Venous drainageof head and neck ih

2. PRESENTER : Dr. ITRAT HUSSAIN
MODERATOR : Dr. ALOK BHATNAGAR

3. 1. Veins
2. Structure of veins
3. Role of veins
4. Classification of venous system
5. Description of veins
A. Internal jugular vein
1. Introduction
2. Tributaries
3. Applied anatomy
4. JVP
B. External jugular vein
1. Tributaries
2. Applied aspect
C. Anterior jugular vein
D. Variations in veins of head & neck

4. 6. Venous sinuses
7. Communication between venous sinuses & extracranial veins
8. CVP
9. Applied anatomy
10. Conclusion

5. Veins (vena) are blood vessels that carry blood towards the heart.
Most veins carry deoxygenated blood from the tissues back to
the heart
Exceptions are the pulmonary and umbilical veins
Usually travel with arteries

6. Structure of Vein
 Veins are thin walled than arteries.
 Large lumen.
 Valves, maintain unidirectional blood flow.
 3 concentric layers ( tunicae)
1) Tunica intima - innermost layer(endothilial cells &
internal elastic lamina)
2) Tunica media –Middle layer ( contains muscle tissue,
elastic fibres, collagen , external elastic lamina)
3) Tunica adventitia – outer coat (elastic and collegen
tissue, muscle fibres)

8. Differences between arteries and veins

9. Arteries Veins
Oxygen Concentration: Arteries carry oxygenated blood (with the
exception of the pulmonary artery and
umbilical artery).
Veins carry deoxygenated blood (with the
exception of pulmonary veins and umbilical
vein).
Types: Pulmonary and systemic arteries. Superficial veins, deep veins, pulmonary veins
and systemic veins
Direction of Blood Flow: From the heart to various parts of the body. From various parts of the body to the heart.
Anatomy: Thick, elastic muscle layer that can handle
high pressure of the blood flowing through
the arteries.
Thin, elastic muscle layer with semilunar
valves that prevent the blood from flowing in
the opposite direction.
Overview: Arteries are red blood vessels that carry blood
away from the heart. resistance vessels
Veins are blue blood vessels that carry blood
towards the heart. capacitance vessels
Rigid walls: more rigid collapsible
Thickest layer: Tunica media Tunica adventitia
Location: Deeper in the body Closer to the skin
Valves: Aren't present (except for semi-lunar valves) Are present,

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

11. Veins
Systemic veins Pulmonary Veins
-Right Pulmonary vein
-Left Pulmonary vein
Head & Neck Abdomen & Thorax Upper limb Lower limb

12. Veins of the Head and neck
 Venous drainage from the
face is entirely superficial
 All the venous drainage
from the head and neck
terminate in the internal
jugular vein which join the
subclavian vein to form the
brachiocephalic vein behind
the medial end of the
clavicle
 Two brachiocephalic veins
unite to form superior vena
cava

13. 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

14. Superficial
External jugular,anterior
jugular, Facial and
Superficial temporal
Deep
Pterygoid plexus
Internal jugular

16. Veins of the Head and neck
1) Internal jugular vein:
• It receive blood from the brain,
face and the neck.
• It emerges through the jugular
foramen,as a continuation of the
sigmoid sinus descend down in
the neck, first behind then lateral
to the internal carotid artery
inside the carotid sheath
• Terminate beneath the triangular
interval between the sternal and
the clavicular head of the
sternocleidomastoid muscle
joining the subclavian vein to
form the brachiocephalic vein

17. Bulbs of vein:
a) Superior bulb: located in
jugular fossa on inferior surface
of temporal bone beneath the
floor of middle ear cavity.
b) Inferior bulb: located at the
termination of the vein, lies
beneath the supraclavicular
fossa

18. Relations:
a) Superficially
• Sternocleidomastoid
• Posterior belly of digastric
• Superior belly of omohyoid
• Parotid gland
• Styloid process
• Accessory vein
• Posterior auricular artery
• Occipital artery
• Sternocleidomastoid artery
• Lower root of ansa cervicalis
• Infrahyoid muscle
• Anterior jugular vein
• Deep cervical lymph nodes
• Internal carotid artery
• 9th, 10th,11th & 12th nerve

