The document summarizes the anatomy of head and neck veins. It describes the structure and layers of veins. It then discusses various superficial and deep veins of the head and neck region including the internal jugular vein, external jugular vein, anterior jugular vein, facial vein, pterygoid plexus, and venous sinuses. It notes that venous drainage of the head and neck terminates in the internal jugular vein. The document also briefly mentions diseases of veins.

1. Dr.Bhavesh Dhoke
Dept.of oral and maxillofacial
surgery

2. vein
 Structure
 Function of vein
 Description of veins
1) internal jugular vein
2) external jugular vein
3) anterior jugular vein
4) facial vein
5) pterygoid plexus of vein
 venous sinuses
 communication between venous sinuses and extracranial
veins
 Venous drainage of head and neck
 Diseases of vein

3. Veins (vena) are blood vessels that carry blood towards the heart.
Most veins carry deoxygenated blood from the tissues back
to the heart
except the pulmonary and umbilical veins
Usually travel witharteries

4. Structure ofVein
Veins are thin walled than arteries.
Large lumen.
Valves, maintain unidirection bloodflow.
3 concentric layers ( tunicae)
1) Tunica intima - innermost layer(endothilial cells&
internal elastic lamina)
2) Tunica media –Middle layer
3) Tunica adventitia – outer coat

6. Differences between arteries andveins

7. 1) Return of deoxygenated blood to heart
2) Cushion associated arteries from jaw
movements(periarterial plexus)
3) Protect against extensive intracranial pressure.

8. Veins of the Head and neck
Venous drainage from the
face is entirelysuperficial
All the venous drainage
from the head and neck
terminate in the internal
jugular veinwhich join the
subclavian veinto form the
brachiocephalic veinbehind
the medial end of the
clavicle
Two brachiocephalic veins
unite to form superior vena
cava

9. External group
a) Internal jugular
b) External jugular
c) Anterior jugular
d) Oblique jugular
e) Posterior external jugular
Internal group
a) Venous sinuses
b) Emissary veins
c) Diploic veins

10. Superficial
External jugular ,
Facial , Superficial
temporal vein
Deep
Pterygoid plexus
Internal jugular

11. VEINS OF THE NECK
 Veins of the neck are superficial and
deep to the deep fascia.
 Superficial veins are anterior jugular,
external jugular and posterior jugular
veins;
 They drain a smaller part of tissue than
deep veins.
 Deep veins drain all subcutaneous
structures mostly internal jugular veins
and into the subclavian vein

12.  The venous blood of head &neck is drained
almost entirely by the internal jugular vein,
which joins the subclavian vein, behind the
sternoclavicular articulation to form the
brachiocephalic vein.
 The two brachiocephalic vein unites to
form the superior vena cava.
 Along the neck two superficial veins are
added to the deep internal jugular vein
namely the external & anterior jugular vein

13. INTERNAL JUGULAR VEIN:
 The internal jugular vein receives blood from the
brain, face, &neck.
 It commences at the jugular foramen in the skull as
the continuation of the sigmoid sinus it descends
through the neck in the carotid sheath &unites
with the subclavian vein behind the medial end of
the clavicle
 To form the brachiocephalic vein, immediately
below the jugular foramen the vein is widened to
form the superior bulb of the internal jugular vein
which is
 contained in the jugular fossa on the inferior surface
of the temporal bone.

15. Tributaries-
 Into the superior bulb opens the inferior
petrosal sinus,
 Veins of the pharynx, tongue
&sublingual area drain upper part of the
internal jugular vein,
 Anastomosis between internal &external
jugular vein is seen near the upper
corner of the carotid triangle.,

16.  Facial vein along with anterior division of
the Retromandibular vein joins the
internal jugular vein.
 Veins of the larynx & thyroid glands are
main tributaries at the lower part of the
neck.

