venous drainage of head and neck and its branches are described in detail along with applied anatomy for better understanding of the anatomy and its application in oral and maxillary surgeries. knowing the anatomy and the course of the veins is crucial and helps in better locating the vein and ligating it to avoid further complications while performing a oral and maxillofacial surgeries such as in trauma fixation, tumor resection and as well as reconstruction of the defect pertaining to the maxillofacial region.

1. VENOUS
DRAINAGE OF
HEAD AND
NECK
By: A. Shalini Sampreethi. MDS
Sr. lecturer
Department of OMFS
MNR Dental College and Hospital

2. CONTENTS
Introduction
Veins of brain
Dural venous sinuses
Veins of scalp
Veins of neck
Veins of face
Applied aspects
Cavernous sinus thrombosis
conclusion

3. De Motu Cordis" (otherwise known as "On
the Motion of the Heart and Blood") – 1628
a.d
William Harvey
INTRODUCTIO
N

4. INTRODUCTION

6. VEINS OF HEAD AND NECK ARE
DIVIDED INTO:
1. The veins of Brain.
2. Diploic veins.
3. Venous sinuses.
4. Emissary veins .
5. The veins of Scalp.
6. The veins of face.
7. The veins of neck.

7. VEINS OF BRAIN

8. VEINS OF BRAIN:
• These are thin walled &
have no valves and devoid
of muscular tissue.
• Consists of
cerebral,cerebellar veins &
veins of brain stem.
• All drain into
neighbouring sinuses.

9. DIPLOIC VEINS:
• The Diploic veins occupy channels in the dipole of
the cranial bones.
• So long as the cranial bones are separable from one
another, these veins are confined to the particular
bones; but when the sutures are obliterated, they
unite with each other, and increase in size.
• They communicate with the meningeal veins and the
sinuses of the dura mater, and with the veins of the
pericranium.
1)The frontal, which opens into the supraorbital
vein and the superior sagittal sinus.

10. • The anterior temporal,
which is confined chiefly to
the frontal bone, and opens
into the Sphenoparietal sinus
and into one of the deep
temporal veins, through an
aperture in the great wing of
the sphenoid.
• The posterior temporal,
which is situated in the
parietal bone, and ends in
the transverse sinus,
through an aperture at the
mastoid angle of the parietal
bone or through the mastoid
foramen.
• The occipital, the largest of
the four, which is confined
to the occipital bone, and
opens either externally into
the occipital vein, or
internally into the transverse

11. VENOUS SINUSES

12. VENOUS SINUSES
• The venous blood sinuses are blood
filled spaces between Periosteal and
meningeal layers.
• These are lined by endothelium,
composed of fibrous tissues and no
muscular tissues and don’t have
valves.
• Blood moves in both directions in
these sinuses.
• They collect venous blood from the

13. CONTD…..
PAIRED:
• Cavernous
• Superior petrosal
• Inferior petrosal.
• Transverse.
• Sigmoid.
• Sphenoparietal.
UNPAIRED:
• Superior sagittal
• Inferior sagittal.
• Straight sinus.
• Occipital sinus.

15. CAVERNOUS SINUS:
•They are so called
because their cavities
traversed by delicate
strands of tissue that
appear to subdivide each
sinus into a number of
smaller sinuses.
• It lies on body of
sphenoid in the middle
cranial fossa.
• Anteriorly each sinus
reaches the superior
orbital fissure.
• Posteriorly, it reaches

16. • It has internal carotid artery anteriorly and
laterally it has oculomotor nerve, trochlear nerve
and ophthalmic division of trigeminal nerve.
• In the posterior part, it has a pouch like
projection of duramater containing trigeminal
ganglion.