19. b) Posteriorlly
• Rectus capitis lateralis
• Transverse process of atlas
• Levator scapulae
• Scaleneus medius
• Cervical plexus
• Scaleneus anterior
• Phrenic nerve
• Thyrocervical trunk
• Inferior thyroid artery

20. c) Medially
• Internal carotid
artery
• Common carotid
artery
• Vagus nerve

21. Tributaries
1. Inferior petrosal sinus
2. Pharyngeal veins
3. Common facial vein
4. Lingual vein
5. Superior thyroid vein
6. Occipital vein

22. Communications
1. With external jugular by oblique jugular
2. With cavernous sinus by inferior petrosal sinus

23. APPLIED ANATOMY:
1. Infection from middle ear spreads to IJV
2. Surgical removal of deep cervical nodes can
puncture IJV
3. Easy accessibility between two heads of
sternocleidomastoid muscle for introduction of
cannula
4. Thrombophlebitis can occur by spread of infection
in caverous sinus
5. Systolic thrill felt over the vein in mitral stenosis
6. During CCF dilatation of vein occur

24. Jugular venous pulse (JVP)
• Determine activity of the right
atrium
• Seen better then felt
• Normal CVP can be measured from
two points of reference.
• Sternum: 0-5 cm H2O
• Midaxillary line: 5-9 cm H2O
Hepato Jugular reflex
• Elicited by deep compression
of right lobe of liver

25. a) Facial vein (anterior facial vein) :
• Origin – junction of veins of forehead and nose
• Upper part – angular vein
book

26. Anastomosis of facial vein

27. Applied anatomy:
A. Facial vein is common source of bleeding following
surgery involving posterior vestibule lateral to
mandible
B. Infection from face can spread in a retrograde direction
and cause thrombosis of the cavernous sinus. This is
specially occur in presence of infection in upper lip and
lower part of nose. Called dangerous area of the face.
Dangerous area of the face.

28. c) Lingual vein
 The lingual veins begin on the
dorsum, sides, and under
surface of the tongue, and,
passing backward along the
course of the lingual artery, end
in the internal jugular vein.
 Drains tongue and
sublingual region
 Three branches
a) Dorsal lingual veins
b) Deep lingual veins
c) Sublingual vein

29.  Variations:
1. Mostly drains into common facial vein
2. In others – open into IJV and some into common
facial vein
3. Veins from pharynx often join lingual vein

30. d) Retromandibular Vein
• Retromandibular vein:
• formed by the union of
superficial temporal and
maxillary vein from the
pterygoid plexus
• passes downwards in the
substance of the parotid
gland emerging from its
lower border & divide into
two divisions

31. • Anterior division:
• joins the facial vein
• Posterior division:
• pierces the deep fascia and join the posterior
auricular to form the external jugular.
• It empty into the subclavian vein

32. e) Superficial temporal vein
•It begins on the side and vertex of
the skull in a plexus which
communicates with the frontal vein
and supraorbital vein, with the
corresponding vein of the opposite
side, and with the posterior auricular
vein and occipital vein.
•From this network frontal and
parietal branches arise, and unite
above the zygomatic arch to form
the trunk of the vein, which is joined
by the middle temporal
vein emerging from the temporalis
muscle.

33.  It then crosses the posterior root of the zygomatic
arch, enters the substance of the parotid gland, and
unites with the internal maxillary vein to form
the posterior facial vein.
• It drains the lateral scalp
• It drain into and form the retromandibular vein with
the maxillary vein

34. f) Maxillary vein
• It begins in the infratemporal fossa
•It collects blood from the pterygoid
Plexus
•Through the pterygoid plexus It
receives the middle meningeal,
posterior superior alveolar, inferior
alveolar and other veins from the
nose and palate (areas served by
The maxillary artery)
•After that it merges with the
superficial temporal vein to form
the retromandibular vein

35. g) Posterior auricular vein
•The posterior auricular
vein begins upon the side of the
head, in a plexus which
communicates with the
tributaries of the occipital
vein and superficial temporal
veins.
•It descends behind the auricle,
and joins the posterior division
of the posterior facial vein to
form the external jugular.

