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External Carotid Artery, Subclavian Artery, Internal Jugular Vein and Its Tributaries, Thyroid Gland, Parathyroid Glands

External Carotid Artery, Subclavian Artery, Internal Jugular Vein and Its Tributaries, Thyroid Gland, Parathyroid Glands

External carotid , , internal jugular and its tributaries, gland, parathyroid glands

By

Ivo Klepáček Three vascular systems are finally formed:

Intraembryonic (cardinal); aortic sac (later gives VJI ACErise )

Vitelline (aa. + vv.) THYROIDDevelopment of the vascular Placental system (umbilical Day 27 aa. + vv.) 1st –VJImaxillary artery ACE 2nd – hyoid, stapedial aa. 3rd – common carotid a. and first part of the internal carotid a., external carotid a. 4th – part of the subclavian aa. THYROIDsome of intersegmental Main arteries (left) Brachiocephalic trunk (right)

Internal carotid artery VJI ACEExternal carotid artery THYROID Variations of the aortic arch branches VJI ACE THYROID pretrachealis a ACC VJI ACEPretracheal fascia and ACC THYROID Sympathetic nerve trunks VJI ACE THYROID Common carotid artery

Anterolaterally – skin, fascia, sternocleidomastoid muscle, sternohyoid, sternothyroid, superior belly of the omohyoid

Posteriorly – transverse process of the C4VJI vertebrae, prevertebral muscles,ACE

Medially – wall of the and larynx, trachea, esophagus, the lobe of the thyroid gland THYROIDLaterally – the internal , (posterolaterally) branches: Arteria carotis Temporalis superficialis, maxillaris, externa ACE thyroidea sup., lingualis, pharyngea ascendens, auricularis posterior, occipitalis

a. pharyngea VJIascendens ACE a. STCLM

THYROIDFor full head External carotid instead of orbit, inner artery ECA and brain VJI ACE THYROID VJI ACE

Variety THYROIDVarieties ECA Anterolaterally – sternocleidomastoid muscle, XII. nerve, within is crossed by VII.VJI nerve, fascia, skin ACE

Medially – wall of the pharynx, , stylopharyngeus, THYROIDpharyngeal branch of the vagus For head without orbit, inner ear and brain Superficial temporal artery Arteria temporalis superficialis

For gl. parotis, TMJ, m. orbicularis oculi, m. temporalis;

• glandular branches VJI ACEtransversa faciei (for mimic muscles) • rr. auriculares anteriores (capsule of TMJ) • a. zygomaticoorbitalis • a. temporalis media • frontal branches THYROID• parietal branches Superior thyroid a., Arteria thyroidea VJI ACEsuperior For thyroid gland,; Ventral branch anastomoses with the same contralateral opposite artery ; Dorsal branch anastomoses with inferior thyroid a.,

THYROID• glandular branches • superior laryngeal a., muscular branches Superior pharyngeal a., Arteria pharyngea VJI ACEascendens The very thin artery, supplies pharynx

pharyngeal branches (for truncus sympathicus, vagus, n. hypoglossus and pharynx) • Meningeal branches (for dura mater) THYROID• inferior tympanic artery (for ) For ;

• Suprahyoid branch • Sublingual a. (for ) • Dorsal lingual branches (from tongue root to VJI ACEepiglottis) • a. profunda linguae (deep lingual a. – for intraglossal muscles; it proceeds to THYROIDfrenulum linguae) Arteria lingualis - inside paralingual canal (canalis paralingualis) Trigonum Pirogovi (Pirogoff ´triangle) Angulus Béclardi (Béclard´ angle)

Pierre Augustin Béclard, French anatomist VJI ACE(*1785- †1825) THYROID Nikolaj Ivanovič, Pirogov Russian surgeon (*1810 - †1881) Arteria facialis VJI ACEFor and face; • Ascending palatine a. (for soft palate and ) • Glandular branches (for submandibular gland) • Submental a. (for mylohyoid a., anterior belly of digastric m.)

