Arteries of head and neck

The brachiocephalic trunk, the left common carotid artery and the left subclavian artery, which carry blood to the head and neck, upper limbs, to the front wall of the chest and abdomen, consistently leave the arch of the aorta.

The brachiocephalic trunk (truncus brachiocephalicus) departs from the arch of the aorta at the level of cartilage II of the right rib; in front of it is the right brachiocephalic vein, behind - the trachea. Going up and to the right, the brachiocephalic trunk does not give any branches and only at the level of the right sternoclavicular joint is divided into two terminal branches - the right common carotid and right subclavian artery.

The right common carotid artery (a.carotis communis dextra) is the branch of the brachiocephalic trunk, and the left common carotid artery (a.carotis communis sinistra) departs directly from the arch of the aorta and is usually longer than the right one by 20-25 mm. The common carotid artery lies behind the pectoral and noctuid-mastoid and scapular-hyoid mice and covering the middle fascia of the neck. The artery should be vertically upward in front of the transverse processes of the cervical vertebrae, without giving branches along the way.

Outside the common carotid artery, the internal jugular vein is located, and behind the artery and this vein is a wandering nerve; Inside - the trachea and esophagus first, and above - the larynx, pharynx, thyroid and parathyroid glands. At the top of the thyroid cartilage, each common carotid artery is divided into the outer and inner carotid arteries, which have approximately the same diameter. This place is called bifurcation of the common carotid artery. A small extension at the beginning of the external carotid artery is called a sleepy sinus (sinus caroticus). At this point, the outer shell of the artery is thickened, it has many elastic fibers and nerve endings. The middle shell is less developed than in other places of this artery. In the field of bifurcation of the common carotid artery, the body is 2.5 mm long and 1.5 mm thick - a dormant glomus (intercellular glomerulus, 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. To the initial part of the external carotid artery from the outside is the sternocleidomastoid muscle, in the region of the carotid triangle - the superficial plate of the cervical fascia and the subcutaneous muscle of the neck. Being inward from the sylvolus muscle and the back abdomen of the dorsal muscle, the external carotid artery at the level of the neck of the lower jaw (in the thickness of the parotid gland) is divided into its terminal branches - the superficial temporal and maxillary arteries. On its way, the external carotid artery gives off a series of branches that branch away from it in several directions. The anterior group of branches is the upper thyroid, lingual and facial arteries. The posterior group of branches includes the sternocleidomastoid, occipital and posterior ear arteries; the ascending pharyngeal artery is guided medially.

External carotid artery

The internal carotid artery (a.carotis interna) supplies the brain and the organ of vision. The internal carotid artery is distinguished by cervical, stony, cavernous and cerebral parts. On the neck, this artery does not give branches. The cervical part (pars cervicalis) is located laterally and posteriorly, and then medially from the external carotid artery. Between the throat medially and the internal jugular vein laterally, the inner 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 the vagus nerve, in front and laterally the hyoid nerve, above the glossopharyngeal nerve. In the sleepy channel is the stony part (pars petrosa) of the internal carotid artery, which forms a bend and delivers into the tympanum the thin sleepy-tympanic arteries (aa.carotico-tympanicae).

Internal carotid artery

The subclavian artery (a.subclavia) starts from the aorta (left) and the brachiocephalic trunk (right), blood supply to the brain and spinal cord, skin, muscles and other organs of the neck, shoulder girdle, upper limb, and the front wall of the thoracic and abdominal cavities, pericardium , pleura and diaphragm. The left subclavian artery is about 4 cm longer than the right one. The subclavian artery circumscribes the dome of the pleura and exits the thoracic cavity through the upper aperture, enters (together with the brachial plexus) into the interstitial space, then passes under the clavicle, bends through the 1st rib (lies in the eponymous furrow). Below the lateral edge of this rib, the artery penetrates into the armpit, where it continues as the axillary artery.

Conditionally subclavian artery is divided into three departments:

1. from the place of origin to the inner edge of the anterior staircase;
2. in the interstellar space and
3. at the exit from the interstellar gap.

In the first department, three branches branch out from the artery: the vertebral and internal thoracic arteries, the thyroid shaft, in the second part - the reartered trunk, in the third - sometimes the transverse artery of the neck.