36. h) Occipital vein
 The occipital vein begins
as a plexus at the posterior
aspect of the scalp from
the external occipital
protuberance and superior
nuchal line to the back part
of the vertex of the skull.
 From the plexus emerges a
single vessel, which pierces
the cranial attachment of
the Trapezius and, dipping
into the venous plexus of
the suboccipital triangle,
joins the deep cervical
and vertebral veins.

37.  Occasionally it follows the course of the occipital
artery and ends in the internal jugular; in other
instances, it joins the posterior auricular vein and
through it opens into the external jugular.
 The parietal emissary vein connects it with
the superior sagittal sinus; and as it passes across the
mastoid portion of the temporal bone, it receives
the mastoid emissary vein which connects it with
the transverse sinus.
 The occipital diploic vein sometimes also joins it.

38. Drains major part of face & scalp
•Begins behind the angle of the
mandible by the union of the posterior
auricular and posterior division of
the retromandibular veins.
•It descend obliquely, deep to the
platysma, receive the posterior external
jugular vein pierce the deep fascia just
above the clavicle and drain into the
subclavian vein

39. Tributaries:
 Formative
 Occipital vein
 Oblique jugular
 Posterior external jugular
 Terminal
 Transverse cervical
 anterior jugular
 Suprascapular vein

40. Applied anatomy
a) Injury to the vein cause air embolism
b) Vein becomes dilated above compression level during
Valselva’s manoevre
c) Vene puncture performed on this vein
d) Surgical division of sternocleidomastoid muscle requires
special care of the vein
e) Increased venous pressure indicates congestive cardiac
failure

41. •start below the chin, pass
beneath the platysma to the
suprasternal notch.
•Pierce the deep fascia and is
connected to the other side
by an anastomosing vein the
jugular arch
•angles laterally to pass deep
to sternocleidomastoid and
open in the external jugular
vein.

42. Tributaries:
1. Skin
2. Superficial tissues of neck
Applied anatomy:
1. Special care required to
preserve the vein during
surgical treatment
of wry neck

43. Formation:
• Venous spaces between the osteal and meningeal layers of
duramater
• Formed by reduplication of meningeal layer
Features:
• Lined by endothelium
• Receive blood from
a) Brain
b) Orbit
c) Internal ear
d) CSF
• Valveless
• Bidirectional flow

44. Classification
Posterosuperior group Anteroinferior group
Unpaired
a) Superior sagittal
b) Inferior sagittal
c) Straight
d) Occipital
Paired
a) Transverse
b) Sigmoid
c) Petrosquamous
Unpaired
a) Anterior intercavernous
b) Posterior intercavernous
c) Basilar
Paired
a) Cavernous
b) Superior petrosal
c) Inferior petrosal
d) Sphenoparietal
e) Middle meningeal

46. Course:
•Begins antriorly at crista galli by
union of tiny meningeal veins.
•Communicate with veins of frontal
sinus , occasionally with the veins of
nose through foramen caecum
•Runs upwards and backwards, and
large in size
•Ends near internal occipital
protuberance by turning to one side ,
usually right , continuous with right
transervers sinus
Cross section: Triangular

47. Tributaries:
1. Veins from nose
2. Superior cerebral vein
3. Parital emissary vein
4. Venous lacunae
5. Communication with
cavernous sinus
Applied anatomy:
Infection from nose, scalp and diploe cause thrombosis
of this sinus

48. 1. Situated in posterior 2/3 of falx cerebri
2. Ends by forming straight sinus
3. It receives
1. Veins of falx cerebri
2. Veins from cerebrum