• Superior and inferior labial aa. THYROID(they form circle around rima oris) • alaris nasi m. • angularis m. Arteria maxillaris – VJI ACEbranches THYROID Arteria maxillaris – retromandibular branches VJI ACE THYROID Arteria maxillaris – retromandibular part

• a. auricularis profunda • a. tympanica anterior VJI ACE• a. meningea media • a. alveolaris THYROIDinferior • Superior posterior alveolar a. • Infraorbital a. • Palatine descendens a.: a. palatina major et minores a. canalis pterygoidei • a. sphenopalatina: a. nasales posteriores laterales et VJI ACEnasales posteriores septales

Arteria maxillaris THYROID– branches from pterygopalatinous part For soft meningeal membranes;

• Occipital branches • Sternocleidomastoid brr. (sternocleidomastoid a. – crosses arcus nervi hypoglossi) • Auricular br. • Mastoid ale br. (for dura mater near mastoid canal) • Meningeal brr. (for dura VJI ACEmater near for. jugulare)

• Stylomastoid a. (for cavum tympani, canales semicirculares and cellulae mastoideae; • Posterior tympanic a. THYROIDsupplies cavum tympani) + posterior auricular a. Arteriae occipitalis + auricularis posterior Internal carotic artery ICA Carotic sinus (baroreceptor)  Cervical part – sinus caroticus, no branches  Petrous part – caroticotympanic aa.  Cavernous part – meningeal branch, hypophysial br. ganglionic trigeminal inferior brr.  CerebralVJI part – ophtalmic ACE a., (right angle), superior hypophysial a., communicans posterior a., choroid anterior a.  Terminal branches:  Anterior cerebral a. THYROID Medial cerebral a. Carotic siphon Willis circle (circulus arteriosus cerebri Willisi) VJI ACE THYROID Internal carotid artery Arteria carotis interna VJI ACE THYROID Internal carotid artery - intracranial branches Internal carotid artery ICA

Anterolaterally – below the digastric lies XII. nerve, sternocleidomastoid muscle, fascia, skin – above the digastric lies the pharyngeal branch of the vagus, IX. nerve, stylohyoid, stylopharyngeus muscles, parotid gland,VJI external carotid artery ACE

Posteriorly – sympathetic trunk, longus capitis muscle, transverse vertebral process THYROIDMedially – wall of the pharynx, Laterally – , X. nerve VJI ACE THYROID ACI has anastomoses with in ophtalmic a. Willis´ arterial cerebral VJIcircle ACE

circulus Thomas Willis arteriosu (1621-1673), s cerebri an English physician THYROIDWillisi VJI ACE

Ophtalmic artery THYROIDArteria ophtalmica VJI ACE THYROID Development of the venous system Umbilical from the chorion Vitelline veins from the yolk sac Cardinal veins from VJIthe ACE embryonic body THYROID Venae capitis et colli Head and neck VJI ACEveins THYROID Superficial veins: external jugular, anterior jugular and branches VJI ACEDeep veins Venae profundae: THYROIDPlexus pterygoideus Internal jugular Vena facialis VJI ACE THYROID Vena facialis can be open to from: Vena jugularis externa Vena jugularis interna Vena jugularis anterior VJI ACE THYROID Pterygoid plexus VJI ACE THYROID VJI ACE THYROID Pterygoid and its tributaries: n superior ophtalmic p inferior ophtalmic n infraorbital VJI ACEvein to pterygoid plexus (through – rete) r deep facial u buccal THYROIDinferior alveolar vein ... h VJI ACE THYROID VJI ACE THYROID VJI ACE

THYROIDInternal jugular vein Vena jugularis interna Subclavian artery (a. subclavia) – VJI ACE THYROID Subclavian artery Parts and trunci (a. subclavia) – relations and branches  sulcus arteria subclaviae pulmonis  apertura thoracis superior  sulcus arteriae subclaviae costae primae  fissura scalenorum branchesVJI exhibit variations ACE  (thoracic outlet syndrom)  steal phenomenon (a. vertebralis)

Arteria subclavia Arteria vertebralis THYROIDTruncus thyrocervicalis Truncus costocervicalis arteria thoracica interna

 Prevertebral part Cervical or transverse part (C6-C1) → spinal and muscular branches  Atlantic part – sulcus a.v., meVJImbrana ACE atlantooccipitalis post., foramen occipitale magnum  Intracranial part  Meningeal brr. a. inferior posterior cerebellar brr. (→ a. spinalis post.) THYROID Ant. spinalis branches a. vertebralis Arteries VJI ACE THYROID VJI ACE

THYROIDTrigonum scalenovertebrale Scalenovertebral triangle Blood source for brain: Carotis interna 80% Vertebralis 20% VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID VJI ACE

Lymph outflow from the head THYROIDtissues VJI ACEjugulodigastric THYROIDjuguloomohyoid Glandula thyroidea Thyroid gland VJI ACE THYROID Thyroid gland – structure and role

