Video: Main veins of the head and neck

Have you ever wondered why vampires always go for the neck? Maybe it's because of that big juicy jugular vein that lies just underneath the muscles of the neck. No bony obstacles in the way. The large internal jugular vein carries all of that bloody goodness from the brain back down to the heart to be reoxygenated again, so it's an excellent target point for any vampire – easy access and loaded with blood. Enough of that creepy vampire talk, though. We all know vampires aren't real. But just to be safe, I'll put on a turtleneck while we plow on with today's tutorial. Today we're going to learn about the main veins of the head and neck.

We're going to start by taking a look at the three main veins of the head and neck – the internal jugular vein, the subclavian vein, and the brachiocephalic vein. We'll then explore the main tributaries of each of these veins and describe the specific areas these veins and their tributaries drain. To finish off, we'll look at some clinical notes concerning the venous drainage of the head and neck.

Before we dive into the bulk of this tutorial, let's just have a quick reminder of what veins do. Veins are blood vessels that mainly drain deoxygenated blood from areas around the body except for the pulmonary veins which carry oxygenated blood from the lungs to the heart. Venous blood is returned to the heart where it is pumped to the lungs to be reoxygenated. The ultimate goal for the veins of the head and neck is to bring venous blood to the superior vena cava which transports blood to the right atrium of the heart.

Most veins contain valves which help to maintain a unidirectional blood flow. While arteries have branches, veins have tributaries. Tributaries are smaller veins which drain into the larger main veins. We'll meet some of those today.

Okay, let's focus on the veins of the head and neck. We'll begin with the internal jugular vein.

The internal jugular vein is a paired vessel extending from the base of the skull to the sternal end of the clavicle on each side of the body. Looking at this transverse section through the neck, we can see that the internal jugular vein travels within the fibrous carotid sheath just lateral to the carotid artery. This vein can be found just deep to the sternocleidomastoid muscle and therefore is not usually visible on the surface of the skin. The internal jugular vein is the main brain drain. It is formed by the union of the sigmoid and inferior petrosal sinus.

The internal jugular vein then extends down to the neck to drain into the brachiocephalic vein as we can see in this posterior view of the neck. It drains venous blood from the majority of the skull, brain, oral cavity, and superficial structures of the head and neck. Tributaries of the internal jugular vein include the sigmoid sinus, the inferior petrosal sinus, the meningeal veins, the pharyngeal venous plexus, the common facial vein, and the superior and middle thyroid veins. Let's quickly take a look at each of these tributaries now.

The sigmoid sinus, which we have already mentioned, collects and drains venous blood from the regions of the brain. It is formed as a continuation of the transverse sinuses of the brain. It drains into the internal jugular vein at the jugular foramen of the skull.

The inferior petrosal sinus lies within the middle cranial fossa and drains regions of the middle cranial fossa, brain, and inner ear. They originate from the posteroinferior aspects of the cavernous sinuses on each side of the sella turcica. The inferior petrosal sinus travels through the jugular foramen of the skull to drain into the internal jugular vein.

In this image, we can identify one of the many meningeal veins – the middle meningeal vein. The meningeal veins travel with the meningeal arteries and drain the dura mater which is one of the meninges surrounding the brain. The meninges are protective membranous layers that envelope and protect the brain and spinal cord.

Moving on to the neck, we find the pharyngeal venous plexus, a network of veins which surrounds the pharynx. The pharyngeal venous plexus is formed by the union of the pharyngeal veins posterolateral to the larynx. It drains regions of the pharynx and superficial neck into the internal jugular veins.

The common facial vein drains the superficial structures of the face. This vein is formed by the union of the facial vein and the anterior branch of the retromandibular vein. It travels inferiorly to drain into the internal jugular vein just below the jaw as we can see here.

The final tributaries of the internal jugular vein are the superior and middle thyroid veins. These veins originate from a glandular venous plexus and drain regions of the thyroid gland. The superior and middle thyroid veins accompanied with their arterial counterparts course anterior to the common carotid artery to drain into the internal jugular vein.

Let's now move on to take a look at the subclavian vein.

The subclavian vein is one of the main veins of the neck. It is also a paired vessel with both a left and a right counterpart. As its name suggests, it lies tucked just beneath the clavicle. The subclavian vein begins as a continuation of the axillary vein at the lateral edge of the first rib. As it travels towards the sternal end of the clavicle, it joins with the internal jugular vein to form and drain into the brachiocephalic vein. The subclavian vein drains the upper limb and small portions of the neck. Tributaries of the subclavian vein include the anterior jugular vein, the external jugular vein, and the veins of the upper limb. Let's quickly take a look at each of these tributaries.

The anterior jugular vein is a paired blood vessel that drains structures of the anterior compartment of the neck. It is formed by the confluence of the submandibular veins just under the chin. It travels down the anterior surface of the neck and drains into the subclavian vein just before it joins with the internal jugular vein. The anterior jugular vein can sometimes drain directly into the external jugular vein.