49. Situated at junction of falx cerebri and tentorium cerebelli
Continuation of inferior
sagittal sinus
Tributaries:
1. Inferior sagittal sinus
2. Great cerebral vein
3. Superior cerebellar veins

50. 1. Large paired sinus , right
sinus larger than left
2. Situated in posterior part of
attached margin
of tentorium cerebelli
3. Begins as continuation of
superior sagittal sinus (right)
and straight sinus (left)

51.  Triangular cross section
 Ends at mastoid angle
 Tributaries:
1. Superior petrosal sinus
2. Inferior cerebral vein
3. Posterior temporal deploic vein
4. Inferior cerebellar vein
5. Inferior anastomotic vein
6. Petrosquamous sinus

52. Confluence of sinus:
•The point where the superior
sagittal sinus, straight sinus
and occipital sinus unite
called Confluence of sinus
•Located on the right side of
the internal occipital
protuberance

53. • Each sinus right & left is
direct communication of
traservers sinus
• S- shaped
• Extends from posteroinferior
angle of parietal bone to
posterior part of jugular
foramen , becomes the
superior bulb of jugular vein.
• Grooves the mastoid part of
temporal bone

54. Tributaries:
1. Communication with pericranium veins
2. Communication with sub occipital venus plexus
3. Labyrinthine veins
4. Cerebellar veins
Applied anatomy
• Thromboisis of the sinus occur from the infection of
the in the middle ear & otitis media or in mastoid
process called mastoiditis
• During operation on mastoid process should be careful
about the sigmoid sinus, so that it not exposed.

55. •The occipital sinus is the smallest
of the cranial sinuses.
•It is situated in the attached margin
of the falx cerebelli, and is generally
single, but occasionally there are two.
•It commences around the margin of
the foramen magnum by several
small venous channels, one of which
joins the terminal part of
the transverse sinus; it
communicates with the posterior
internal vertebral venous plexuses
and ends in the confluence of the
sinuses.

56. 1. Paired sinus, large venous space situated in MCF
2. Extent: petrous part of temporal bone to SOF

57. Relation:
Medially Pituitary gland
Sphenoidal sinus
Laterally Temporal lobe with uncus
Superiorly Optic tract, optic chiasma,
Olfactory tract,ICA
Inferiorly Foramen lacerum , junction of body & greater
wing of sphenoid bone
Anteriorly Superior orbital fissure & apex of orbit
Posteriorly Petrous part of temporal bone

58. Structure passing
through sinus
Structures in
lateral wall of
sinus
ICA
VI cranial nerve
III cranial nerve
IV cranial nerve
V 1 and V2 division
of V cranial nerve

59. Tributaries
From orbit
a) Superior ophthalmic
vein
b) Inferior ophthalmic
vein
c) Central vein of retina
From brain
a) Middle cerebral vein
b) Inferior cerebral vein
Meningeal
a) Middle meningeal
vein
b) Sphenoparietal
sinus

60. Communication with:
a) Transverse sinus
b) IJV
c) Pterygoid venous plexus
d) Facial vein
e) Superior sagittal sinus
f) Opposite cavernous sinus

61. • Usually two in number
• Connects two cavernous
sinus
• Form venous circle
• Situated at anterior
and posterior margins of
diaphragma sellae

62. 1. Its originate from
posterosuperior corner of
cavernous sinus , courses
posteriorly and laterally along
the superior crest of temporal
pyramid, reaches transverse
sinus, bends to continue into
sigmoid sinus
2. Connection between transverse
and cavernous sinus
3. Tributaries:
1. Cerebellar vein
2. Inferior cerebral vein
3. Veins from tympanic cavity

63. Shorter and wider
•Arises from the inferoposterior corner
of the cavernous sinus
• follow petro-occipital fissure
backward to the anterior border of
jugular foramen
•Crosse the 9th,10th & 11th nerve and
empties into superior bulb of internal
jugular vein
Tributaries:
1. labyrinthine vein
2. veins from aqueduct of cochlea
3. vein from medulla pons and
cerebellum

