SEMINAR ON ECA

ECA BRANCHES, THEIR COURSE,TERRITORIES SUPPLIED &DANGEROUS INTRACRANIAL ANASTOMOSIS : 

ECA BRANCHES, THEIR COURSE,TERRITORIES SUPPLIED &DANGEROUS INTRACRANIAL ANASTOMOSIS KRISHAN JAIN

Aortic Arch & great vessels : 

Aortic Arch & great vessels Safe, successful transfemoral catheterization of Aorta Major Branches: 3 Innominate Left common carotid Left subclavian

Carotid arteries : 

Carotid arteries RCCA LCCA Mid-cervical level, typically around C3 to C5 or at superior border of thyroid cartilage CCA bifurcates into ECA & ICA (bifurcation can be as low as D2- D3 level)

ECA - Course & Relations : 

ECA - Course & Relations Generally arises medial and anterior to the ICA In 15% ECA originates lateral to the ICA, this variation occurs more frequently on the right (3:1)

External Carotid Artery : 

External Carotid Artery Supplies extracranial structures Generally 8 branches ECA branches, territories supplied, & functional hemodynamic balance is quite variable Ant: 1. Sup. Thyroid A. 2. Lingual A. 3. Facial A.

Slide 7: 

Post: 1. Occipital A. 2. Post. Auricular A. Medial: 1. Asc. Pharyngeal A. Terminal: 1. Sup Temporal A. 2. Maxillary A.

Possible dangerous anastomoses : 

Possible dangerous anastomoses Orbit Cavernous sinus Middle ear Upper cervical area Foramen magnum

Views : 

Views AP view Most branches run in an AP plane Superimposition Technical overexposure LATERAL VIEW Depicts most of the branches of ECA Points To Remember Vessels that cross one another without anastomosing lie in different anatomic planes. Vessels that appears to cross a bony barrier, without a deflection in their course, must lie in a more superficial tissue plane.

Superior Thyroid Artery (a. thyreoidea superior) : 

Superior Thyroid Artery (a. thyreoidea superior) First branch Arises just below the level of the greater cornu of the hyoid bone Ends in the thyroid gland. BRANCHES: Hyoid Superior Laryngeal Sternocleidomastoid Cricothyroid

Lingual Artery (a. lingualis) : 

Lingual Artery (a. lingualis) Second branch First tight concave curve inferiorly, then wider convex curve inferiorly forming a loop it runs horizontally forward, beneath the Hyoglossus finally, ascends almost perpendicular to the tongue, turns forward on its lower surface as far as the tip

Branches : 

Branches Hyoid Sublingual Dorsales linguae Profunda linguae Terminal dorsal A of the tongue Ranine branches

Facial Artery(external maxillary a., a. maxillaris externa) : 

Facial Artery(external maxillary a., a. maxillaris externa) Arises a little above the lingual artery Two general courses are described as the artery crosses the face diagonally from inferolateral to superomedial Postero-lateral course over the cheek – jugal Antero-medial course closer to mouth - labial ends at the medial commissure of the eye, under the name of the angular artery this vessel, both in the neck and on the face, is remarkably tortuous

Branches : 

Branches Cervical Branches: Ascending Palatine Tonsillar Glandular Mental Muscular Facial Branches: Inferior Labial Superior Labial Lateral Nasal Angular Muscular

Lingual/Facial A: : 

Lingual/Facial A: Confusing Lateral view – lingual A rises proximally, AP view – facial A loops under the body of mandible to access the lateral plane, lingual A has a direct route towards the midline and the tip of the tongue

Peculiarities : 

Peculiarities The facial artery not infrequently arises in common with the lingual It varies in its size and in the extent to which it supplies the face it occasionally ends as the sub mental not infrequently it extends only as high as the angle of the mouth or nose. The deficiency is then compensated for by enlargement of one of the neighboring arteries.

Occipital Artery (a. occipitalis) : 

Occipital Artery (a. occipitalis) Arises from the posterior part of the external carotid, opposite the facial Ends in the posterior part of the scalp May arise from ICA or proatlantal intersegnental A Branches: 2 – named endocranial branches Stylomastoid A Transmastoid A Meningeal br A of falx cerebelli

Posterior Auricular Artery (a. auricularis posterior) : 

Posterior Auricular Artery (a. auricularis posterior) small and arises above the posterior belly of diagastric It ascends, under cover of the parotid gland, above which it divides into its auricular and occipital branches. Branches: Stylomastoid Auricular Occipital

Ascending Pharyngeal A. (a. pharyngea ascendens) : 

Ascending Pharyngeal A. (a. pharyngea ascendens) A small branch arises from medial aide of ECA Long, slender vessel, deeply seated in the neck Ascends vertically between the ICA and pharynx, to the under surface of the base of the skull Branches: Pharyngeal trunk Superior Middle Inferior 2. Neuromeningeal trunk Hypoglossal Jugular 3. Inferior Tympanic 4. Musculospinal A.

Slide 29: 

Variant sites of origin: Common trunk with Occipital A Origin from ICA Lateral View: Appears to lie in front of or on the vertebral column AP view: Medial to the main ECA trunk

Superficial Temporal Artery (a. temporalis superficialis) : 

Superficial Temporal Artery (a. temporalis superficialis) Smaller of the two terminal branches It begins in the substance of the parotid gland, behind the neck of the mandible Divides into two branches, a frontal and a parietal Branches: Transverse Facial Anterior Auricular Post deep Temporal Frontal Parietal Zygomatico-orbital

Internal Maxillary Artery (a. maxillaris interna) : 

Internal Maxillary Artery (a. maxillaris interna) Larger of the two terminal branches Arises behind the neck of the mandible, and is imbedded in the substance of the parotid gland it supplies the deep structures of the face divided into mandibular, pterygoid, and pterygopalatine portions.

Branches : 

Branches Middle Meningeal Accessory Meningeal Sphaenopalatine Descending(greater) palatine Descending lesser palatine Infraorbital 7. Deep temporal 8. Masseteric 9. Inferior alveolar 10. Superior alveolar 11.buccal 12. Pterygovaginal 13.mandibular vidian 14. A of foramen rotundum

Middle Meningeal Artery (a. meningea media; medidural artery) : 

Middle Meningeal Artery (a. meningea media; medidural artery) largest artery that supplies the dura it ascends to the foramen spinosum through which it enters the cranium divides into two branches, anterior and posterior. Branches: Numerous small vessels supply the semilunar ganglion and the dura Superficial Petrosal A. Superior Tympanic artery Orbital branches Temporal branches

Accessory meningeal A. : 

Accessory meningeal A. Arises as a common trunk with MMA or distal to MMA from IMA Lateral View: more oblique anterior slant, in contrast to straight course of MMA AP View: slanted medially towards cavernous sinus

Slide 47: 

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