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Suroical Importance: Extra-dural hemorrhaae from:

Diploic veins, dural venous sinuses or middle meningeal artery.

1. The Rt. is a branch of innominate artery.

2. The Lt. is a branch of the arch of aorta.

E n d S: At the outer border of the 1't rib by forming the axillary artery.

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DiviSiOnS: scalenus anterior divides it into 3 parts; medial, behind & lateral.

I HEAD & NECK

Branches:

A- First part medialto scalenus anterior & gives 3 branches:

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- lt is the artery usually chosen for coronary bypass operation.

- Branches:

a. Upper 6 intercostalAs.

b. Anterior perforating As.

c. PericardiophrenicAs.

d. MediastinalAs.

e. 2 terminal branches (superior epigastric & musculophrenic As).

2. Vertebral artery

Unites with its fellow at the lower border of pons to give basilar

artery (then to circle of Willis).

3. Thyro-ceruical trunk, which gives:

a) lnferior thyroid artery (to thyroid gland).

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ln thyroidectomy, this artery should be ligated in continuity to avoid

dropping in the thorax which might necessitate thoracotomy to stop

bleeding.

b) Supra-scapular artery.

c) Transverse cervical artery.

B- Second part: deep to scalenus anterior

It gives costo-cervical trunk, which gives:

1. Superior intercostal artery which gives the upper 2 intercostal arteries

(the rest of intercostal arteries arise from aorta).

2. Deep cervical artery.

C- Third part

Lateral to scalenus anterior, usually gives no branches rarely gives

descending cervical artery that share in anastomosis around scapula.

Relations:

on?''1';

r^ncarotid sheath, phrenic nerve, sternomastoid, infra-hyoid muscres

and RLN on the right side.

. 2nd part. scalenus anterior muscle.

Posterior:

' o 3'd part: lower trunk of the brachial plexus & 1't rib, separated from the

cervical pleura by supra-pleural membrane (fibrous sheet attached to Cz

& inner border of the 1ttrib = Sibson's fascia).

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Surqical Imoortance:

Exposure:

. Median sternotomy.

. 1 cm above the clavicle extending from the supra-sternal notch about 10 cm

laterally.

Compression:

. The Rt. subclavian artery arises from descending aorta & passes posterior to

the trachea & esophagus. The aberrant artery is usually asymptomatic but may

cause dysphagia (dysphagia lusoria).

. Compression of the subclavian artery by the cervical rib may result in an

aneurysm, which is a potential source of emboli to the hand. Because of the

good collateral circulation, critical ischemia is rare, but the patient will complain

of chronic ischemia of upper limb.

Obstruction:

o Proximal to vertebral arterv: vertebral a. acts as collateral to the arm & steals

flow from the basilar artery (subclavian steal syndrome).

art: collaterals are formed with the intercostal anastomosis (costocervical trunk with branches of the axillary artery)

around the scapula (transverse cervical branch from

circumflex humeral branches of the axillary artery).

in addition to anastomosis

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HEAD & NECK I

1)

*

.3td cranial nerve (oculo-motor).

.4th cranial nerve (trochlear)

. Ophthalmic division of Sth cranial nerve (trigeminal).

o Maxillary division of Sth cranial nerve (trigeminal).

2) Structures passing inside the cavernous sinus:

o Internal carotid artery.

.6th cranial nerve (abducent).

3) Communicatigns,with cavernous sinus:

o lt receives:

- Ophthalmic vein.

- Spheno-parietalsinus.

- Superficial middle cerebralvein.

. lt gives: origin to superior and inferior petrosal sinuses.