17. APPLIEDANATOMY:
1. Infection from middle ear spreads to IJV
2. Surgical removal of deep cervical nodes can puncture
IJV
3) Thrombophlebitis of IJV can occure with
cannulation
4) Systolic thrill felt over the vein in mitral stenosis
5) During CCF dilatation of veinoccur

18. EXTERNAL JUGULAR VEIN
 It drains mainly scalp and face. .it is formed by the
 union of posterior division of the retromandibular vein
with the posterior auricular vein and
 begins near the angle of the mandible just below or
in the parotid gland.
 From here it descends obliquely superficial to the
sternocleidomastoid to the root of the neck and then
it crosses the deep fascia
 And ends in the subclavian vein. Although valves are
present in the external jugular vein but
 it doesn’t prevent regurgitation. It is covered by the
platysma, superficial fascia and the skin

19. Tributaries
 It receives the posterior external
jugular vein and transverse,cervical ,
suprascapular and anterior jugular vein
near it’ s end.
 It is also joined by the branch from the
internal jugular vein near the parotid
gland.

20. POSTERIOR EXTERNAL
JUGULAR VEIN
 It begins in the occipital scalp and drains
into the skin and the superficial
 muscles in the postero superior region
of the neck.
 It joins the middle part of the external
jugular vein.

21. ANTERIOR JUGULAR VEIN
 It arises near the hyoid bone and descends
between the midline and the anterior
border of the sternocleidomastoid. Deep to
the sternocleidomastoid
 it joins the external jugular vein or may
enter subclavian vein directly.
 There are usually two anterior jugular veins
which are united just above the manubrium
by large transverse jugular arch
 which receives the inferior thyroid
tributaries.

22. FACIAL VEIN
 It is the main vein of the face.
 It travels obliquely downwards by the side of the nose
&descends to the anterior border
 & then passes over the surface of the masseter. It
crosses body of the mandible
 &runs in the neck to drain into the internal jugular vein.
 The common facial vein originates below the angle of the
mandible from the junction of the facial &retromandibular
vein,
 Above its junction with the superior labial vein it is termed
as angular vein. The angular vein receives the frontal
vein,
 supraorbital vein, veins from the lower lid &from the
bridge of the nose.

23.  Supraorbital vein begins near the zygomatic process
of the frontal bone, passes medially piercing the
orbicularis oculi & unites with the supratrochlear vein
,frontal &supra orbital veins anastomoses through
wide venous nets with the other veins of the scalp.
Superficial temporal, posterior auricular &occipital
veins.
 The angular vein is constantly in communication with
the superior ophthalmic vein just above the medial
palpebral ligament,
 & as superior ophthalmic vein opens into the
cavernous sinus a link between facial vein &
intracranial sinuses of the duramater is seen
 Facial vein lacks valves & because of its connection
with the cavernous sinus it has the clinical
significance in the spread of infection.

24. Cavernous sinus
thrombosis
 It is a serious complication of infections of the upper &
lower face & neck region .it is more likely to be involved in
the potentially fatal spread of infection.
 Each cavernous sinus communicates with each other,
with pterygoid plexus of veins,& superior ophthalmic vein
which anastomoses with the facial vein.
 These major veins drain teeth through the posterior
superior &inferior vein & lips through the superior &
inferior labial veins.
 none of the veins that communicate with the cavernous
sinus have valves to prevent the retrograde blood flow
back into the cavernous sinus

25.  therefore dental infection that drain through this
major veins initiate theinflammatory respone
resulting in blood stasis ,thrombus
formation,&increasing extra vascular fluid pressure.
Increased pressure can change the direction of
blood flow,enabling the transport of this thrombus
into the venous sinuses causing cavernous sinus
thrombosis.
 Needle track contamination can also result in spread
of infection through pterygoid plexus of veins while
administrating posterior superior alveolar block
incorrectly.non odontogenic infections originating
from the danger triangle of face i.e orbit , nasal
region & para nasal sinus.

26. superficial temporal vein:
 It begins from the wide spread plexus of
veins on side of the scalp & along
zygomatic arch,frontal & parietal
tributaries unite anterior to the auricle,
crosses temporal root of zygomatic arch
to pass from the temporal region & enter
the substance of the parotid gland.
 It joins maxillary vein posterior to the
neck of the mandible to form the
retromandibular vein.