17. TRANSVERSE SINUS:
• They lie horizontally as
indicated by their names.
• Each sinus begins posteriorly
at the internal occipital
protuberance.
• The right sinus is usually
continuation of superior
sagital sinus.
• The left sinus is a
continuation of straight sinus.
• Each sinus reaches petrous
part of temporal bone where

18. SIGMOID SINUS:
• The right and left sigmoid
sinuses are the continuations of
transverse sinuses
• By name, each sinus is S-
shaped.
• Each sinus runs downwards
and medially in a deep groove
on the mastoid part of the
temporal bone and then across
the jugular process of occipital
bone.
• Finally it reaches the jugular
foramen ends in the upper end
of internal jugular vein

19. INFERIOR PETROSAL SINUS:
• Begins at the posterior end of the cavernous
sinus.
• It runs downwards and laterally in groove
between petrous temporal bone and basilar part
of occipital bone.
• Ends internal jugular vein.
SUPERIOR PETROSAL SINUS:
• Begins at the posterior end of
the cavernous sinus.
• It terminates by joining the
junction of sigmoid & transverse
sinus.
SPHENOPARIETALSI
NUS:
• Runs medially along the sharp
posterior edge of the floor of
anterior cranial fossa.
• Ends by joining the anterior end

20. UNPAIRED SINUSES:
SUPERIOR SAGITTAL SINUS:
• Occupies triangular space
produce by the reflection of the
inner layer of duramater to
form falx cerebri.
• It begins anteriorly in front of
crista galli.
It runs backwards deeply
grooving frontal bone & two
parietal bones & occipital bones
• The sinus ends at the internal
occipital protuberance
• It becomes continous with the
right transverse sinus.
INFERIOR SAGITTAL SINUS:
• Lies within the lower free
margin of the falx cerebri.
• It begins anteriorly and ends
posteriorly by joining the
straight sinus.

21. STRAIGHT SINUS:
• Straight sinus lies in the
triangular space where lower
edge of posterior part of falx
cerebri joins tentorium cerebelli.
• Anteriorly it receives inferior
sagital sinus.
• Posteriorly straight sinus ends
by becoming continuous with
transverse sinus.
OCCIPITAL SINUS:
• Lies in the midline in relation to floor of the posterior
cranial fossa.
• Anterior end of occipital sinus bifurcates into two
channels that pass through the foramen magnum to join
sigmoid sinus.
• Posteriorly it ends in confluence of sinuses.

22. EMISSARY VEINS:
• These are the valveless veins that pass through the
skull bones and connect the veins of scalp to venous
sinuses .
• These are important route for spread of infections.
•Posterior Auricular/occipital drain into Mastoid
emissary Vein inturn drain into Sigmoid Sinus
• Veins of Scalp drain into Parietal emissary which
drains into superior sagittal sinus.
• Sigmoid Sinus drain into venous plexus of hypoglossal
canal into internal jugular vein.
• Confluence of Sinuses drain into Occipital emissary

24. VEINS OF SCALP

25. VEINS OF SCALP:
• Supratrochlear and Supraorbital veins unite at the
medial margin of orbit to form facial vein
• Superficial temporal vein is found by union of
numerous tributaries present in the scalp.It unites with
maxillary vein in the substance of parotid gland to form
retromandibular vein .
• Occipital vein begins by union of some veins in the
posterior part of scalp.it drains into suboccipital veneous
plexus .
• Veins of scalp freely anastamose with one another and

27. VEINS OF FACE

28. VEINS OF THE FACE:
Superficial
• Supratrochalear.
• Supraorbital.
• Angular.
• Facial.
• Deep facial.
• Superficial temporal.
• Retromandibular
• posterior auricular
Deep
• Superior ophthalmic.
• Inferior ophthalmic.
• Ethmoidal.
• Pterygoid plexus.
• Maxillary vein
• Lingual vein.
28

