Venous supply of head and neck

Click to edit Master subtitle style Moderator-Dr. Chandana Kalita Presented By Dr. Saindhya tora Sonowal 1st year MDS
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Introduction

Internal jugular veins-chief veins of the head and neck

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Superficial veins of head and neck

Correspond

to branches of the external carotid artery. External jugular vein-most prominent and the main channel of drainage of the superficial veins of the neck.

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Superfic ial tempor al vein Retrom andibular vein Posteri or auricul ar vein External jugular Facial vein Common 5/19/12 facial vein

External jugular vein

Sternocl eidomastoid muscle

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External jugular vein Subclavia n vein

Anterio r jugular vein Transv erse cervica l artery Suprasca pular artery 5/19/12

Some

veins from the neck( vertebral, inferior thyroid) descend into the upper part of the thorax and terminate in the brachiocephalic veins.

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The internal jugular veins

Upper end form the superior bulb ,occupies the jugular fossa on the base of the skull and becomes continuous with the sigmoid sinus. Lower end(inferior bulb ) lies behind the sternal end of the clavicle and joins the subclavian vein to form the brachiocephalic vein. In the neck, it lies alongside the internal carotid and the common carotid arteries in the carotid sheath.

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Posteriorly

the vein is related to:-

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 Superficially

the vein is covered by:-

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The tributaries of the internal jugular vein include the intracranial sinuses and several other veins.

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Subclavian veins

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 The

tributaries are:-

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Intracranial venous sinuses

Within the cranial cavity there are venous channels which are formed of duramater. The duramater or endocranium consists of 2 layers- outer and inner layer. The inner layer is closely united to the outer layer over most of its extent. However at some places the 2 layers are separated by spaces lined by endothelium which constitutes the intracranial venous sinuses or dural venous sinuses.

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The main intracranial venous sinuses are:1) Unpaired sinusesa) Superior sagital sinus b) Inferior sagital sinus c) Straight sinus 2)Paired sinusesa) Transverse sinus b) Sigmoid sinus c) Cavernous sinus d) Occipital sinus

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Superior sagittal sinus occupies the triangular space produced by the reflection of the inner layer of duramater to form the falx cerebri. begins anteriorly in front of crista galli then runs backwards deeply grooving the frontal bone, the 2 parietal bones and occipital bone. ends in the internal occipital protruberance where it becomes continuous with the right transverse sinus, and sometimes with the left sinus.
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Inferior sagital sinus lies within the lower free margin of the falx cerebri. begins anteriorly and ends posteriorly by joining the straight sinus.

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Straight sinus lies in the triangular interval where the lower edge of the posterior part of the falx cerebri joins the tentorium cerebelli. Anteriorly it receives the inferior sagittal sinus and a vein from the inferior of the brain called the great cerebal vein. Posteriorly it ends by becoming continuous with the transverse sinus of the opposite side(usually the left)

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Occipital sinus lies in the midline in relation to the floor of the posterior cranial fossa. Here the dura is raised into a fold called the falx cerebelli and the sinus lies within this fold. The anterior end bifurcates into 2 channels that pass round either side of the foramen magnum to join the corresponding sinus. It ends posteriorly in the confluence
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Transverse sinuses the right and the left sinus lies horizontally. begin posteriorly at the internal occipital protruberance. right sinus is usually a continuation of the superior sagittal sinus. each sinus runs in a curve at first laterally and then forwards along the line of attachment of the tentorium cerebelli. finally it reaches the petrous part of the temporal bone where it becomes continuous with the sigmoid sinus.
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Sigmoid sinuses S-shaped first runs downward and medially in a deep groove on the mastoid part of the temporal bone, and then across the jugular process of the occipital bone. finally it runs forward to reach the jugular foramen where it ends by becoming continuous with the upper end of the internal jugular vein. The upper part of the sinus is related anteriorly to the mastoid antrum from which it is separated only by a thin plate of bone and from there infection can spread.
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Cavernous sinuses so called because their cavities are traversed by delicate strands of tissue that appear to subdivide each sinus into a number of smaller spaces or caverns. lie in the middle cranial fossa, anteroposteriorly on either side of the body of the sphenoid bone. Anteriorly each sinus reaches the superior orbital fissure. Posteriorly it reaches the apex of the petrous part of the temporal bone.
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 Relations:-

