neck. The cervical part (pars cervicalis) is located laterally and behind, and then medially from the external carotid artery. Between the pharynx medially and the internal jugular vein laterally, the internal carotid artery rises vertically upward to the external opening of the carotid canal. Behind and medially from the internal carotid artery are the sympathetic trunk and vagus nerve, in front and laterally - the hypoglossal nerve, above - the glossopharyngeal nerve. In the carotid canal is the petrosal part (pars petrosa) of the internal carotid artery, which forms a bend and gives off thin carotid-tympanic arteries (aa.carotico-tympanicae) into the tympanic cavity.

Internal carotid artery

The subclavian artery (a.subclavia) originates from the aorta (on the left) and the brachiocephalic trunk (on the right), supplies the brain and spinal cord, skin, muscles and other organs of the neck, shoulder girdle, upper limb, as well as the anterior wall of the thoracic and abdominal cavities, pericardium, pleura and diaphragm. The left subclavian artery is approximately 4 cm longer than the right one. The subclavian artery goes around the dome of the pleura and exits the thoracic cavity through the superior aperture, enters (together with the brachial plexus) into the interscalene space, then passes under the clavicle, bends over the 1st rib (lies in the groove of the same name). Below the lateral edge of this rib, the artery penetrates the axillary cavity, where it continues as the axillary artery.

Conventionally, the subclavian artery is divided into three sections:

1. from the origin to the inner edge of the anterior scalene muscle;
2. in the space between the stairs and
3. at the exit from the inter-staircase space.

In the first section, three branches depart from the artery: the vertebral and internal thoracic arteries, the thyrocervical trunk, in the second section - the costocervical trunk, in the third - sometimes the transverse artery of the neck.

The vertebral artery (a.vertebralis) is the largest branch of the subclavian artery, departing from its upper semicircle at the level of the 7th cervical vertebra. It is divided into 4 parts: between the anterior scalene muscle and the long muscle of the neck is its prevertebral part (pars prevertebralis). Then the vertebral artery goes to the 6th cervical vertebra - this is its transverse [cervical] part (pars transversaria, s.cervicalis), it passes upward through the transverse openings of the 6th-2nd cervical vertebrae. Having exited the transverse opening of the 2nd cervical vertebra, the vertebral artery turns laterally and passes into the atlantal part (pars atlantica). After passing through the opening in the transverse process of the atlas, the artery goes around its superior glenoid fossa (surface) from behind, pierces the posterior atlanto-occipital membrane, and then the dura mater of the spinal cord (in the spinal canal) and enters the cranial cavity through the foramen magnum. Here is its intracranial part (pars intracranialis). Behind the pons of the brain, this artery joins with a similar artery on the opposite side, forming the basilar artery. From the second, transverse, part of the vertebral artery, the spinal [radicular] branches (rr.spinales, s.radiculares) extend, penetrating through the intervertebral openings to the spinal cord, and the muscular branches (rr.musculares) go to the deep muscles of the neck. All other branches separate from the intracranial part of the vertebral artery:

1. meningeal branches (rr.meningei; 2-3 in total) go to the dura mater of the brain in the posterior cranial fossa;
2. the posterior spinal artery (a.spinalis posterior) goes around the outside of the medulla oblongata and then descends down the back surface of the spinal cord, anastomosing with the artery of the same name on the opposite side;
3. the anterior spinal artery (a.spinalis anterior) joins with the artery of the same name on the opposite side into an unpaired vessel that goes down into the depths of the anterior fissure of the spinal cord;
4. The posterior inferior cerebellar artery (right and left) (a.inferior posterior cerebelli), having encircled the medulla oblongata, branches out in the posterior inferior parts of the cerebellum.

The basilar artery (a.basilaris) is an unpaired vessel located in the basilar groove of the pons. At the level of the anterior edge of the pons, it divides into two terminal branches - the posterior right and left cerebral arteries. The following branch off from the trunk of the basilar artery:

1. the anterior inferior cerebellar artery, right and left (a.inferior anterior cerebelli), branches on the lower surface of the cerebellum;
2. the artery of the labyrinthine, right and left (a.labyrinthi), passes next to the precochlear nerve (VIII pair of cranial nerves) through the internal auditory canal to the inner ear;
3. the arteries of the bridge (aa.pontis) supply blood to the bridge;
4. the midcerebral arteries (aa.mesencephalicae) go to the midbrain;
5. The superior cerebellar artery, right and left (a.superior cerebelli), branches in the upper parts of the cerebellum.

The posterior cerebral artery (a.cerebri posterior) goes behind and upwards, encircles the cerebral peduncle, branches on the lower surface of the temporal and occipital lobes of the cerebral hemisphere, and gives off cortical and central (deep) branches. The posterior communicating artery (from the internal carotid artery) flows into the posterior cerebral artery, resulting in the formation of the arterial (Willisian) circle of the brain (circulus arteriosus cerebri).

The right and left posterior cerebral arteries participate in the formation of this circle, closing the arterial circle from behind. The posterior cerebral artery is connected to the internal carotid on each side by the posterior communicating artery. The anterior part of the arterial circle of the cerebrum is closed by the anterior communicating artery, located between the right and left anterior cerebral arteries, which branch off from the right and left internal carotid arteries, respectively. The arterial circle of the cerebrum is located at its base in the subarachnoid space. It encompasses the optic chiasm from the front and sides; the posterior communicating arteries lie on the sides of the hypothalamus, the posterior cerebral arteries are in front of the pons.