The vertebral artery (a.vertebralis) - the largest branch of the subclavian artery, departs from its upper semicircle at the level of the VII cervical vertebra. It is divided into 4 parts: between the front staircase and the long neck muscle is its pre-invertebral part (pars prevertebralis). Further, the vertebral artery is directed to the sixth cervical vertebra - this is its cervical part (pars transversaria, s.cervicalis), it passes up through the transverse apertures of the VI-II cervical vertebrae. Exiting the transverse opening II of the cervical vertebra, the vertebral artery turns laterally and passes into the atlant part (pars atlantica). Passing through the hole in the transverse process of the atlas, the artery bends behind its upper articular fossa (surface) perforates the posterior atlanto-occipital membrane, and then the hard shell of the spinal cord (in the spinal canal) and through the large occipital foramen enters the cavity of the skull. Here is its intracranial part (pars intracranialis). Behind the bridge of the brain, this artery connects to a similar artery of the opposite side, forming a basilar artery. From the second, transversal, part of the vertebral artery spinal [branch] branches (rr.spinales, s.radiculares), penetrating through the intervertebral foramina to the spinal cord, and the muscular branches (rr.musculares), going to the deep muscles of the neck. All other branches are separated from the intracranial part of the vertebral artery:

1. meningeal branches (rr.meningei, total 2-3) are sent to the dura mater of the brain in the posterior cranial fossa;
2. posterior spinal artery (a.spinalis posterior) curves outside the medulla oblongata, and then descends the back of the spinal cord, anastomosing with the same-named artery of the opposite side;
3. the anterior spinal artery (a.spinalis anterior) is connected to the same-named artery of the opposite side into an unpaired vessel, which is directed downwards in the depth of the anterior fissure of the spinal cord;
4. the posterior lower cerebellar artery (right and left) (a.inferior posterior cerebelli), circling the medulla oblongata, branches into the posterior parts of the cerebellum.

Basilar artery (a.basilaris) - unpaired vessel, located in the basilar fissure of the bridge. At the level of the anterior edge of the bridge is divided into two terminal branches - the posterior right and left cerebral arteries. From the trunk of the basilar artery depart:

1. anterior lower cerebellar artery, right and left (a.inferior anterior cerebelli), branch on the lower surface of the cerebellum;
2. the artery of the labyrinth, right and left (a.labyrinthi), pass next to the precursor-cochlear nerve (VIII pair of cranial nerves) through the internal auditory passage to the inner ear;
3. the bridge arteries (aa.pontis) supply the bridge with blood;
4. the middle cerebral arteries (aa.mesencephalicae) are directed to the middle brain;
5. the upper cerebellar artery, right and left (a.superior cerebelli), branches into the upper parts of the cerebellum. 

The posterior cerebral artery (a.cerebri posterior) goes behind and up, bends the leg of the brain, branches out on the lower surface of the temporal and occipital lobes of the cerebral hemisphere, gives off the cortical and central (deep) branches. The posterior connective artery (from the internal carotid artery) flows into the posterior cerebral artery, resulting in the formation of the arterial (vyllic) circle of the large brain (circulus arteriosus cerebri).

In the formation of this circle, the right and left posterior cerebral arteries, which close the arterial circle behind, are involved. The posterior cerebral artery with the internal carotid on each side connects the posterior connective artery. The anterior part of the arterial circle of the large brain is closed by the anterior connective artery, located between the right and left anterior cerebral arteries that extend respectively from the right and left internal carotid arteries. The arterial circle of the large brain is located on its base in the subarachnoid space. It covers the front and sides of the visual crossover; posterior connective arteries lie on each side of the hypothalamus, posterior cerebral arteries are in front of the bridge.

