颈外动脉系(神经外科)课件.ppt

1、精品资料 你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘”“太阳当空照，花儿对我笑，小鸟说早早早”External Ca The external carotid artery supplies the scalp,face,ear,nose,pharynx,dura mater and the upper part of the neck.Due to the extensive anastomoses among the interna

2、l,external carotid arteries and the vertebro-basilar arterises,imaging or superselective imaging of the external carotid artery is important in investigation of craniofacial or intracranial pathology.Some tributaries of the external carotid artery,especially the transcranial anastomoses are ususally

3、 small,however they may become hypertrophic in various pathological conditions(such as dural arterio-venous fistula,meningioma),which have practical implication in interventional neuroradiology.External Ca The external carotid artery ususally branches from the common carotid artery at C4 level,altho

4、ugh there may be variation in the level of branching.After bifurcation from the common carotid artery,it gives 8 major branches.Normal external carotid artery,lateral projection.1.lingual artery 4.posterior auricular artery 2.facial artery 5.internal maxillary artery 3.occipital artery 6.superficial

5、 temporal arteryExternal Ca1 Lingua Lingual artery is the second branch of the external carotid arartery,which mainly supplies the ipsilateral side of the tongue and sublingual glands.It branches from the anteromedial wall of the external carotid artery,slightly above the superior thyroid artery and

6、 inferior to the facial artery.It is present on the C3 vertebral body level and inferior to the angle of mandible on lateral projection.Lingua Normal lingual artery,lateral projection 1.dorsal lingual artery 2.pharyngeal branches 3.deep lingual artery 4.sublingual arteryThe lingual artery divides in

7、to pharyngeal and lingual segmentsLingua Normal lingual artery,lateral projection.1.branches of the submandibular gland 2.suprahyoid branches 3.sublingual artery 4.mandibular branch 5.submental branch 6.deep lingual artery2、FACIA Facial artery is the third branch of the external carotid artery.It ma

8、inly supplies the skin over the face,masseter,salivary glands and most of the oral mucosa.It can be divided into the horizontal submental portion and the superficial ascending portion 1、FACIA1.trunk of the facial artery 2.principal artery of the submandibular gland 3.submental artery 4.mental artery

9、 5.buccal artery 6.superior labial artery 7.inferior labial artery8.subnasal artery9.alar artery10.angular arterySubmental horion It runs from the origin in the external carotid artery to the groove of facial artery over the mandible.This part of the artery runs initially in a convex downward manner

10、 along.It can be shown clearly in lateral projection important branches:1 ascending palatine artery 2 artery of the submandibualr gland 3 submental artery1.ascending palatine artery(APA)5.inferiro masseteric artery2.the arnterior branch of APA 6.long facial artery(posterior buccal artery)3.the poste

11、rior branch of APA 7.buccal branch of internal maxillary artery4.middle masseteric arterySubmandibuay Selective angiography of facial artery,lateral projection.Opacification of the submandibual gland and its feeders(arrows)Superficial asion It mainly supplies the skin and muscle of the face,cheek,li

12、ps and nose.It has 6 major branches 1 Inferiro masseteric artery 2 Mental artery 3 Buccal artry 4 Labial artery 5 Alar artery 6 Angular arteryInferiro massry It is the first branch of facial artery after it passes the mandible and lateral projection reveals that the artery runs superiorly to supply

13、the masseter and the skin above,with extensive anastomosis with the internal maxillary artery and the transverse facial artery.Mental It originates from the facial artery at the midpoint of the mandible and lateral projection reveals that the artery runs anteriorly in a horizontal manner,it supplies

14、 the skin of the mental area and the mandible,with extensive anastomosis with the inferior dental artery,submental artery and the inferior labial1 ascending palatine artery 2 submental artery3 mental artery 4 inferior labial artery5 superior labial artery 6 subnasal arteryBucca It supplies the area

15、bounded by the anterior margin of the masseter,posterior margin of the nasal alae,inferior orbital margin and the superior part of the submental area.It usually divides into 3 branches:the anterior,middle and posterior buccal arteries.They all run antero-superiorly on lateral projection.there may be

16、 hypertrophy of the posterior buccal artery and prolongation of its course.It was sometimes named as long facial artery.In this occasion,the anterior and middle buccal arteries may be absent 1.ascending palatine artery(APA)5.inferiro masseteric artery2.the arnterior branch of APA 6.long facial arter

17、y(posterior buccal artery)3.the posterior branch of APA 7.buccal branch of internal maxillary artery4.middle masseteric arteryLabial artery ry It divides into superior and inferior arteries along the upper and lower lips after originating from the facial artery.It supplies the lips and its mucosa an