30. DEEP VEINS OF FACE

31. PTERYGOID PLEXUS OF
VEINS

32. SUPERFICIAL TEMPORAL VEIN:
•It accompanies the superficial temporal artery.
• Formed a little above zygomatic arch by union of
numerous tributaries.
• After descending superficial to the Zygomatic arch it is
joined by the maxilary vein to form the retromandibular
vein.
MAXILLARY VEIN:
•It runs along with a part of the maxillary artery.
• Has origin in pterygoid plexus which is found in
temporal fossa.
• The plexus is connected to facial vein by deep facial
vein and to the cavernous sinus by emissary veins.
•Within the substance of the parotid gland the maxillary
vein ends by joining the superficial temporal vein to

33. RETROMANDIBULAR VEIN:
• Lies behind ramus in the parotid gland.
• Formed by the union of superficial temporal and
maxillary vein.
• The vein is superficial to external carotid artery within
the gland.
• It divides into anterior & posterior branches.
• The anterior branch joins the facial vein to form
common facial vein.
• The posterior branch joins the posterior auricular vein
to form external jugular vein.
POSTERIOR AURICULAR VEIN:
• Begins by union of tributaries present in the

34. • Passes downwards and
forwards behind auricle and
receives veins from cranial
surface.
• Ends by joining the
posterior division of
retromandibular vein.
FACIAL VEIN:
• Begins near the medial angle of eye by union of
supratrochlear and supraorbital vein.
• It runs downwards and backwards and terminates by
joining anterior branch of retromandibular vein to form
common facial vein which ends by joining internal
jugular vein.
• It lies over the buccinator muscle, body of mandible
and lower part of masseter.
sinus.

35. • Below the mandible, it crosses the submandibular gland
posterior belly of diagastric and stylohyoid muscle.
• Superiorly the vein communicates with superior
ophthalmic vein and through them to cavernous sinus.
LINGUAL VEIN:
• Accompanies lingual artery and
joins the internal jugular vein near
greater cornu of hyoid bone.
• The venous drainage from tip of
the tongue is by deep lingual vein.
• It terminates directly in the
internal jugular vein.

36. SUPERIOR THYROID VEIN:
• Corresponds the artery enters the
internal jugular or facial vein.
MIDDLE THYROID VEIN:
• Corresponds the artery and crosses
the common carotid artery and drains
the lower part of the gland.
• It ends into internal jugular vein.
INFERIOR THYROID VEIN:
• They arise from the lower part of
the thyroid gland descends over
trachea to form plexus.
• The Rt. & Lt. veins drain into
brachiocephalic veins.

37. VEINS DRAINING THE EYEBALL & ORBIT
INFERIOR OPTHALMIC VEIN:
• Lies below the eyeball.
• Terminates in cavernous sinus
either directly or by joining superior
ophthalmic vein.
CENTRAL VEIN OF RETINA:
•Accompanies artery.
• Ends in cavernous sinus directly or through
superior ophthalmic vein.
SUPERIOR OPTHALMIC VEIN:
It accompanies the ophthalmic artery.
• Anteriorly communicates with the facial vein
posteriorly it passes through superior orbital fissure
and ends in cavernous sinus.
•Infection on the face can spread to the cavernous
sinus through this
route

38. VEINS OF NECK

41. VEINS OF NECK
•The chief veins of head and neck
are right and left internal jugular
veins.
•Origin: Each vein begins at the
base of the skull and descends
along common and internal
carotid artery.
•On either side, the upper end of
the vein lies in the jugular
foramen on the base of the skull.
Here it becomes continuous with
INTERNAL JUGULAR VEIN

42. •The upper end of the vein is
enlarged to form superior
bulb which occupies jugular
fossa and inferior vein shows
enlargement called inferior
bulb.
•It ends by joining the
subclavian vein to form
brachiocephalic vein.
•Both rt. & Lt. brachiocephalic
vein join to form superior
vena cava which ends in right
atria.
•It receives the common
facial, lingual, superior,
inferior, middle thyroid veins