27. Retromandibular vein:
 It is formed by the union of the superficial
temporal & maxillary vein in the substance of
the parotid gland behind the neck of the
mandible.
 The vein emerges at the lower pole of the
gland to unite with the facial vein,
 It continues downwards on the outer surface of
the stylohyoid &digastric muscles
 In some cases however the a deep branch of
retromandibular vein follows the external
carotid artery in its deep course
 &empties into the internal jugular vein.

29. Middle temporal vein
 Above the root of zygomatic arch ,a
middle temporal vein opens into the
superficial temporal vein. This middle
temporal vein drains into the venous
plexus situated underneath the temporal
fascia
 The two maxillary veins are the outlet of
the large &dense pterygoid venous
plexus which surrouds the maxillary
artery in the infra temporal fossa.

30. Pterygoid
plexus of veins
 Veins of the deep structures of the face
open here.
 It is situated between the temporal &lateral
pterygoid or between the lateral &medial
pterygoid muscles depending on the
course of the maxillary artery..anteriorly it
reaches the tuberosity of the maxilla
,superiorly to the base of the skull.

31. VEINS OF THE SCALP &
FACE:
 The superficial part of scalp is drained by supra orbital
&supra trochlear veins.
 Supratrochlear vein- it starts from the venous network
connected to the frontal tributaries of the superficial temporal
vein,
 it descends near the midline to the bridge of the nose.
where it unites with the supraorbital vein to form the facial
vein near the medial canthus of the eye.
 Supraorbital vein begins near the zygomatic process of the
frontal bone passes medially piercing the orbicularis oculi &
unites with the supratrochlear vein .
 frontal &supra orbital veins anastomose through wide
venous nets with the other veins of the scalp.superficial
temporal,posterior auricular &occipital veins.

32. SINUSES OF THE
DURAMATER
 The blood of the brain and the eye is
collected by system of specialized vein
in the duramater called sinuses. These
sinuses are non collapsible and are
formed by the dense rigid and inelastic
tissue of the duramater.
 They drain eventually into the internal
jugular vein but there are numerous
communications between the sinuses and
the extracranial vein.

34. SUPERIOR
SAGITTAL SINUS
 This sinus commences in the region of crista gali of
the ethmoid bone and curves posteriorly in the
midline over the frontal, parietal and occipital bones.
 On its way it receives numerous veins from the
convexity of the brain.
 Arachnoid granulations are small cauliflower like
extension that protrude into the lateral aspects of the
superior saggital sinus .
 csf leaks back across the arachnoid membrane
through these archnoid granulations to enter the
venous blood of the superior sagittal sinus.

35. SUPERIOR PETROSAL SINUS
 small and narrow, connects the cavernous with the
transverse sinus.
 It runs lateralward and backward, from the posterior
end of the cavernous sinus, over the trigeminal
nerve, and lies in the attached margin of the
tentorium cerebelli and in the superior petrosal
sulcus of the temporal bone; it joins the transverse
sinus where the latter curves downward on the inner
surface of the mastoid part of the temporal.
 It receives some cerebellar and inferior cerebral
veins, and veins from the tympanic cavity.

36. INFERIOR SAGITTAL SINUS
 A narrow sinus, enclosed in the lower
free border of a sickle shape median
fold of the dura
 The falx cerebri separates the two
hemispheres of the cerebrum.

37.  INFERIOR PETROSAL SINUS
Situated in the inferior petrosal sulcus formed by the
junction of the petrous part of the temporal bone
with the basilar part of the occipital bone.
 It begins in the postero-inferior part of the cavernous
sinus, and, passing through the anterior part of the jugular
foramen, ends in the superior bulb of the internal jugular
vein.
 The inferior petrosal sinus receives the internal auditory
veins and also veins from the medulla oblongata, Pons,
and under surface of the cerebellum.

38. OCCIPITAL SINUS
 This small vein begins on either side of
the great occipital foramen & ascends in
the midline.
 It ends at the inner occipital eminence.