18、d anastomoses with the contralateral partner.The inferior labial artery is usually larger than the superior one by 1-2mm in diameter.It runs anteriorly in a convex upward manner after originating from the facial artery near the nasal alae,and supplies the nasal alae,nostrils and the surrounding muco

19、sa Nasal and superior labial distribution of the facial artery,lateral projection.1.alar artery 4.angular artery 2.subnasal artery 5.angular vein 3.superior labial arteryAngula It is the terminal branch of the facial artery.It runs along the lateral aspect of the nose to the inner canthus and anasto

20、moses with the dorsal nasal artery of the ophthalmic artery.It also anastomoses with the infraorbital artery at the infra-orbital foramen.The angular artery is one of the important anastomosis between the extracranial and intracranial circulation.1.trunk of the facial artery 7.inferior labial artery

21、 2.principal artery of the submandibular gland 8.subnasal artery 3.submental artery 9.alar artery 4.mental artery 10.angular artery 5.buccal artery 11.angular vein 6.superior labial artery 12.facial vein2、FACIA1 ascending palatine artery(APA)2 the anterior branch of APA3 the posterior branch of APA

22、4 the artery of submandibular gland5 inferior masseteric arteries 6 submental artery7 posterior buccal artery8 superior labial artery9 inferiro labial artery10 subnasal artery11 alar artery12 descending palatine artery13 buccal artery of internal maxillary artery14 anterior buccal artery It is the m

23、ajor supplying vessel of the pharyngeal muscles and also supplies the meninges,nerves and the tympanic cavity.It originates from the medial or posterior wall of the external carotid artery,usually below the origin of the occipital artery and immediate next to the lingual artery.There are lots of var

24、iation of its origin The ascending pharyngeal artery is small and ascends between the internal and external carotid artery vertically or with slight curvature.It divides into anterior and posterior group.AnteriIt consists of all the anterior branches supplying the pharynx.It further branches into as

25、cending and descending branches.It is usually divided into 3 branches 1.superior pharyngeal artery 2.middle pharyngeal artery 3.inferior pharyngeal artery 4.anterior branch of ascending palatine artery5.neuromeningeal branch6.musculospinal branchIt is the terminal branch of the ascending pharyngeal

26、artery and ends at the inferior aspect of the petrous bone near the carotid canal.It runs antero-medially and supplies the Eustachian tube opening.Rosenmullar recess and the surrounding tissue,and anastomoses with the descending palateing branch of the accessory meningeal artery and the Vidian arter

27、y of the internal maxillary artery.It gives an important branch,i.e.internal carotid ramus which accompanies the internal carotid artery through the foramen lacerum into the cavernous sinus to anastomose with the inferolateral trunk of the cavenous sinus of ICA；it also anastomoses with the recurrent

28、 artery of foramen lacerum from the C5 portion of the internal carotid artery.Normal ascending pharyngeal artery,lateral projection.Anastomoses with artery of the pterygoid canal(arrow).Occipital artery(arrowhead),and vertebral artery(open arrow)1.superior pharyngeal artery 5.occipital artery2.neuro

29、meningeal artery 6.vidian artery3.musculospinal artery 7.terminus of internal maxillary artery4.vertebral artery 8.posterior cerebral artery2.Middle pharh It supplies the posterior and lateral wall of the pharynx,through another branch it supplies the soft palate.It anastomoses with the ascending pa

30、latine artery of the facial artery,descending pharyngeal artery of the internal maxillary artery and the descending palatine branch of the accessory meningeal artery Normal ascending pharyngeal artery,lateral projectionAnastomosis with the descending palatine branch of the accessory meningeal artery

31、(arrow).Anastomosis with vertebral artery(double arrows).1.superir pharyngeal artery 5.neuromeningeal branch2.middle pharyngeal artery 6.musculospinal artery3.inferior pharyngeal artery 7.vertebral artery4.descending palatine branchInferior pharch It runs inferiorly to the middle pharyngeal branch t

32、o supply the postero-lateral wall of the pharynx.Posteri It includes all the posterior branches supplying the nerves,meninges,vertebral bodies and paravertebral muscles.Due to the extensive anastomosis with the intracranial vessels,it has an important place in interventional neuroradiology It is usu

33、ally divided into 3 branches 1.inferior tympainic artery 2.neuromeningeal artery 3.musculospinal branch1.Inferior tyy It can branch from either the anterior or posterior group.It originates near the jugular foramen and runs through the Jacobsons canal to the opening of the Eustachian tube where it b

