VENOUS DRAINAGE OF HEAD AND NECK

MODERATOR PRESENTER
Dr UDAY KIRAN Dr BHANU PRASEEDHA
 Introduction
 The venous system is a network of conduits i.e. veins which transport deoxygenated
blood from tissues to heart except pulmonary and umbilical veins.
 They serve as the major reservoirs of blood.
 About 84% of entire blood volume of body is in systemic circulation and 16% in
heart and lungs.
 Of the 84% in systemic circulation
 64% is in veins
 13% in arteries
 7% in systemic arterioles and capillaries.
 Structure of vein
 Veins are thin walled than arteries.
 Large lumen.
 Valves, maintain unidirectional blood flow.
 3 concentric layers of vein:
 1.tunica intima,
 2.tunica media,
 3.tunica adventitia.
Artery vs Vein
Classification of veins

superficial deep Communicating or perforator

pulmonary systemic
 Veins of head ,face ,brain and neck
Exterior of head and brain neck
face

Supratrochlear vein Diploic veins External jugular vein

Supraorbital vein Cerebral veins Anterior jugular vein
Facial vein Dural venous sinuses Internal jugular vein
Superficial temporal Meningeal vein Sub clavian vein
vein

Maxillary vein Brachiocephalic vein

Pterygoid venous
plexus

Retromandibular vein

Posterior auricular vein

Occipital vein
 Venous drainage of brain
 No valves
 Walls owing to absence of muscular tissue
 Extremely thin
 Pierces the arachnoid memebrane
 inner or meningeal layer of duramater
 Open into cranial venous sinuses

cerebral cerebellar

Superior cerebral vein Superior cerebellar vein

Middle cerebral vein Inferior cerebellar vein

Inferior cerebral vein

Within the brain small venous channels

Large cerebral veins, cerebellar veins ,veins of brainstem

Neighbouring dural venous sinuses

Internal jugular vein

 Cerebral veins
 Lies in subarachnoid space
 Superior cerebral veins
 8to12 in number
 Drain into brain above lateral
sulcus
 Terminate into SSS and
superficial middle cerebral
vein
 Middle cerebral vein
 Begins on lateral surface of
hemisphere
 Terminates into cavernous or
sphenoidal sinus
 Inferior cerebral vein
 Drain lateral surface of
temporal lobe
 Terminate into transverse sinus
 DEEP CEREBRAL VEINS
 They drain the internal
structures;
1. Basal ganglia
2. Internal capsule
3. Thalamus
 They merge to form the Internal
Cerebral Veins.
 The two veins unite in the
midline to form the Great
Cerebral vein.
 This short vessel is continuous
with the Straight Sinus.
Cerebellar veins
 They are present on the surface of cerebellum
 Superficial cerebellar veins ends in straight sinus
 Inferior cerebellar veins which are large and end in transverse ,superior petrosal and
occipital sinus.
 Dural venous sinuses
Classification
Paired Unpaired
 Cavernous sinus  Superior sagittal sinus
 Superior petrosal sinus  Inferior sagittal sinus
 Inferior petrosal sinus  Straight sinus
 Transverse sinus  Occipital sinus
 Sigmoid sinus  Anterior intercavernous sinus
 Sphenoidal sinus  Posterior intercavernous sinus
 Petrosquamous sinus  Basilar plexus of veins
 Middle meningeal sinus
Dural venous sinuses
Superior sagittal sinus
 Applied anatomy

 Thrombosis of SSS: It occurs due to spread of infection from nose ,scalp, diploe
resulting in
 Raise in intracranial tension
 Delirium , convulsions
 Subdural hematoma: it occurs due to tear of cerebral veins where they enter SSS
Inferior sagittal sinus
Straight sinus
Transverse sinus
Sigmoid sinus
Superior petrosal sinus
Inferior petrosal sinus
Cavernous sinus

23
Relations
Tributaries
 Communications – Draining channels
THROUGH INTO

Superior petrosal sinus Transverse sinus

Inferior petrosal sinus Internal jugular vein

Emissary veins Pterygoid plexus of veins

Superior ophthalmic vein Facial vein

Anterior and posterior intercavernous Communicates with the opposite side

sinuses

26
Applied anatomy
 Carotid-cavernous fistula
 Head trauma resulting in rupture of cavernous part of internal carotid artery can
produce what is known as carotid cavernous fistula.
 A pulsating exophthalmos can result as the venous pressure in sinus would increase
and reverse the flow of blood in ophthalmic veins.
 Various routes leading to CST
meningitis
Brain abscess

Superficial
middle cerebral
vein
Inferior cerebral
vein
Sphenoparietal
sinus
Otitis media
Face
(labrynthine vein)
Nose Superior and
Superior and
Paranasal sinuses inferior petrosal
orbit
inferior
ophthalmic vein
Cavernous sinus Mastoid abscess
(mastoid emissary vein)
sinus

Pterygoid
venous plexus
 Venous drainage of cranial dura mater

 Middle meningeal vein

 Two branches-
 anterior branch crosses floor of mcf from foramen ovale or foramen spinosum to the
pterion in the form of two channels that accompany middle meningeal artery
 posterior branch may traverse the foramen spinosum to end into the pterygoid
plexus
 Emissary veins