The internal thoracic artery (a.thoracica interna) originates from the inferior semicircle of the subclavian artery opposite and somewhat lateral to the vertebral artery. The artery descends down the posterior surface of the anterior chest wall, adjacent to the cartilages of the 1st-8th ribs from behind. Under the lower edge of the 7th rib, the artery divides into two terminal branches - the muscular-diaphragmatic and superior epigastric arteries. A number of branches originate from the internal thoracic artery:

1. mediastinal branches (rr.mediastinales) go to the mediastinal pleura and the tissue of the superior and anterior mediastinum;
2. thymus branches (rr.thymici);
3. bronchial and tracheal branches (rr.bronchiales et tracheales) are directed to the lower part of the trachea and the main bronchus of the corresponding side;
4. the pericardiodiaphragmatic artery (a.pericardiacophrenica) begins from the trunk of the internal thoracic artery at the level of the 2nd rib and, together with the phrenic nerve, descends along the lateral surface of the pericardium (between it and the mediastinal pleura), gives off branches to the pericardium and diaphragm, where it anastomoses with other arteries that supply blood to the diaphragm;
5. the sternal branches (rr.sternales) supply blood to the sternum and anastomose with the same branches on the opposite side;
6. the perforating branches (rr.perforantes) pass through the upper 5-6 intercostal spaces to the pectoralis major muscle, skin, and the 3rd, 4th and 5th perforating arteries (in women) give off the medial branches of the mammary gland (rr.mammarii mediales);
7. the anterior intercostal branches (rr.intercostales anteriores) extend in the upper five intercostal spaces in a lateral direction to the intercostal muscles;
8. the muscular-diaphragmatic artery (a.musculophrenica) runs downward and laterally to the diaphragm. Along the way it gives off intercostal branches to the muscles of the five lower intercostal spaces;
9. The superior epigastric artery (a. epigastrica superior) enters the sheath of the rectus abdominis muscle through its posterior wall, supplies this muscle with blood, being located on its posterior surface. At the level of the umbilicus, it anastomoses with the inferior epigastric artery (a branch of the external iliac artery).

The thyrocervical trunk (truncus thyrocervicalis) arises from the subclavian artery at the medial edge of the anterior scalene muscle. The trunk is about 1.5 cm long and in most cases divides into four branches: the inferior thyroid, suprascapular, ascending, and superficial cervical arteries.

1. the inferior thyroid artery (a. thyroidea inferior) runs up the anterior surface of the longus colli muscle to the thyroid gland and gives off glandular branches (rr. glandulares) to it. The pharyngeal and esophageal branches (rr.pharyngeales et oesophageales), tracheal branches (rr.tracheales) and the inferior laryngeal artery (a.laryngealis inferior) also branch off from the inferior thyroid artery, which anastomoses with the superior laryngeal artery (a branch of the superior thyroid artery) under the plate of the thyroid cartilage;
2. the suprascapular artery (a.suprascapularis), which was previously called the transverse artery of the scapula, goes downward and laterally between the clavicle in front and the anterior scalene muscle behind. Then, along the lower belly of the omohyoid muscle, the artery goes backward, to the superior notch of the scapula, through which it penetrates the supraspinatus, and then into the infraspinous fossa, to the muscles located there. It anastomoses with the artery that encircles the scapula (a branch of the subscapular artery), and gives off the acromial branch (r.acromialis), which anastomoses with the branch of the same name from the thoracoacromial artery;
3. the ascending cervical artery (a. cervicalis ascendens) goes up the anterior surface of the anterior scalene muscle and supplies blood to the deep muscles of the neck (sometimes it comes from the transverse artery of the neck);
4. The superficial cervical artery (a. cervicalis superficialis) runs laterally and upwards in front of the anterior scalene muscle and the brachial plexus and the muscle that lifts the scapula. In the outer part of the lateral triangle of the neck, the artery goes under the trapezius muscle, which it supplies. Sometimes the artery branches off from the ascending cervical artery.

The costocervical trunk (truncus costocervicalis) departs from the subclavian artery in the interscalene space, where it immediately (at the level of the neck of the 1st rib) divides into two intercostal arteries:

1. g the deep cervical artery (a. cervicalis profunda) runs posteriorly between the 1st rib and the transverse process of the 7th cervical vertebra, rises up to the 2nd cervical vertebra, gives off branches to the spinal cord, semispinalis muscles of the head and neck;
2. the highest intercostal artery (a. intercostalis suprema) goes down in front of the neck of the first rib and branches in the first two intercostal spaces, giving rise to the posterior intercostal arteries, the first and second (aa. intercostales posteriores, prima et secunda).

Transverse artery of the neck. (a.transversa cervicis) most often passes between the trunks of the brachial plexus posteriorly. At the level of the medial end of the spine of the scapula, the artery ascends up to the second cervical vertebra, gives off branches to the spinal cord, divides into a superficial branch (r. superficialis), which follows to the muscles of the back, and a deep branch (r.rpofundus), which passes along the medial edge of the scapula downwards to the muscles and skin of the back. Both branches of the transverse artery of the neck anastomose with branches of the occipital artery (from the external carotid artery), posterior intercostal arteries (from the thoracic part of the aorta), with the subscapular artery and the artery surrounding the scapula (from the axillary artery).

[ 1 ], [ 2 ], [ 3 ], [ 4 ]