34、ranches into three tributaries:1.Ascending branch which goes with the greater petrosal nerve and anastommoses with the petrosal branch of the middle meningeal artery.2.Anterior branch which goes anteriorly and anastomoses with the caroticotympanic artery of the internal carotid artery.3).Posterior b

35、ranch which goes posterioly into the facial canal and anstomoses with the stylomastoid artery.Neuromeningeal branch It runs postero-superiorly to the jugular foramen and divides into branches to go intracranially via the hypoglossal canal and the jugular foramen.Muscular branchIt branches posteriorl

36、y from the posterior group to supply the paravertebral muscles and the vertebral bodies.It anastomoses with the vertebral artery,occipital artery and the deep cervical artery of the costocervical trunk Posteri 1.superior pharyngeal artery 2.middle pharyngeal artery 3.inferior pharyngeal artery 4.inf

37、erior tympainic artery 5.neuromeningeal artery 6.musculospinal branch 7.vertebral artery 8.basilar artery4、OCCIPIT It supplies the occipital muscles,skin and dura,and via the stylomastoid artery to supply the petrous bone.It ususally originates from the posterior wall of the external carotid artery

38、and in rare occasions it may originate from the vertebral.It divides into 3 portion on lateral projection:the ascending,horizontal and further ascending segment.5、INTERNAL MAX Internal maxillary artery is the deep terminal branch of the external carotid artery.It starts from the level of the mandibu

39、lar collum and ends in the roof of pterygopalatine fossa,which is well shown up in lateral projection.It has 14 branches and 1 terminal.According to its distribution and territory,it can be divided into 6 groups.The details of branching and distribution are as follows:Diagram of the internal maxilla

40、ry artery in lateral view1 middle meningeal arter2 accessory meningeal artery3 anterior deep temporal artery4 middle deep temporal artery5 Vidian artery6 artery of the foramen rotundum7 inferior dental artery8 buccal artery9 masseteric artery10 descending palatine artery11 infraorbital artery12 sphe

41、nopalatine artery13 superior dental artery14 posterior deep temporal artery 5.1.1 Anterior tympanic artery 5.1.2 Middle meningeal artery 5.1.3 Accessory meningeal artery5.1.1 Anterior try It is the first branch of the internal maxillary artery and ususally originates from the angle between the inter

42、nal maxillary artery and the superficial temporal artery.It runs along the tympanic cord and through the foramen deep to the tempro-mandibular joint to enter the facial canal and anastomoses with the stylomostoid artery of the occipital artery.This artery is an important artery supplying the middle

43、ear.Lateral porjection shows an anterior convex acuate shape anterior to the external auditory canal.5.1.2 Middle menry Being the second ascending branch from the internal maxillary artery,its main trunk runs antero-medially and enters the skull via foramen spinosum.It then runs anteriorly,superiorl

44、y and laterally between the two layers of the dura in the middle cranial fossa along the greater wing of sphenoid to the pterion.There may be a bony canal near the pterion,in which the artery runs a wavy course,and can be evident in lateral projection.After exiting from the bony canal,it runs poster

45、iorly to the coronal suture and ends in the anterior fonticulus.The important branches of the middle meningeal artery can be divide into 4 groups:1.Extracranial group;2.Skull base group;3.Anterior group;4.Posterior group 1.Extracranial group:It branches from the origin of middle meningeal artery to

46、the foramen spinosum,which supplies the surrounding muscles and mucosa.The accessory meningeal artery may originate from this part.2.Skull base group:It branches from the foramen spinosum to the entrance of the Vidian bony canal near the pterion,which has extensive anastomosis 3.Anterior group:It di

47、stributes in the dura of the orbit,base of anterior cranial fossa and the convex surface of the frontal lobe.It sometimes may give a branch to anastomose with the lacrimal artery or the ophthalmic artery through the superior orbital fissure.4.Posterior group:It divides into several branches after or

48、iginating from the middle meningeal artery and runs posterosuperiorly to supply the parieto-occipital dura.It also supplies the tentorium and the posterior cranial fossa.5.1.3 Accessory mry It may originate directly from the internal maxillary artery,or from the extracranial group of middle meningea

49、l artery.It runs anterosuperiorly to divide into 4 branches:1).Superior branch 2).Posterior branch 3).Infero-medial branch 4).Descending palatine branch In lateral projection,the accessory meningeal artery runs anero-superiorly in an oblique manner and gives the descending palatine branch which runs

50、 antero-inferiorly,forming a characteristic inverted“V”to aid its identification 5.2 Extracranial muscg branch The branch of internal maxillary artery that supplies the temporalis muscle,includes the middle deep temporal artery and the anterior deep temporal artery.The latter also supplies the orbit