 Mastoid emissary vein

 Parietal emissary vein
 Condyloid emissary vein
 Emissary veins connecting
cavernous sinus with pterygoid
venous plexus are four and pass
through different foramina :
(a)through foramen lacerum
(b)through foramen ovale
(c)Emissary sphenoidal
foramen (Foramen Vesali)
 Occipital emissary vein
 Zuckerkandl’ s vein
Diploic veins
Venous drainage of scalp
Supra trochlear vein

Supra trochlear vein

Supraorbital vein
Superficial temporal vein
Posterior auricular vein
Occipital vein
Applied anatomy
 The 4th layer of scalp is loose areolar tissue.
 Infection in that layer readily spread to intracranial sinuses through emissary vein(valveless).
Venous drainage of face
Facial vein
Facial vein

Applied anatomy
 Has no valves and it connects to cavernous
sinus by two ways
 1.ophthalmic 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.
Dangerous area of face:
•  Infection from face can spread in a retrograde direction and cause thrombosis of the
cavernous sinus.
• This is specially likely to occur in the presence of infection in the upper lip and in the
lower part of the nose, this is known as dangerous area of face
• Facial vein is connected to cavernous sinus through superior ophthalmic vein & it provides
a pathway for spread of infection from face to cavernous sinus causing cavernous sinus
thrombosis.
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 with the
infratemporal fossa through the inferior ophthalmic vein and deep facial veins.Because of
these connections, an infection of face may spread to cavernous sinus and pterygoid
plexus of veins.
 Blood from medial angle of the eye,nose and lips usually drains inferioirly through the
facial vein, especially when a person is erect and as facial vein has no valves blood may
pass through it in opposite direction.
 In individuals with thrombophlebitis of the facial vein, pieces of infected clot may extend
into the intracranial venous system and produces thrombophlebitis of cavernous sinus.
Pterygoid plexus of veins
Retromandibular vein
Maxillary vein
Cervical veins
External jugular vein
 Tributaries-PAST
 Posterior external jugular vein
 Anterior jugular vein
 Suprascapular vein
 Transverse cervical vein
 In parotid gland it is often joined by branch of internal jugular vein
Posterior external jugular vein
Anterior jugular veins
Internal jugular vein
Relations
 Applied anatomy
 Infection from middle ear spreads to IJV.
 Surgical removal of deep cervical nodes can puncture IJV.
 Thrombophlebitis of IJV can occur with cannulation.
 Systolic thrill is felt over the vein in mitral stenosis.
 During congestive cardiac failure dilatation of veins occur.
 Unusual venous drainage pattern
 In one of the cadavers the following variation was observed, the facial vein was found running
downward & backwards at the anterior border of masseter, where the submental vein united
with the facial vein to form a common venous channel. The common venous channel united
with the retromandibular vein at the angle of the mandible to form the common facial vein.
Before this common facial vein joins the internal jugular vein , a venous channel originating
from the anterior jugular vein comes & joins the common facial vein &which then joins the
internal jugular vein.

 ( j anat.soc.india,52(1),64-65 (2003))
 Subclavian vein
 These are paired veins one
on either side of the body.
 Each vein is continuation
of axillary vein and runs
from outer border of first
rib to medial border of ant
scalene muscle.
 From here it joins with
IJV to form
brachiocephalic
vein(innominate vein).
 The angle of union is
termed as venous angle.
 Applied aspect
 For central line placement
such as swan-ganz
catheter.
 Deep cervical veins

 The deep cervical vein (posterior

vertebral or posterior deep cervical
vein) accompanies its artery between
the Semispinales capitis and colli.
 It begins in the suboccipital region
by communicating branches from
the occipital vein and by small veins
from the deep muscles at the back of
the neck.
 It receives tributaries from the
plexuses around the 
spinous processes of the cervical
vertebræ, and terminates in the lower
part of the vertebral vein.
Central venous catheterization
Venous drainage of tongue
 Venous drainage of salivary glands

 Parotid gland-drains into external and internal jugular veins.

 Submandibular gland-drains into common facial or lingual vein and ultimately into
internal jugular vein.
 Sublingual gland-drains into lingual vein and ultimately into internal jugular vein
Venous drainage of thyroid gland
 Venous drainage
HARD PALATE
Drains into the pterygoid plexus of veins
SOFT PALATE
Drains into pterygoid and tonsillar plexus of veins
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.
AUDITORY TUBE
drains into pharyngeal plexus and pterygoid plexus of veins
NASAL SEPTUM
The veins form a plexus which is more marked in the lower part of septum of little’s area.
The plexus drain anteriorly into facial vein posteriorly through the sphenopalatine vein to
pterygoid venous plexus.
LATERAL WALL OF NOSE
The veins from plexus which drain anteriorly into facial vein
Posteriorly into pterygoid plexus of veins
Medially into pterygoid plexus of veins
Venous drainage of larynx
Venous drainage of orbit
 References

 GRAYS ANATOMY
 DANIEL M LASKIN –VOL 1
 B.D CHAURASIA TEXT BOOK OF ANATOMY – HEAD AND NECK
 ANATOMY FOR SURGEONS-HENRY HOLLINSHED