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Major veins of the head and neck.
Hey everyone! It’s Nicole from Kenhub, and in this tutorial, we're going to be looking at the veins of the head and neck. So, in the head and the neck, there are several large veins all of which drain directly to a large vein known as the superior vena cava which we can see here on this image in green, and the superior vena cava drains all the blood from the head and neck. The superior vena cava is a short vein as we can see with no valves and is formed by the union of the left brachiocephalic vein and the right brachiocephalic vein which we can pointed out by these arrows here. It also receives a contribution from the azygos vein arising inferiorly. And the azygos vein is not visible in this image but it runs up the thoracic vertebral column draining blood from the posterior chest and the abdominal walls. Located in the superior mediastinum, the superior vena cava opens into the right atrium, which again we can see on this image and, ultimately, the superior vena cava receives all the venous blood from the head and neck region, upper limbs, part of the thorax and mediastinum via the brachiocephalic veins and their tributaries.
So, in this slide, we're going to have a brief chat about the brachiocephalic veins, and on these images we can see in green the left brachiocephalic vein on the left and the right brachiocephalic vein on the right. And as we mentioned before, the brachiocephalic veins drain venous blood from the head, neck, upper limbs, part of the thorax and the mediastinum into the superior vena cava. And the left and right brachiocephalic veins each are formed by the confluence of the internal jugular vein and the subclavian vein.
And the following veins are the main tributaries of the brachiocephalic vein – the internal jugular vein, the subclavian vein, the vertebral vein, and the internal thoracic vein. And the internal thoracic vein will not be covered in this tutorial as it pertains primarily to the thoracic region. And note that these veins are called tributaries because they drain into the brachiocephalic vein.
So, our first cab off the rank as we've mentioned is the internal jugular vein. And the internal jugular vein which we can see highlighted in a very lovely green is one of the principal veins of the head and the neck providing major venous return from the brain, the upper face and the neck. It's also the largest of the three jugular veins and we'll talk about the other two veins a little bit later on. And the internal jugular vein is formed by the union of the inferior petrosal sinus and the sigmoid sinus either in or distal to the jugular foramen. Let's remember that our sigmoid sinus and inferior petrosal sinus drain the posterior dural venous sinus veins and the cavernous sinus respectively. The tributaries of the internal jugular vein are the dural venous sinuses which are not visible in this image, the superior thyroid vein, the common facial vein, and the posterior auricular vein which also is not visible in this image.
Now, let's move on to the subclavian vein. And the left and right subclavian veins drain the upper limbs and they are also continuous with the left and right axillary veins which of course drain the axillae. And each subclavian vein unites with the respective sides internal jugular vein at a 90° angle at a point known as the jugulo-subclavian venous junction to form the brachiocephalic veins. And notes that the thoracic duct and the right lymphatic trunk drain into the central venous system at the jugulo-subclavian venous junction on the left and right side respectively. And in this image, we can see the thoracic duct on the left here and the right lymphatic trunk on the right. And the external jugular vein is a tributary of the subclavian vein.
Although not a direct tributary of the brachiocephalic vein, the external jugular vein is a major vein of the neck. It runs superficial to the investing layer of the deep cervical fascia and deep to the platysma muscle providing venous drainage for the external cranium and face. Though not visible in this image, the external jugular vein is formed by the confluence of the retromandibular vein and the posterior auricular vein within the parotid gland of each side. And external jugular vein receives additional venous return from the facial vein, hence, the anterior jugular vein which is the smallest of the three jugular veins.
So, now, we're just going to go back to the tributaries of the brachiocephalic veins and, while we're here, let's take a look at the vertebral vein. And the vertebral vein, like all the venous vessels we've looked at so far, is a paired structure and it accompanies the vertebral artery along the vertebral column and has the following tributaries – the occipital vein, the anterior vertebral vein, the deep cervical vein and the internal and external venous plexuses.
So now that we've had looked at some of the veins of the neck, now we'll move on to look at the veins of the face. And the first vein we're going to look at is the facial vein. And the facial vein as the name suggests is a major vein of the face and it begins from the lateral side of the nose and also receives drainage from the external palatine vein. And, of course, the facial vein lies posterior to the facial artery and joins the retromandibular vein inferiorly to form the common facial vein which then drains into the internal jugular vein.
Moving to the superior aspect of the face, we can now see the supraorbital vein in green which begins its course on the forehead. And the supraorbital vein drains the forehead, the eyebrow region and the upper eyelids. And the supraorbital vein courses inferiorly superior to the frontalis muscle and typically joins with the frontal vein at the medial angle of the orbit to form the angular vein.
And let's talk a little bit more about the frontal vein so the frontal vein also known as the supratrochlear vein originates from a venous plexus on the forehead that has merged with the frontal branches of the superficial temporal vein. And the paired frontal veins run inferiorly along the forehead and unite in the area which I've just circled here and that area is called the root of the nose and this union forms the nasal venous arch. The frontal veins then diverge again and merge with their respective side supraorbital vein to form the angular vein as we've talked about in the slide before.
And as we've mentioned, the union of the frontal vein and the supraorbital vein at the medial angle of the orbit forms the angular vein and the angular vein is continuous with the facial vein at the medial angle and it communicates here with the superior ophthalmic vein.
The retromandibular vein is formed by the maxillary vein and the superficial temporal vein. It gives off an anterior division which joins the facial vein to form the common facial vein and a posterior division which together with the posterior auricular vein forms the external jugular vein. The superficial temporal vein originates in a venous plexus on the lateral aspect of the skull with the frontal vein and the supraorbital vein. And the superficial temporal vein communicates with the occipital vein and the posterior auricular vein. It also gives off frontal and parietal branches which unite above the zygomatic arch to form a common trunk just here. And this common trunk is joined by the middle temporal vein and crosses the roof of the zygomatic arch to enter the parotid gland where it unites with the internal maxillary vein to form the posterior facial vein.
And, finally, let's take a look at our last vein which is the posterior auricular vein. And as we just saw, the posterior auricular vein communicates with the occipital vein and the superficial temporal vein and it also passes inferiorly posterior to the ear where it joins with the posterior division of the retromandibular vein to form the external jugular vein.
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