Parts Lobus dx., sin. (4) isthmus (6) VJIlobus pyramidalis (6) ACE

Metabolic role

 thyroxin T4, trijodtyronin T3 THYROID calcitonin External forms, VJI ACEcovers, varieties Capsula propria Fascia perithyroidea THYROID Thyroid gland - structure  capsule  septated internal space  follicles (50 - 900 um)  Ball-like VJIOne-layered epithelium lining ACE follicles  Contains colloid - thyreoglobulin  Follicular cells - thyreoglobulin, (accelerates metabolic activity and growth)  Parafollicular cells - calcitonin THYROID(decreases Ca level in blood and supports Ca accumulation in bones) Thyroid follicles Follicular cells VJI ACE THYROID Colloid Parafollicular cells (clear cells) Thyroid gland - development

Develops from the epithelialVJI ACE proliferation in the point between copula and THYROIDtuberculum impar Thyroid gland - development From day 24 Endodermal pouch to primitive pharynx Descent to the VJI ACEsuprasternal area (thyroglossal duct, foramen caecum Formation of the lobes (even pyramidal lobe) THYROIDAppearance of the parathyroid glands VJI ACE THYROID Ductus thyroglossus VJI ACE THYROID Thyroglossal duct VJICysta ACE thyreoglossea

Thyroglossal THYROIDcyst Thyroid gland Arterial supply VJI ACE

A. thyroidea sup. (from a. carotis ext.) A. thyroidea inf. (from truncus thyrocervicalis); is crossing THYROIDn. laryngeus recurrens A. thyroidea ima (2% - from arcus aortae) VJI ACE THYROID Thyroid gland VJI ACEVenous supply Vv. thyroideae sup., mediae et inf. Plexus thyroideus impar (to v. brachiocephalica sin.) THYROIDLymph bilaterally VJI ACE Vazivové obaly štítné žlázy

Fascial coats THYROIDof the thyroid gland ThyroidVJI ACE gland

Parathyroid THYROIDbody a. thyroidea inferior n. laryngeus reccurens VJI ACE THYROID VJI ACEhypothyroidism THYROID Tracheotomy VJI ACE THYROID Coniotomia Coniotomy VJI ACE

Approaches THYROIDduring tracheotomy Tracheotomia Tracheotomy Tracheostomia Tracheostomy VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID VJI ACE THYROID Glandula parathyroidea parathyroid glands

 2 pirs of the ball-like glands  drobných kulovitých útvarů  Theu have role in bone VJImetabolism ACE  parathormon (PTH) increases escape Ca from bones to the blood

 development – from dorsal parts THYROIDof the III. and IV. Pouch during week 5 Parathyroid glands

 usually 4 pieces located on the dorsal surface of the thyroid gland, 2 - 6  Upper bodies (= glandula parathyroidea sup.) at level of area where a.VJI thyroidea inf., n. laryngeus reccurensACE are crossed  Lower bodies at levels from angulus mandibulae to pericardium  vessels: each body has own vessel from a. thyroidea inferior IMPORTANT  During full thyroidectomy save minimally one  During parathyroidectomy save one or one half of it, or it is THYROIDneccessity to arrange full retransplantation to the antebrachium muscles or to the m. STCLM Příštítná tělíska – vývoj parathyroid glands - development VJI ACE THYROID Parathyroid glands - structure

 capsule + septae  parenchym is composed of trabeculae VJI Main cells – giant cells (4ACE- 8 um) THYROID Sources: www.lf1.cuni.cz http://anat.lf1.cuni.cz/internet.htm Dauber W: Pocket Atlas of Human Anatomy, Barnes and Noble 2000 E.K.Sauerland: Grant s Dissector 1999 Schuenke et al.: Neck and internal organs. Atlas of anatomy, Thieme Klepáček, Ivo, Mazánek Jiří a kol: Klinická anatomie ve stomatologii. Praha, Grada, 2001 Netter: Atlas of Human Anatomy, Icon 2003 BerkowitzVJI et al.: Oral Anatomy, Histology andACE Embryology. 3rd Edition, Mosby 2002 Woelfel, Scheid: Dental Anatomy, 6th ed. Williams & Wilkins, 2002 Schumacher, G. – H.: Anatómia pre stomatologov 1. diel Martin, Osveta, 1992 Čihák, Radomír: Anatomie 1, 2 Praha, Avicenum, 1987, 1988 Rohen, Johannes W., Yokochi, Chirio: Human anatomy. Photoatlas of the systemic and topographic anatomy, 1998 Seichert, Václav: A little anatomical atlas, 1999 THYROIDOwn archive VJI ACE THYROID

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