The internal thoracic artery (a.thoracica interna) departs from the lower semicircle of the subclavian artery opposite and is somewhat lateral to the vertebral artery. The artery descends down the posterior surface of the anterior thoracic wall, adjacent to the cartilages of I-VIII ribs. Under the lower edge of the VII rib, the artery splits into two terminal branches: the muscular-diaphragmatic and the superior epigastric artery. From the internal thoracic artery leaves a series of branches:

1. mediastinal branches (rr.mediastinales) go to the mediastinal pleura and fiber of the upper and anterior mediastinum;
2. thymus branches (rr.thymici);
3. bronchial and tracheal branches (rr.bronchiales et tracheales) are sent to the lower trachea and the main bronchus of the corresponding side;
4. the pericardial diaphragmatic artery (a.pericardiacophrenica) starts from the trunk of the inner thoracic artery at the level of the second rib and, along with the diaphragmatic nerve, descends the lateral surface of the pericardium (between it and the mediastinal pleura), gives branches to the pericardium and diaphragm, where it anastomoses with other arteries that supply the diaphragm ;
5. the sternal branches (rr.sternales) supply the sternum and anastomose with the same branches of the opposite side;
6. the perforating branches (rr.perforantes) pass in the upper 5-6 intercostal spaces to the large pectoral muscle, the skin, and the 3rd, 4th and 5th perforating arteries (in women) give 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 the lateral direction to the intercostal muscles;
8. the muscular-diaphragmatic artery (a.musculophrenica) is directed downward and lateral to the diaphragm. On the way, he gives intercostal branches to the muscles of the five lower intercostal spaces;
9. the upper epigastric artery (a.epigastrica superior) enters the vagina of the rectus abdominis through its posterior wall, blood supply this muscle, located on its posterior surface. At the level of the navel, anastomoses with the lower epigastric artery (branch of the external iliac artery). 

The shchotosheyny trunk (truncus thyrocervicalis) departs from the subclavian artery at the medial edge of the anterior staircase. The trunk is about 1.5 cm long and in most cases is divided into four branches: the lower thyroid, suprapathic, ascending and superficial arteries of the neck.

1. the lower thyroid artery (a thyroidea inferior) is directed up the front surface of the long neck muscle to the thyroid gland and gives to it glandular branches (rr. Glandulares). The pharyngeal and esophageal branches (rr.pharyngeales et oesophageales), tracheal branches (rr.tracheales) and the lower laryngeal artery (a.laryngealis inferior), which under the plate of the thyroid cartilage anastomose with the upper laryngeal artery (the branch of the upper thyroid arteries);
2. the suprapulpular artery (a.suprascapularis), which was formerly called the transverse artery of the scapula, goes down and lateral between the clavicle in front and the front staircase behind. Then, along the lower abdomen of the scapular-hyoid muscle, the artery goes to the back, to the upper vlezke of the scapula, through which it penetrates into the supragastric and then into the subacute fossa, to the muscles lying there. Anastomoses with the artery surrounding the scapula (branch of the subscapular artery), and gives the acromial branch (r.acromialis), which anastomoses with the branch of the same name from the pectoral artery;
3. the ascending cervical artery (a.cervicalis ascendens) goes up the front surface of the anterior staircase and blood supply to the deep muscles of the neck (sometimes moving away from the transverse artery of the neck);
4. the superficial cervical artery (a.cervicalis superficialis) goes laterally and upwards from the front staircase 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 blood supply. Sometimes the artery moves away from the ascending cervical artery.

The costal cervical trunk (truncus costocervicalis) departs from the subclavian artery in the interstitial space, where it immediately (at the level of the neck of the 1st rib) is divided into two intercostal arteries:

1. The laxative cervical artery (a.cervicalis profunda) follows posteriorly between the 1st rib and the transverse process of the VII cervical vertebra, rises up to the 2nd cervical vertebra, gives branches to the spinal cord, semi-oval muscles of the head and neck;
2. the highest intercostal artery (a. Intercostalis suprema) goes down in front of the neck of the 1st rib and branching in the first two intercostal spaces, giving the posterior intercostal arteries, the first and second (aa., intercostales posteriores, prima et secunda).

The 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 scapula, the artery rises upward to the cervical vertebra, gives branches to the spinal cord, divides into the superficialis, following the muscles of the back, and the deep branch (r.rpofundus) that passes along the medial edge of the scapula down to the muscles and back. Both branches of the transverse artery of the neck are anastomosed with the 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 artery surrounding the scapula (from the axillary artery).

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