64. Communication between
intracranial veins &
extracranial veins
Emissary
•Mastoid
•Parietal
•Condylar
•Occipital
•Sphenoid
•Zuckerkandl’s
Ophthalmic
•Superior
opthalmic
•Inferior
opthalmic
Venous
plexus
•Pterygoid
•Suboccipital
•Pharyngeal
Diploic
•Frontal
•Anterior
temporal
•Posterior
temporal
•Occipital

65. Superior opthalmic vein
•The superior ophthalmic
vein begins at the inner angle of
the orbit in a vein named
the nasofrontal which
communicates anteriorly with
the angular vein; it pursues the
same course as the ophthalmic
artery, and receives tributaries
corresponding to the branches of
that vessel.

66. • Forming a short single trunk, it passes between the
two heads of the Rectus lateralis and through the
medial part of the superior orbital fissure, and ends in
the cavernous sinus.
• The ethmoidal veins drain into the superior
ophthalmic vein

67. Inferior opthalmic vein
•Formed in floor and
medial wall of orbit
•Ends by joining superior
opthalmic vein
Tributaries:
• Veins from rectus inferior,
obliqus inferior, lacrimal sac
• Communication with pterygoid
plexus
Applied anatomy:
•Blood borne infections of nose or teeth spread into cavernous
sinus

68. Diploic veins:
• situated in diploe of cranial vault
Characteristics
1. Valve less
2. Non-collespable
3. Pouch like elevation at
irregular interval
4. On x-ray of skull appear as
transparent bands
5. Communicate with meningal,
sinuses and veins of pericranium
Types:
• Frontal
• Anterior temporal
• Posterior temporal
• Occipital

69. EMISSARY
Characteristics:
1. Valve-less
2. Some veins are constant other inconstant or may be absent
3. Thin valves tightly attached to surrounding bones
Types:
1. parietal
2. occipital
3. mastoid
4. condylar
5. Spheniod
6. Zuckerkandl’s

70. a) PTERYGOID
Location:
Between lateral and
medial pterygoid or
between temporal
and lateral pterygoid

71. Boundaries:
1. Anterior-maxillary
tuberosity
2. Superior-base of skull
Termination:
• Posteriorly these veins
unite to form deep facial
or maxillary vein

72. Tributaries:
1. Sphenopalatine
2. Deep temporal
3. Pterygoid
4. Masseteric
5. Buccal
6. Dental
7. Greater palatine
8. Middle meningeal
9. Inferior opthalmic

73. Applied anatomy:
 PSA block
-haematoma
 Serves as media for spread of external infection
to the cavernous sinus

74. b) SUBOCCIPITAL:
1. Located in suboccipital triangle
2. Receives blood from
1. Muscular veins
2. Transverse sinus
3. Occipital veins
4. Internal vertebral venous plexus
5. Condylar emmissary veins
3. Drains into vertebral veins

76. c). PHARYNGEAL VENOUS PLEXUS:
1. Located on postero lateral region of pharynx
2. Receives blood from
1. Pharynx
2. Soft palate
3. Pre vertebral region
3. Drains into internal jugular and facial veins

77. pressure of blood in the
thoracic vena cava, near
the right atrium
Normal CVP can be measured
from two points of reference:
Sternum: 0–5 cm H2O
Midaxillary line: 5-10 cm H2O
Site
Normal
pressure range
(in mmHg)
Central venous pressure 3–8
Right ventricular
pressure
systolic 15–30
diastolic 3–8
Pulmonary artery
pressure
systolic 15–30
diastolic 4–12
Pulmonary vein/
Pulmonary capillary wedge pressure
2–15
Left ventricular
pressure
systolic 100–140
diastolic 3-12

78. Factors that
decrease CVP
include:
Hypovolemia
Deep inhalation
Distributive
shock
Factors that increase CVP
include:
Hypervolemia
forced exhalation
Tension pneumothorax
Heart failure
Pleural effusion
Decreased cardiac output
Cardiac tamponade
Mechanical ventilation