39. TRANSVERSE SINUS;
 The point where the superior saggital sinus ,straight sinus
,&occipital sinus unite is called the confluence of the
sinuses.From here the blood is drained by the paired
transverse sinus.,Sometimes the straight &superior
saggital sinus do not join but continue each into one
transverse sinus,
 Even if they join also a greater amount of blood usually
enters into the right transverse sinus
than the left,as a consequence the right internal jugular
vein is often much larger than the left.

40.  The transverse sinus runs almost
horizontally across the occipital bone &
then over the temporal bone to the point
where the superior crest of the temporal
pyramid commences. From this point
the transverse sinus continues in an S
shaped curve as the sigmoid sinus,
descending towards the cranial base,
the sigmoid sinus continues through the
jugular foramen into the internal jugular
vein.

41. CAVERNOUS SINUS
 It is a large venous space situated in the
middle cranial fossa on either side of the
sphenoid bone.
 The floor of the sinus is formed by the
endosteal duramater .the lateral wall, roof,
&medial wall is formed by meningeal
duramater.
 Anteriorly the sinus extends up to the
medial end of the superior orbital fissure
&posteriorly up to the apex of petrous
temporal bone.

42. SIGMOID SINUS
 It continues medially from the
transverse sinus & ends at the mouth of
the jugular foramen.
 Thus all venous blood ultimately
collected by the sigmoid sinus drains
through the jugular foramina to the
internal jugular vein below.

43.  There are 4 ways by which extracranial
veins communicate with the
intracranial veins.
1. Emissary veins
2. Diploic veins
3. Venous plexus surrounding internal
carotid artery & cranial nerves
4. Through superior ophthalmic vein or
facial vein and retromandibular vein.

44.  But the most important of our concern is
the connection between pterygoid plexus &
cavernous sinus through foramina ovale
,foramina lacerum , & sphenoidal foramina.
 Pterygoid plexus of veins is drained by
posterior superior alveolar vein which
drains the posterior part of the maxilla,so
infection from this region can directly enter
into cavernous sinus through the pterygoid
plexus
 Facial vein through the deep facial vein
communicates with the pterygoid plexus.

45. Emissary Veins
 The emissary veins pass through
apertures in the cranial wall and
establish communication between the
sinuses inside the skull and the veins
external to it.
 Some are always present, others only
occasionally so.

46. Diploic veins:
Four diploic veins are present
 Frontal diploic vein- connects to superior sagittal sinus & to the frontal vein
 Anterior temporal vein- connects to sphenoparietal sinus & deep temporal vein.
 Posterior temporal vein – connects to sigmoid sinus &to the occipital vein
 Occipital diploic vein- connects to transverse sinus & to the occipital veins
The veins that connect the sinuses & the extracranial veins along the
internal carotid artery & many of the cranial nerves are loosely connected
with the surrounding tissue & therefore collapsible.
This acts as compressible cushioning allowing for the changes in the
volume of the artery during its pulsation.

47. Spread of infection through the
facial vein
 The facial vein makes clinically important
connections with the cavernous sinus
through the superior ophthalmic vein, the
pterygoid plexus ,a network of small veins
within the infratemporal fossa through the
inferior ophthalmic & deep facial veins.
Because of these connections, an infection
of the face may spread to the cavernous
sinus & pterygoid venous plexus.
 Blood from the medial angle of the eye,
nose, &lips usually drains inferiorly through
the facial vein, especially when a person is
erect, & as facial vein

48. has no valves blood may pass through it in the opposite direction.
 Consequently, venous blood from the face may enter the cavernous
sinus.
 In individuals with thrombophlebitis of the facial vein, pieces of
infected clot may extend into the intracranial venous system &
produces thrombophlebitis of the cavernous sinus.
 Infection of the facial vein spreading to dural venous sinuses may
result from the lacerations of the nose or be initiated by pimples on
the side of the nose &upper lip, consequently the triangular area
from the upper lip to the bridge of the nose is considered the
danger area of the face.