43. EXTERNAL JUGULAR VEIN
• It is formed by the union of
posterior division of
retromandibular vein with the
posterior auricular vein.
• It’s origin lies within the lower part
of the parotid gland. Level
corresponds to the angle of
mandible.
• It is the most prominent superficial
vein of neck.
• It runs downwards over SCM
muscle to reach the lower part of
the posterior triangle to join the
subclavian vein.
• Veins accompanying transverse

45. ANTERIOR JUGULAR
VEIN
• Begins near the hyoid bone
and extends downwards to a
point little above the sterno
clavicular joint.
• Runs laterally deep to the
SCM,but superficial to the
sternohyoid and sternothyroid
muscles and ends by joining
the lower end of EJV.
• Above the sternum the right
and left anterior jugular veins
are united by a transverse vein
called jugular arch.
• Tributaries are some

46. • Each subclavian vein rt. & lt.
begins at the outer border of first
rib.
• It runs medially and parallel to
the subclavian artery.
• The two vessels are separated by
scalenus anterior muscle.
• Ends by joining internal jugular
vein.
• Tributaries are internal jugular
vein,external jugular vein and the
anterior jugular vein.
SUB CLAVIAN VEINS:

47. APPLIED ANATOMY

48. APPLIED ANATOMY:
CATHETERIZATION:
• The right Internal jugular vein can be cannulated for
insertion of central venous line, for the measurement of
central venous pressure or rapid administration of drugs
when a peripheral approach is slow.
• The vein is usually approached through the centre of
the triangle formed by two heads of
sternocleidomastoid and the clavicle.
• The needle is directed parallel to the sagital plane at
30degree posterior angle with entering vein at about 4
to 5 cm depth.
Complication:
• Common carotid puncture.
INTERNAL JUGULAR VEIN

50. INTERNAL JUGULAR VEIN THROMBSIS
• It is a undiagnosed condition that may occur as
a complication of head and neck infection,
central venous abscess, local malignancy, neck
massage, intravenous drug abuse.
• Thrombus may become secondarily infected,
producing a septic thrombophlibitis.
• Thrombosis of this vein refers to intraluminal
thrombus occuring anywhere from intracranial
course to the junction of vein and subclavian
vein to form brachiocephalic vein.

51. Causes:
• Central venous / swan-Ganz catheter
in IJV.
• Central venous or swan-Ganz catheter
in Subclavian vein.
• Neck dessection complication
• Deep neck thrombosis.
• Head and neck malignancy.
• Trauma
• Any neck surgery involving prolonged
traction of vein.
• Individuals who abuse intravenous
drugs using IJV for access.

52. Signs & Symptoms:
Pain and swelling at the angle
of jaw and palpable cord
beneath sternocleidomastoid.
Clinical manifestations:
• Fever.
• Leucocytosis.
• Neck swelling.
• Sepsis syndrome.
• Pleuropulmonary
complications.

53. EXTERNAL JUGULAR VEIN:
CATHETERIZATION:
• It is used for catheterization but presence of
valves and tuberosity make the passage of
catheter difficult.
• As the vein is in most direct line with superior
vena cava it is most commonly used.
• The vein is catheterized about half way
between the level of carotid cartilage and
clavicle.
• The passage of the catheter should be
performed during inspiration when valves are
open.

54. Subclavian vein:
• The rt. Subclavian vein can be used for placement of
central venous line instead of IJV.
• The approach is infraclavicular from a point 2 cms
below the mid point of the clavicle along a line that
passes behind the clavicle towards jugular notch of
sternum.
• The needle enters the clavipectoral fascia and enters
the vein behind the fascia.
Complications:
• Pneumothorax- due to puncture of pleura and
lungs
• Puncture of subclavian artery

