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Carotid Sheath
Dr M Idris Siddiqui
Carotid sheath
Carotid sheath
Extent
&
Position
• From base of skull to root of neck
• It is wedged between
• Investing ,
• Pretracheal ,
• Prevertebral fascia.
It receives contribution from each.
Carotid sheath
Carotid sheath
Contents
In upper neck
• Internal carotid artery(lateral)
– sympathetic nerve fibers (carotid periarterial plexuses).
• Internal jugular vein
• Vagus nerve
– the carotid sinus nerve
• Constituents of ansa cervicalis
In lower neck
• Same except common carotid artery instead of internal
carotid artery.
• Common carotid artery bifurcates at upper part (border)
of thyroid cartilage(between C3& C4).
• Lymph vessels & some deep cervical lymph nodes.
Carotid sheath
Infratemporal fossa
anterior
posterior
laterally
Deepest part of parotid pharynx
gland partly separated by styloid
process & its 3 muscles
medially
Cervical sympathetic trunk on prevertebral fascia
Carotid
sheath
Carotid sheath
The Carotid Sheath
• The carotid sheath and
pretracheal fascia communicate
freely with the mediastinum of the
thorax inferiorly and the cranial
cavity superiorly.
• These communications represent
potential pathways for the spread
of infection and extravasated
blood.
• Carotid sheath is thick on arteries but thin
over veins.
• Sympathetic trunk lie posterior to carotid
sheath (posteriomedial wall).
• Many lymph nodes lie on superficial surface.
• Superior root of ansa cervicalis descend
between common carotid artery & internal
jugular vein & is sometimes embedded in
carotid sheath( triangle of vertebral artery is
closely cevered by carotid sheath & its
contents, overlaps medial border of scalenes
anterior).
Carotid sheath
Carotid sheath
• At the base of skull
• codylar canal lies more medially & between
– carotid canal(in front)
– Jugular foramen(behind).
• IJV lies behind ICA at a lower level, it comes on
lateral side of artery(on scalenes anterior). Vagus
nerve lies throughout behind & between IJV & ICA.
The glossopharyngeal & accessory nerve between
artery & vein and curve away from each other.
• The hyoglossal nerve lies medial to sheath behind
inferior cervical ganglion & turns forwards to
emerge between artery & vein.
• Most of its tract lies anterior to transverse process
of cervical vertebrae when its pulsation can be felt.
Carotid sheath
Carotid sheath
Carotid sheath
Relations of the Internal Carotid Artery
in the Neck
Anterolaterally: Below the digastric lie
The skin,
The fascia,
The anterior border of the sternocleidomastoid, and
The hypoglossal nerve.
Above the digastric lie
The stylohyoid muscle,
The stylopharyngeus muscle,
The glossopharyngeal nerve,
The pharyngeal branch of the vagus,
The parotid gland, and
The external carotid artery.
Posteriorly: The sympathetic trunk,
the longus capitis muscle, and
the transverse processes of the upper three cervical
vertebrae
Medially: The pharyngeal wall and
the superior laryngeal nerve
Laterally: The internal jugular vein and
the vagus nerve
Carotid sheath
Carotid sheath
Carotid sheath
Internal Jugular Vein
• The internal jugular vein is a large vein that
receives blood from the brain, face, and neck. It
starts as a continuation of the sigmoid sinus and
leaves the skull through the jugular foramen. It
then descends through the neck in the carotid
sheath lateral to the vagus nerve and the internal
and common carotid arteries. It ends by joining
the subclavian vein behind the medial end of the
clavicle to form the brachiocephalic vein.
Throughout its course, it is closely related to the
deep cervical lymph nodes.
• The vein has a dilatation at its upper end called the
superior bulb and another near its termination
called the inferior bulb. Directly above the inferior
bulb is a bicuspid valve.
Relations of the Internal Jugular Vein
Anterolaterally: The skin, the fascia, the sternocleidomastoid, and the parotid
salivary gland. Its lower part is covered by the sternothyroid,
sternohyoid, and omohyoid muscles, which intervene between
the vein and the sternocleidomastoid.
Higher up, it is crossed by the stylohyoid, the posterior belly of
the digastric, and the spinal part of the accessory nerve.
The chain of deep cervical lymph nodes runs alongside the vein.
Posteriorly: The transverse processes of the cervical vertebrae, the levator
scapulae, the scalenus medius, the scalenus anterior, the
cervical plexus, the phrenic nerve, the thyrocervical trunk, the
vertebral vein, and the first part of the subclavian artery.
On the left side it passes in front of the thoracic duct.
Medially: Above lie the internal carotid artery and the 9th, 10th, 11th, and
12th cranial nerves. Below lie the common carotid artery and the
vagus nerve.
