Venous Supply of Head, Neck and Face
Venous Supply of Head, Neck and Face
Venous Supply of Head, Neck and Face
1. Arteries
2. Veins
3. Lymphatics
4. Arterioles
5. Capillaries
EMBRYOLOGY OF VEIN
• All veins return deoxygenated blood from all the organs to heart
• Exception:
o Pulmonary veins
o Umbilical veins
VEINS- CLASSIFICATION
Supra-orbital
Superficial temporal
Facial
Maxillary
Pterygoid plexus
Retromandibular
Posterior auricular
Occipital
Cervical veins
external jugular
Internal jugular
Anterior jugular
Subclavian
brachiocephalic
Cranial and Intracranial
Diploic
Cerebral
• Deep facial vein receives from pterygoid venous plexus and also
inferior palpebral, sup. And inf. Labial, buccinator, parotid and
masseteric veins.
• Below mandible, sub-mental, tonsillar, external
palatine(paratonsillar) and submandibular veins joins facial vein
CLINICAL ANATOMY (FACIAL VEIN)
• No valves
• Connects with cavernous sinus by two routes:
1. Ophthalmic or its supraorbital tributary
2. Deep facial vein to pterygoid plexus
• Infection may thus spread from face to intracranial venous sinuses
SUPERFICIAL TEMPORAL VEIN
• Placed partly between temporalis and lateral pterygoid and partly between
two pterygoids.
• Anteriorly reaches from the maxillary tuberosity and superiorly to the base
of skull
• Sphenopalatine, deep temporal, pterygoid, masseteric, buccal, dental,
greater palatine and middle meningeal veins and branches from inferior
ophthalmic veins are all tributaries.
• Connects with facial veins facial veins through deep facial veins &
PTERYGOID VENOUS PLEXUS (CONT.)
• With cavernous sinus through veins that pass through sphenoidal emissary
foramen, foramen ovale and lacerum
• Its deep tributaries are connected with middle meningeal vein.
APPLIED ANATOMY OF
PTERYGOID VENUS PLEXUS
• Between the entrance into subclavian vein, about 4cm above clavicle, it is
often dilated as so called sinus.
• Surface anatomy: usually visible as it crosses sternocleidomastoid
obliquely. Can be seen by effort blowing of mouth closed
TRIBUTARIES OF EJV
• Jugular venous pulse and carotid pulse can be differentiated several ways
• Multiphasic – JVP beats twice in quick succession in cardiac cycle. First beat
is for atrial contraction and second for venous filling. Carotid artery only has
one beat in the cardiac cycle
• Non-palpable – JVP cannot be palpated. If one feels a pulse in neck, it is
generally the common carotid artery.
• Varies with head-up-tilt(HUT) – the JVP varies with angle of neck. If a
person is standing his JV appears to be lower on the neck. The carotid pulse
location does not vary with HUT
ANTERIOR JUGULAR VEIN
• Why we do cannulation?
• Seldinger technique
• IJV often chosen for cannulation because of several advantages:
1. Superficial location
2. Easy ultrasonic visualization
3. Straight course to superior vena cava (right)
4. IJV avoids subclavian “pinch-off syndrome”
DEEP CERVICAL LYMPH NODES
• are found along the internal jugular vein within the carotid sheath.
• In block dissection, the the subclavian vein, JV is removed to facilitate the
removal of nodes.
• In the root of neck, IJV lies behind the gap between sternal and clavicular
heads of SCM and ends by joining the subclavian vein to form
brachiocephalic vein.
• Pharyngeal vein, Common facial vein & superior and middle thyroid veins
also drain into IJV.
DEEP CERVICAL LYMPH NODES (CONT.)
• Undue traction during thyroid surgery can result in avulsion of these veins
from IJV.
• Gentle traction , double ligation of these veins are important steps in
mobilization of thyroid lobes
• Bilateral internal external, posterior external and anterior jugular vein
ligations and excisions performed in the neck due to larynx tumors .
• Radical neck dissection is a standard procedure in the management of head
and neck cancer patients with bilateral lymph node metastasis to the neck.
DEEP CERVICAL LYMPH NODES (CONT.)
• Sacrifice of both internal and external jugular veins bilaterally has been
recognized as a dangerous approach leading to intracranial hypertension
with subsequent neurological sequela and death.
• After bilateral jugular vein ligations, digital subtraction angiography
(DSA) showed that the venous drainage route of the brain had been
diverted from the jugular veins to the vertebral venous plexus.
TRIBUTARIES OF IJV
• At the root of the neck, the right internal jugular vein is a little distance
from the common carotid artery, and crosses the first part of the
subclavian artery, while the left internal jugular vein usually overlaps the
common carotid artery.
• The left vein is generally smaller than the right, and each contains a pair
of valves, which are placed about 2.5 cm above the termination of the
vessel.
APPLIED ASPECTS IJV
• The jugular veins are relatively superficial and not protected by tissues such
as bone or cartilage. This makes them susceptible to damage. Due to the
large volumes of blood that flow though the jugular veins, damage to the
jugulars can quickly cause significant blood loss, which can lead to
hypovolemic shock and then death if not treated
• It should also be noted that cuts or abrasions in the skin near the jugular vein
will bleed longer and more profusely (i.e. from chewing tobacco or shaving
accidents). Since 95% of the body's blood passes through this vein, it takes
on average about 30 minutes to fully stop a shaving abrasion on the face.
LINGUAL VEIN
• These veins occupy channels in diploe of some cranial bones and are
devoid of valves.
• They are large with dilation at regular interval; their thin wall is merely
endothelium. Absent at birth, begin to develop at about 2yrs.
• They communicate with meningeal veins, Dural sinuses & peri cranial
veins.
• Four diploic veins:
1. Frontal diploic vein
2. An ant. Temporal diploic vein
3. A post. Temporal diploic vein
4. An occipital vein
CEREBRAL VEINS
• These are spaces between endosteal & meningeal layers of dura mater.
General features:
• Their walls are formed by dura mater lined by epithelium, muscular coat is
absent
• They have no valves
• Receive: 1. venous drain from brain, meninges and bone
2. the CSF
DURAL VENOUS SINUSES
Paired Unpaired
Thrombosis caused by sepsis in the danger area of face, nasal cavity, paranasal
sinuses give rise to :
• Nervous symptoms:
1. Severe pain in eye and forehead in the area of distributed of ophthalmic nerve.
2. Involvement of 3rd, 4th and 6th nerve resulting in paralysis of muscle supplied.
• Venous symptoms:
1. Marked edema of eyelid, cornea & exophthalmos due to congestion of orbital
vein
APPLIED ANATOMY (CONT.)