Anteriorly, internal carotid artery & abducent nerve. In the lateral wall, occulomotor, trochelar and the ophthalmic division of the trigeminal nerve. Inferiorly, maxillary division of trigeminal nerve. Medially, hypophysis cerebri

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The tributaries and other communications of the cavernous sinus are

Emissary

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Other intercranial sinuses and veins

A)Sphenoparietal sinuses runs medially along the posterior edge of the floor of the anterior cranial fossa. ends by joining the anterior end of the cavernous sinus. B)Superior petrosal sinus begins at the posterior end of the cavernous sinus. runs backwards and laterally along the upper margin of the petrous temporal bone. terminates by joining the junction of the sigmoid sinus and transverse sinus. 5/19/12

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C)Inferior petrosal sinuses begins at the posterior end of the cavernous sinus. runs downwards and laterally in the groove between the petrous temporal bone and the basilar part of the occipital bone. passes through the anterior part of the jugular foramen and terminates by joining the upper end of the internal jugular vein. they are connected by a basilar plexus of veins lying on the basal parts of the sphenoid and occipital bones.
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 D)Middle

meningeal sinus it is the vein accompanying the middle meningeal artery. has frontal and parietal tributaries corresponding to those of the artery. the sinus often terminates in the cavernous sinus but may end in the sphenoparietal sinus. Sometimes the parietal tributary may pass through the foramen spinosum and the frontal tributary may pass through the foramen ovale to end in the pterygoid plexus of veins.

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Veins draining the eyeball and orbit

Superior opthalmic vein accompanies the opthalmic artery. anteriorly communicates with the facial vein. Posteriorly passes through the superior orbital fissure and ends in the cavernous sinus. act as a communication between the facial vein and the cavernous sinus. Infections on the face can spread to the cavernous sinus through this route.

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Inferior opthalmic vein lies below the eyeball. terminates in the cavernous sinus either directly or by joining the superior opthalmic vein. Central vein of the retina accompanies the artery of the same name. ends in the cavernous sinus directly or through the superior opthalmic vein.

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 Dipolic

veins venous channels present within the thickness of the skull bones. drain mostly into the intracranial sinues, but some end in the veins of the scalp.
The

emissary veins connect the intracranial venous sinuses to veins outside the skull. They are numerous and pass through various foramina of the skull.

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Tributaries of the internal jugular vein in the neck

The facial vein

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 While

running across the face the facial vein lies over the buccinator muscle, the body of the mandible and the lower part of masseter. Below the mandible it crosses the submandibular gland, the posterior belly of digastric and the stylohyoid muscles. The terminal part of the vein crosses the internal and external carotid arteries, the hypoglossal nerve and the loop formed by the lingual aretry. The vein communicates with the superior opthalmic veins and through them with the cavernous sinus.

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 The

lingual vein accompanies the lingual artery and joins the internal jugular vein near the greater cornu of the hyoid bone. Some veins of the tongue run along the hypoglossal nerve. They may join the lingual vein or the facial vein or may terminate directly in the internal jugular vein.

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 The

vein corresponds in its course and tributaries with the superior thyroid artery.

superior thyroid

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 The

middle thyroid vein Drains the lower part of the gland. It crosses the common carotid artery to enter the internal jugular vein. The inferior thyroid veins They are not tributaries of the internal jugular vein. They arise from the lower part of the thyroid gland and descends over the front of the trachea forming a plexus over it. The right and the left veins end in the corresponding brachiocephalic veins. In addition the internal jugular vein also receive some veins from the pharynx.
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Other veins of the head and neck Superficial temporal veinIt accompanies the corresponding artery. The vein is formed a little above the zygomatic arch by the union of numerous tributaries present in the scalp. A little below its formation it receives the middle temporal vein. After descending, superficial to the zygomatic arch, it is joined by the maxillary vein to form the retromandibular vein.