Tributaries of the Internal Jugular Vein
–Inferior petrosal sinus
–Facial vein
–Pharyngeal veins
–Lingual vein
–Superior thyroid vein
–Middle thyroid vein
Carotid sheath
Carotid sheath
Carotid sheath
Carotid sheath
Carotid sheath
Carotid sheath
Carotid sheath

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Carotid sheath

  • 1. Carotid Sheath Dr M Idris Siddiqui
  • 4. Extent & Position • From base of skull to root of neck • It is wedged between • Investing , • Pretracheal , • Prevertebral fascia. It receives contribution from each.
  • 7. Contents In upper neck • Internal carotid artery(lateral) – sympathetic nerve fibers (carotid periarterial plexuses). • Internal jugular vein • Vagus nerve – the carotid sinus nerve • Constituents of ansa cervicalis In lower neck • Same except common carotid artery instead of internal carotid artery. • Common carotid artery bifurcates at upper part (border) of thyroid cartilage(between C3& C4). • Lymph vessels & some deep cervical lymph nodes.
  • 9. Infratemporal fossa anterior posterior laterally Deepest part of parotid pharynx gland partly separated by styloid process & its 3 muscles medially Cervical sympathetic trunk on prevertebral fascia Carotid sheath
  • 11. The Carotid Sheath • The carotid sheath and pretracheal fascia communicate freely with the mediastinum of the thorax inferiorly and the cranial cavity superiorly. • These communications represent potential pathways for the spread of infection and extravasated blood.
  • 12. • Carotid sheath is thick on arteries but thin over veins. • Sympathetic trunk lie posterior to carotid sheath (posteriomedial wall). • Many lymph nodes lie on superficial surface. • Superior root of ansa cervicalis descend between common carotid artery & internal jugular vein & is sometimes embedded in carotid sheath( triangle of vertebral artery is closely cevered by carotid sheath & its contents, overlaps medial border of scalenes anterior).
  • 15. • At the base of skull • codylar canal lies more medially & between – carotid canal(in front) – Jugular foramen(behind). • IJV lies behind ICA at a lower level, it comes on lateral side of artery(on scalenes anterior). Vagus nerve lies throughout behind & between IJV & ICA. The glossopharyngeal & accessory nerve between artery & vein and curve away from each other. • The hyoglossal nerve lies medial to sheath behind inferior cervical ganglion & turns forwards to emerge between artery & vein. • Most of its tract lies anterior to transverse process of cervical vertebrae when its pulsation can be felt.
  • 19. Relations of the Internal Carotid Artery in the Neck Anterolaterally: Below the digastric lie The skin, The fascia, The anterior border of the sternocleidomastoid, and The hypoglossal nerve. Above the digastric lie The stylohyoid muscle, The stylopharyngeus muscle, The glossopharyngeal nerve, The pharyngeal branch of the vagus, The parotid gland, and The external carotid artery. Posteriorly: The sympathetic trunk, the longus capitis muscle, and the transverse processes of the upper three cervical vertebrae Medially: The pharyngeal wall and the superior laryngeal nerve Laterally: The internal jugular vein and the vagus nerve
  • 23. Internal Jugular Vein • The internal jugular vein is a large vein that receives blood from the brain, face, and neck. It starts as a continuation of the sigmoid sinus and leaves the skull through the jugular foramen. It then descends through the neck in the carotid sheath lateral to the vagus nerve and the internal and common carotid arteries. It ends by joining the subclavian vein behind the medial end of the clavicle to form the brachiocephalic vein. Throughout its course, it is closely related to the deep cervical lymph nodes. • The vein has a dilatation at its upper end called the superior bulb and another near its termination called the inferior bulb. Directly above the inferior bulb is a bicuspid valve.
  • 24. Relations of the Internal Jugular Vein Anterolaterally: The skin, the fascia, the sternocleidomastoid, and the parotid salivary gland. Its lower part is covered by the sternothyroid, sternohyoid, and omohyoid muscles, which intervene between the vein and the sternocleidomastoid. Higher up, it is crossed by the stylohyoid, the posterior belly of the digastric, and the spinal part of the accessory nerve. The chain of deep cervical lymph nodes runs alongside the vein. Posteriorly: The transverse processes of the cervical vertebrae, the levator scapulae, the scalenus medius, the scalenus anterior, the cervical plexus, the phrenic nerve, the thyrocervical trunk, the vertebral vein, and the first part of the subclavian artery. On the left side it passes in front of the thoracic duct. Medially: Above lie the internal carotid artery and the 9th, 10th, 11th, and 12th cranial nerves. Below lie the common carotid artery and the vagus nerve.
  • 25. Tributaries of the Internal Jugular Vein –Inferior petrosal sinus –Facial vein –Pharyngeal veins –Lingual vein –Superior thyroid vein –Middle thyroid vein