49. Venous drainage of scalp
• Supratrochlear vein
• Supraorbital vein
• Superficial temporal vein
• Posterior auricular vein
• Occipital vein

50. Applied anatomy
 The 4th layer of scalp is loose areolar
tissue
 And infection in that layer readily
spread to intracranial sinuses through
emissary vein(valveless)

51. Venous drainage of face
 supratrochlear+supraorbital=angular
vein
 Superficial temporal and maxillary vein
 Retromandibular vein
 Posterior auricular vein
 External jugular vein
 Internal jugular vein

53. Applied anatomy
 Facial vein have no valve and it connect
cavernous sinus by two way
1) opthalmic vein or supraorbital
vein.
2)via deep facial vein to pterygoid
plexus and hence to cavernous sinus
Thus infective thrombosis of facial vein
may extend to intracranial venous sinuses
lead to cavernous sinus thrombosis

54. Venous drainage of tongue
 Dorsal lingual vein- drain the dorsum
and side of tongue
 Deep lingual vein -drain the tip of the
tongue and join sublingual vein
 All these vein terminate in internal
jugular vein

56. VEINOUS DRAINAGE OF SALIVARY GLANDS:
1.Parotid gland: Drains into external and internal jugular veins.
2.Submandibular gland: Drains into common facial or lingual vein
and ultimately into internal jugular vein.
3.Sublingual gland: Drains into lingual vein and ultimately into
internal jugular vein.

57. VEINOUS DRAINAGE OF THE THYROID GLANuuD
*The thyroid is drained by superior,middle and inferior
thyroid veins.
*The superior thyroid vein emerges at upper pole and
accompanies the superior thyroid artery ending in
Internal Jugular Vein.
*The middle thyroid vein also ends in I.J.V
*The inferior thyroid veins emerging at the lower border
of isthmus,form a plexus in front of trachea and drain
into the left brachiocephalic vein.
NOTE: A fourth thyroid vein (Kocher’s vein) may emerge
between the middle and inferior veins and drain
into the internal jugular vein.

58. VEINOUS DRAINAGE OF:
1) HARD PALATE:
Drains into the Pterygoid plexus of veins
2)SOFT PALATE:
Drains into pterygoid and tonsillar plexus of veins
3)PHARYNX:
The veins form a plexus on posterolateral aspect
of pharynx which receives blood from pharynx,
Soft palate and prevertebral region.It then drains
into internal jugular and facial veins.
4)AUDITORY TUBE:
Into pharyngeal plexus and pterygoid plexus of veins.

59. 5)NASAL SEPTUM:
*The veins form a plexus which is more marked in the
Lower part of septum ot Little’s area.
*The plexus drains anteriorly into facial vein,posteriorly
through the sphenopalatine vein to pterygoid venous
plexus.
6)LATERAL WALL OF NOSE:
*The veins form a plexus which drains anteriorly into the facial vein
;posteriorly into ,into the pharyngeal plexus of veins and from the
middle part,to the pterygoid plexus of veins.

60. VEINOUS DRAINAGE OF THE PARANASAL SINUSES:
1) MAXILLARY SINUS:
Into the facial vein and pterygoid plexus of veins
2) SPHENOIDAL SINUS:
Into pterygoid venous plexus and cavernous sinus
3) ETHMOIDAL SINUS:
Into pterygoid plexus and cavernous sinus
4) FRONTAL SINUS:
Into supraorbital and superior ophthalmic veins.

61. VEINOUS DRAINAGE OF LARYNX:
A)UPTO THE VOCAL FOLDS:
By the superior laryngeal vein which drains into
superior thyroid vein.
B)BELOW THE VOCAL FOLDS:
By the inferior laryngeal vein which drains into
inferior thyroid vein.

62. VENOUS DRAINAGE OF EAR:
A)EXTERNAL EAR:
Veins from outer surface drains into external
jugular vein and those from inner surface drain
into transverse sinus and venous plexus around
auditory tube.
B)MIDDLE EAR:
Veins from middle ear drain into superior petrosal
sinus and the pterygoid plexus of veins.
C)TYMPANIC OR MASTOID ANTRUM:
The veins drain into mastoid emissary
vein,posterior auricular vein and sigmoid sinus.

63. D)INTERNAL EAR:
The labyrinthine vein drains into superior petrosal
sinus the transverse sinus.Other inconstant veins
emerge at different points and open seperately
into superior and inferior petrosal sinuses and the
internal jugular vein.