79. INDICATION:
EMERGENCY VENOUS
ACCESS
NUTRITIONAL SUPPORT
MEDICATIONS
CENTRAL VENOUS
PRESSURE MONITORING
HAEMODIALYSIS
CONTRAINDICATIO
N
DISTORTED LOCAL
ANATOMY
VASCULAR INJURY
H/O RADIATION
BLEEDING DISORDER
THROMBOLYSIS
CENTRAL VENOUS CATHETERIZATION

82. CAUSES:
INFECTION LIKE A
FURUNCLE IN THE DANGEROUS
TRIANGLE OF FACE
CAVERNOUS SINUS THROMBOSIS
SINUSITIS,INFECTION
OF EYES AND
NOSE,TOOTH
INFECTION,HEAD
INJURY

83. MARKED
EDEMA OF
EYELIDS
PAIN IN EYE,FORE-
HEAD(OPHTHALMIC
NERVE)
OPHTHALMOPLEGIA
(III,IV,VI)
CLINICAL FEATURES

84. TREATMENT
DEFINITIVE: BROAD SPECTRUM ANTIBIOTICS
I.V ANTIBIOTICS FOR 3-4 WEEKS
EMPIRICAL THERAPY: PENICILLINASE RESISTANT
PENICILLIN+THIRD/FOURTH GEN CEPHALOSPORIN
ADJUNCTIVE:CORTICOSTEROIDS
DIAGNOSIS: CT SCAN, MRI
OF HEAD,LUMBAR
PUNCTURE,
BLOOD CULTURE,FLUID
CULTURE

85. ARTERIO VENOUS COMMUNICATION
ESTABLISHED B/W INTERNAL CAROTID ARTERY
AND CAVERNOUS SINUS IN CASE OF FRACTURE OF
BASE OF SKULL FOLLOWING SEVERE HEAD
INJURIES
 C/F: PULSATING EXOPHTHALMOS
. LOUD SYSTOLIC MURMER HEARD
OVER THE EYE
. OPHTHALMOPLEGIA
. MARKED ORBITAL AND CONJUNCTIVAL
EDEMA

86. HAEMANGIOMA
MANIFEST IN THE FIRST FEW
MONTHS OF BIRTH
VASCULAR MALFORMATION
DUE TO ANOMALOUS
DEVELOPMENT OF VASCULAR
PLEXUS.
TYPES:CAPILLARY,
CAVERNOUS AND MIXED

87. FACIAL SPIDER VEINS
SMALL VISIBLE VEINS SEEN
ALONG THE DISTRIBUTION
OF THE FACIAL VEIN
COMMONLY IN NOSE,
CHEEKS AND CHIN DUE TO
COLLECTION OF BLOOD IN
THE VEIN
CAUSE: IDIOPATHIC
TREATMENT: LASER,
SCLEROTHERAPY

88. THROMBOPHLEBITIS MEANS BLOOD
CLOT CAUSING INFLAMMATION.
CAUSE: IV CATHETERS, INJURY TO THE
VEIN
C/F: PAIN,REDNESS, BULGING OF THE
VEIN
SUPERFICIAL(SKIN): BENIGN
DEEP: DEEP VEIN THROMBOSIS
THROMBOPHLEBITIS

89. Conclusion
 Owing to their structural and functional differences
from other systemic veins, their great anatomic
variability, and their intra-extra cranial connections,
the veins of the head and neck region are very
important from a surgical point of view. They also
play a significant role in evaluation, investigations &
management of medical/surgical patients. Hence a
comprehensive knowledge of the anatomy of veins of
the head & neck, their structure & physiology, is
essential for surgical practice.

90. 1. Textbook of oral anatomy-sicher & dubrul
2. Human Anatomy – B.D. Chaurasia
3. Wikipidia

92. DON’T POP YOUR ZITS ,
IT CAN LEAD TO MENINGITIS….