55. CAVERNOUS SINUS THROMBOSIS:
• Facial vein is connected to cavernous sinus by superior
opthalmic vein.
• It provides pathway for spread of infection from face
to the cavernous sinus.
• spread of infection from the sinuses (sphenoid,
ethmoid, or frontal) or middle third of the face.
• Less common primary sites of infection include dental
abscess, nares, tonsils, soft palate, middle ear, or
orbit.
• Staphylococcus aureus is a most common infectious
microbe

56. CLINICAL FEATURES:
• Abrupt onset of unilateral periorbital edema,headache
photophobia, and proptosis.
• Sensory deficits of the ophthalmic and maxillary
branch of the fifth nerve are common.
• Periorbital sensory loss and impaired corneal reflex
may be noted.
• Papilledema,and decreased visual acuity and
blindness may occur from venous congestion within
the retina.
• Fever,Tachycardia,sepsis,headache with nuchal
rigidity, Pupil may be dilated and sluggishly reactive.
• Infection can spread to contralateral cavernous sinus
within 24–48 hr of initial presentation

57. • The diagnosis of cavernous sinus thrombosis is made
clinically, with imaging studies to confirm the clinical
impression.
• Proptosis, ptosis, chemosis, and cranial nerve palsy
beginning in one eye and progressing to the other
eye establish the diagnosis.
TREATMENT:
• Recognizing the primary source of infection and
treating the primary source is the best way to
prevent cavernous sinus thrombosis.
• Broad spectrum antibiotics are used until a definite
pathogen is found-
nafcillin,cefotaxime,metronidazole.

58. • Surgical drainage with sphenoidotomy is indicated if
the primary site of infection is thought to be the
sphenoidal sinuses.
• All patients should be monitored for signs of
complicated infection, continued sepsis, or septic
emboli while antibiotic therapy is being administered.
CAVERNOUS SINUS FISTULA:
• Result of head trauma/degenerative /aneurysmal
vessel disease.
• Proptosis which may be pulsatile
• Vascular dilatation in the tissues of the orbit and
globe
• 3rd, 4th , 6th cranial nerve palsies.
• Treatment is by passing a catheter up the carotid
into the fistula and then occluding it with
dilatable balloons or flex metal coils.

59. PULSATING EXOPATHLMUS
• Because of peculiar relationship of cavernous
sinus to internal carotid artery a communication
may occur as a result of injury. When this
happens, the arterial pressure is communicated
through sinus to veins of orbit (which open into
sinus).
• With this result, eyeball becomes prominent and
pulsates with each beat- pulsating exopthalmus.

60. IJV LIGATION IN RND
Unilateral ligation of ijv is carried out in routine radical neck dissections.
Bilateral ijv ligation Should not be usually carried out unless a condition arises
where it cannot be avoided.
One side done first. The side having less metastic lymph nodes ( Mc Gregor).
The time period between the 2 dissections should be 3 – 4 weeks
Symptoms swelling of the face and eyelids , increased ICP (headache)
Zhonghua Kou Qiang Yi Xue Za Zhi. 2000 Jan;35(1):64-6.
Conserving external jugular veins will reduce the increase of ICP and
shorten the recovery time from increased ICP. The conservation of the
external jugular veins will compensate the back flow of intracranial veins after
RND

62. VENIPUNCTURE

63. Venous system drains the cells of the body of the
metabolites and waste to carry deoxygenated blood back
to the heart  lungs/kidneys for recycling the blood.
They maintain the blood pressure by changing the
diameter of the vessel wall.
A good sound anatomical knowledge is needed by a
surgeon to carry out procedures where these veins will
be encountered in the operating field.
Since the veins are superficial and take the blood back to
the heart from where it is redistributed to the other parts
of the body medications can be infused intravenously.
CONCLUSION

64. BIBILOGRAPHY
• Cunninghams manual of practical
anatomy.
• Anatomy of head & neck by RJ LAST
•Chourasia B.D- HUMAN ANATOMY
•Color atlas ofHead and neck
anatomy –Frank Netter.
•Grays Anatomy

65. THANK YOU