The external jugular vein drains superficial structures of the head including the scalp and face. It is formed by the union of the posterior auricular vein and the posterior branch of the retromandibular vein near the angle of the mandible. This vein travels down the neck superficial to the sternocleidomastoid muscle and drains into the subclavian vein right before it joins with the internal jugular vein. As a continuation of the axillary vein, the subclavian vein ultimately receives deoxygenated blood from all the veins of the upper limb.

Moving on to the final main vein of the head and neck, we meet the brachiocephalic vein. The brachiocephalic vein is also known as the innominate vein. As we know, the brachiocephalic vein is formed by the confluence of the internal jugular vein and the subclavian vein just posterior to the sternoclavicular joint. Venous blood from regions of the head and neck, upper limb, and the upper part of the thorax drain into the brachiocephalic vein. It then drains into the superior vena cava and into the right atrium of the heart.

The brachiocephalic vein receives four main tributaries which include the internal jugular vein and the subclavian vein which we've already described earlier. The other tributaries are the vertebral vein and the internal thoracic vein. As its name suggests, the vertebral vein travels along the vertebral column down through the transverse foramina of the cervical vertebrae to reach the brachiocephalic vein. The vertebral vein originates from a venous plexus in the suboccipital triangle and drain structures such as the suboccipital muscles, the prevertebral muscles of the neck, and the cervical spine. It terminates at the base of the neck and drains into the brachiocephalic vein just medial to the internal jugular vein.

The internal thoracic vein drains the upper thorax, chest wall, and breasts and is formed as continuations of the musculophrenic and superior epigastric veins of the thorax. As it collects venous blood from surrounding structures, it travels superiorly to drain into the brachiocephalic vein. As with most veins in the body, this vein contains valves which are vitally important here to prevent the backflow of blood as the vein travels superiorly.

Before we finish up, let's take a quick look at some clinical notes surrounding the veins of the head and neck.

You may have heard of the danger triangle of the face before. This is the triangle that extends from the corners of the mouth to the bridge of the nose. The reason why this is such a dangerous area is because of the veins in our face. The facial vein communicates with the cavernous sinus via the angular vein. This is a fact of great clinical significance because any infection of the region of the face drained by the facial vein can spread to the cavernous sinus resulting in a serious condition called thrombosis of the cavernous sinus.

The cavernous sinus is a venous sinus of the brain which houses important cranial nerves involved in eye movements. Thrombosis of the cavernous sinus may lead to internal strabismus or crossed eyes if cranial nerve 6 is damaged, doubled vision while looking downward if cranial nerve 4 is affected, or ophthalmoplegia which is a paralysis or weakness of the eye muscles. An infection that spreads to the facial vein and then to the dural venous sinuses may simply occur as a result of a nasal abscess or after squeezing a large pustule or pimple on the side of the nose and upper lip so leave those pimples alone.

We've made it to the end of this tutorial, but before we finish, let's go over a quick summary of what we learned today.

In today's tutorial, we learned about the main veins of the head and neck. The main purpose of these veins is to drain venous blood to the superior vena cava and into the heart. The first vein that we met was the internal jugular vein. This vein drains regions of the brain, skull, oral cavity as well as the superficial structures of the face and neck. We met the main tributaries of the internal jugular vein which included the sigmoid sinus, the inferior petrosal sinus, the meningeal veins, the pharyngeal venous plexus, the common facial vein, and the superior and middle thyroid veins.

The sigmoid and inferior petrosal sinus unites to form the internal jugular vein and drain regions of the brain. The meningeal veins drain the meninges surrounding the brain. The pharyngeal venous plexus drains the pharynx and the superficial neck. The common facial vein drains the superficial structures of the face and the superior and middle thyroid veins drain the thyroid gland.

Next, we came to the subclavian vein which is one of the main veins of the neck. It begins as a continuation of the axillary vein at the lateral edge of the first rib. The subclavian vein drains regions of the upper limb and neck. It has three main tributaries which include the anterior jugular vein, the external jugular vein, and the veins of the upper limb. The anterior jugular vein drains regions of the neck. The external jugular vein drains the scalp and face. As a continuation of the axillary vein, the subclavian vein ultimately drains the blood from all the veins of the upper limb.

The final vein that we met was the brachiocephalic vein. This vein is formed by the union of the internal jugular vein and the subclavian vein. The brachiocephalic vein drains regions of the head, neck, upper limbs, and upper thorax. The four main tributaries of the brachiocephalic vein include the internal jugular vein, the subclavian vein, the vertebral vein, and the internal thoracic vein. The vertebral vein drains the cervical spine and the prevertebral muscles while the internal thoracic vein drains regions of the upper thorax and chest.

Finally, we identified the danger triangle of the face and explored how superficial infections within this area can spread to deeper regions such as the cavernous sinus which may lead to thrombosis of the cavernous sinus.

That brings us to the end of this tutorial. See you next time and happy studying!