1. PRESENTER:
Dr. Ashish Soni

2. 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

3. 6. Venous sinuses
7. Communication between venous sinuses & extracranial veins
8. CVP
9. Diseases of veins
10. Conclusion

4. 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

5. Structure of Vein
 Veins are thin walled than arteries.
 Large lumen.
 Valves, maintain unidirection 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)

7. Differences between arteries and veins

8. 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,

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

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

11. 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

12. 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

13. Superficial
External jugular Facial
Superficial temporal
Deep
Pterygoid plexus
Internal jugular

15. Veins of the Head and neck
• 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

16. 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 lesser
supraclavicular fossa

17. 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

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

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

20. Tributaries
1. Inferior petrosal sinus
2. Pharyngeal veins
3. Common facial vein
4. Lingual vein
5. Superior thyroid vein
6. Kocher vein
7. Occipital vein
8. Thoracic duct (left)
9. lymphatic duct (right)

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

22. Superficial
cerebral
veins
Superior
sagittal
sinus
Right
transverse
sinus
Right
sigmoid
sinus
Right IJV
Special characteristics of the blood flow
Deep
cerebral
vein
Great
cerebral
vein
Straight
sinus
Left
transverse
sinus
Left
sigmoid
sinus
Left IJV
1
2

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
7. Queckenstedt’s test – to find out block in CSF
cerculation the test is perform during lumbar puncture

24. Jugular venous pulse (JVP)
• Determine activity of
atrium
• Seen better then felt
• Preferable over EJV
• Elevation of JVP indicative
of cardiac failure
Hepato Jugular reflex
• Elicited by deep compression
of right lobe of liver

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

26. Angular vein receives:
1. Frontal vein
(anterior parts of
scalp)
2. Supraorbital vein
(eyebrows)
3. Superior
ophthalmic vein
(opens into
cavernous sinus)

27. Anastomosis of facial vein

28. 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.

29. 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

30.  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

31. 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

32. • 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

33. 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.

34.  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

35. 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

36. 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 auricula, and joins the
posterior division of
the posterior facial vein to form
the external jugular.

37. 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
thesuboccipital
triangle, joins the deep
cervical and vertebral veins.

38.  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 joins it

39. 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

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

41. 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

42. •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
•angle laterally to pass deep
to sternocleidomastoid and
open in the external

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

44. 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

45. 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

47. 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

48. 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

49. 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

50. 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

51. 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)

52.  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

53. 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

54. • 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

55. 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.
• Otitic hydrocephalus

56. •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.

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

58. 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

59. 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

60. 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

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

62. Applied anatomy:
1. Arterio – venous aneurysm occurs due to rupture of
internal cardiac artery
Symptoms:
a) Loud systolic thrill
b) Exophthalmos
c) Conjunctivitis
2. Thrombosis of the sinus resulting in meningitis due to
infections in dengerous area of face , nasal cavity and
PNS
Symptoms:
a) pain in eye
b) Oedema of eye lids , cornea and root of nose
c) Exophthalmos

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

64. 1. Its originate from
posterosuperior corner of
cavernous sinus , courses
posteriorly and laterally along
the superior crest of temporal
pyramid, reaches transvers
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

65. 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

66. Communicate cavernous
sinus with superior sagital
sinus
Unite to form
- parietal
- frontal
Liable to be torn during skull
fracture

67. 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

68. 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.

69. • 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

70. 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

71. Diploic veins:
• situated in diploe of cranial veins
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

72. 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

73. Veins connecting cavernous sinus with pterygoid
venous plexus pass through different foramina
1. Foramen lacerum
2. Foramen ovale
3. Foramen vesali
4. Foramen spinosum
Applied anatomy:
• Inflammatory process due to infection pass
through these veins and give rise to thrombosis of
the sinus

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

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

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

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

78. 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

80. 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

81. 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: 8-15 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

82. 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

89. Anatomical Variations of Internal Jugular Vein as seen by
“Site Rite II” Ultrasound Machine - an initial experience in
Pakistani Population
Hameedullah,M. A. Rauf,F. H. Khan ( Department of
Anaesthesia. The Aga Khan University Hospital, Karachi. )
49 cases :the angle of the mandible (p value <0.05),
22 cases: the thyroid cartilage
20 cases: the cricoid cartilage
46cases: the supraclavicular area (p value <0.05).
In 93% of cases the IJV was found to be larger than the carotid
artery.

90. The jugular veins and its tributaries form the primary
venous drainage of head & neck.
As these are surrounded by many important anatomic
structures so care should be taken to preserve these
veins during any surgical manipulation of surrounding
structures.

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