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 The

maxillary vein It runs alonside the 1st part of the maxillary artery. It has its origin in the pteriod plexus of veins which is present in the infratemporal fossa. The veins corresponding to the branches of the maxillary artery drain into this plexus. The plexus is connected to the facial vein through the deep facial vein. It is connected to the cavernous sinus by a number of emissary veins. The plexus is drained by the maxillary vein which ends by joining the superficial temporal vein to form the retromandibular vein.
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 The

retromandibular vein It lies behind the ramus of the mandible. It is formed by union of the superficial temporal and maxillary veins. It is embedded in the parotid gland. Within the gland the vein is superficial to the external carotid artery and deep to the facial nerve. Descending within the substance of the gland the vein divides into anterior and posterior branches. The anterior branch joins the facial vein. The posterior branch joins the posterior auricular vein to form the external jugular vein.
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 The

posterior auricular vein It begins by the union of tributaries present in the posterior part of the scalp. It passes downwards and forwards behind the auricle and receives veins from its cranial surface. Finally it ends by joining the posterior division of the retromandibular vein

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The external jugular vein

Formed by union of the posterior division of the retromandibular vein with the posterior auricular vein. The origin lies within the lower part of the parotid gland or just below it. The level corresponds to the angle of the mandible. From here the vein runs downwards and somewhat backwards and ends by joining the subclavian vein The termination lies behind the middle of the clavicle, near the lateral margin of the scalenus anterior muscle. The greater part of the vein is superficial being covered by skin, superficial fascia and platysma. 5/19/12 As a result the vein can be clearly seen in the

It pierces the deep fascia near its termination to reach the subclavian vein. The vein crosses the sternocleidomastoid obliquely running downwards and backwards across it. Apart from the veins that form it, the external jugular vein receives a number of tributaries. These arethe posterior external jugular vein from the upper and posterior part of the neck, the transverse cervical and suprascapular veins that accompany the corresponding arteries, and the anterior jugular vein.

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 The

anterior jugular vein It runs down the front of the neck a short distance from the midline. It begins near the hyoid bone and extends downwards to a point a little above the sternoclavicular joint. Here the vein turns laterally deep to the sternocledomastoid, but superficial to the sternohyoid and sternothyroid muscles, and ends by joining the lower end of the external jugular vein or subclavian vein. Just above the sternum the right and left anterior jugular veins are united by a transverse vein called the jugular arch.
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 The

occipital vein It begins by union of some veins draining the posterior part of the scalp. It descends in the scalp a few centimeters behind the auricle. Reaching the attachment of the trapezius to the superior nuchal line it pierces and become deep. It then reaches the suboccipital triangle where it ends in a plexus from which the deep cervical and vertebral veins begin.

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The deep cervical vein It begins in the venous plexus present in the suboccipital region. It accompanies the corresponding artery through the deep muscles of the back of the neck and ends by joining the lower part of the vertebral vein.
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 The

vertebral vein It also begins in the suboccipital venous plexus. It enters the foramen transversarium of the atlas and runs downwards in the form of a dense plexus around the vertebral artery. It is only at the foramen transversarium of the 6th cervical vetebra that the plexus takes the form of a single vessel. The vein runs downwards behind the internal jugular vein and ends in the upper part of the corresponding bracheiocephalic vein.
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Veins of the head and neck

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Clinical correlations v Variability- The anterior jugular vein (paired) may

v

be single or absent. Injury to veins- superficial veins in neck injuries, especially the external jugular vein (in its lower border where it pierces the deep fascia).

Communication between cavernous sinus & internal carotid artery may occur as a result of injury. Arterial pressure is communicated through the sinus to veins of the orbit and as a result the eyeball becomes prominent and pulsates with each heartbeat (pulsating exophthalmos).
v

Venous pressureexamined.

External

jugular

vein

is

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Thrombosis of the venous sinuses- cavernous, superior sagital and sigmoid sinus. Dangerous area of the face- supraorbital vein communicates with the superior opthalmic vein, which drains into the cavernous sinus. The facial vein also communicates through the deep facial vein and the pterygoid plexus. So an infection in this area can reach the sinus causing thrombosis. Clinically the area is upper lip and lower part of the nose.

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Thank You

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