Human Anatomy Part 2 - K. A. Dyubenko, A. K. Kolomiytsev, Yu. B. Chaykovsky 2008

Specialized Section
Cardiovascular system, systema cardiovasculare - Venous system
Veins of the systemic circulation - Superior vena cava system - Veins of the head and neck

Class="center">Internal jugular vein

The internal jugular vein, v. jugularis interna (Fig. 63), is a paired vessel that originates within the jugular foramen at the Base of the Skull. It drains venous Blood from the Organs of the HEAD and Neck (the Brain and its Meninges, Eyeball, orbital Tissues, skull and Nasal cavity walls, Pharynx, and Tongue). The internal jugular vein begins with a slight dilation, the superior bulb of the internal jugular vein, bulbus venae jugularis superior. The internal jugular vein runs inferiorly, initially lying against the posterior surface of the Internal Carotid Artery, and subsequently against the anterior surface of the External Carotid Artery. Starting from the upper level of the Larynx, it is located on the Deep Muscles of the Neck, posterior to the sternocleidomastoid Muscle (m. sternocleidomastoideus) as part of the neurovascular bundle of the neck (a. carotis communis et n. vagus), in which v. jugularis interna lies laterally, a. carotis communis medially, and n. vagus between them and posteriorly. Above the level of the sternoclavicular joint, prior to joining the subclavian vein, it forms the inferior dilation of the internal jugular vein, bulbus venae jugularis inferior. Below this dilation, in the area of the venous angle (Pirogov's angle), there are 2–3 Valves. Posterior to the sternoclavicular articulation, the internal jugular vein unites with the subclavian vein to form the brachiocephalic vein, v. brachiocephalica. The diameter of the internal jugular vein, as well as the topography of its tributaries and anastomoses with other jugular Veins, can vary significantly (A. S. Vishnevsky, O. M. Maksymenkov).

Topographically and anatomically, the tributaries of the internal jugular vein are divided into intracranial and extracranial.

Intracranial tributaries of the internal jugular vein:

1. Sinus durae matris;

2. Vv. ophthalmicae;

3. Vv. auditivae;

4. Vv. diploicae;

5. Vv. meningeae;

6. Vv. cerebri.

Fig. 63. Internal jugular vein, v. jugularis interna, and subclavian vein, v. subclawia (after Toldt)

1. The Dural Venous Sinuses, sinus durae matris (Figs. 64, 64 A), are wide, valveless channels with non-collapsible walls. They perform a drainage function, carrying venous blood away from the brain, Orbit, eyeball, Inner ear, cranial bones, and meninges. Injuries to these sinuses result in bleeding that is difficult to stop.

The dural venous sinuses include:

✵ Superior sagittal sinus, sinus sagittalis superior, the longest sinus. It is formed at the outer margin of the falx cerebri and the sagittal sulcus. The sinus runs from the foramen cecum along the sulcus of the superior sagittal sinus to the internal occipital protuberance (protuberantia occipitalis interna), where it merges in a T-shape with the transverse sinuses. The junction point is called the confluence of sinuses (confluens sinuum). The superior sagittal sinus receives veins from the cranial bones and the cerebral hemispheres.

✵ Inferior sagittal sinus, sinus sagittalis inferior, runs along the lower margin of the falx cerebri. Near the lower edge of the falx, it empties into the straight sinus, sinus rectus.

✵ Straight sinus, sinus rectus, is located at the junction of the falx cerebri and the tentorium cerebelli. It receives the great cerebral vein and the inferior sagittal sinus. It terminates at the confluence of the transverse and superior sagittal sinuses, known as the confluence of sinuses (confluens sinuum).

✵ Transverse sinus, sinus transversus, is situated in the sulcus of the same name on the Occipital bone. It extends from the internal occipital protuberance to the sigmoid sinus of the Temporal bone, continuing through the jugular foramen into the superior bulb of the internal jugular vein.

✵ Sigmoid sinus, sinus sigmoideus, a paired sinus. It originates at the posteroinferior angle of the Parietal bone, runs through the mastoid sulcus of the temporal bone, and terminates in the region of the jugular foramen.

✵ Occipital sinus, sinus occipitalis, is located within the falx cerebelli. It extends from the internal occipital protuberance to the foramen magnum, where it connects with the sigmoid sinus or, occasionally, empties directly into the superior bulb of the jugular vein.

✵ Cavernous sinus, sinus cavernosus, is a large, paired, flat sinus located on either side of the sella turcica; it is named for the numerous Connective Tissue trabeculae that traverse it, giving it a spongy, cavernous appearance. Passing through the sinus cavity are the internal carotid artery, Abducens nerve, Trochlear nerve, Oculomotor nerve, and the first branch of the Trigeminal nerve. The superior ophthalmic vein, v. ophthalmica superior, empties into the cavernous sinus.

✵ Intercavernous sinus, sinus intercavernosus, is located anterior and posterior to the sella turcica. It connects the cavernous sinuses and receives venous blood from the orbital veins and the basilar plexus (plexus basilaris).

✵ Superior petrosal sinus, sinus petrosus superior, lies in the superior petrosal sulcus of the temporal bone pyramid. It connects the cavernous and sigmoid sinuses.

Fig. 64. Dural venous sinuses and VEINS OF THE head (after F. Kiss and J. Szentágothai)

✵ The inferior petrosal sinus, sinus petrosus inferior, lies in the inferior petrosal sulcus of the petrous part of the temporal bone. It connects the cavernous sinus with the bulb of the internal jugular vein.

✵ The sphenoparietal sinus, sinus clinoideus, is located along the posterior border of the lesser wings of the Sphenoid bone and communicates with the cavernous sinus.

✵ The confluence of sinuses, confluens sinum, is a dilatation of the venous sinuses situated in the region of the internal occipital protuberance, at the junction of the superior sagittal, occipital, straight, and transverse sinuses.

2. Veins of the orbit, vv. ophtalmicae (Fig. 64). The main ones include:

✵ The superior ophthalmic vein, v. ophtalmica superior, which extends from the medial angle of the eye to the lateral wall of the orbit, crossing the Optic nerve. It exits the orbit via the superior orbital fissure and drains into the cavernous sinus. It receives several tributaries: the nasofrontal vein, v. nasofrontalis; ethmoidal veins, vv. ethmoidales; lacrimal vein, v. lacrimalis; palpebral veins, vv. palpebrales; conjunctival veins, vv. conjunctivales; vortex veins, vv. vorticosae; ciliary veins, vv. ciliares; central retinal vein, v. centralis retinae; and episcleral veins, vv. episclerales.

✵ The inferior ophthalmic vein, v. ophtalmica inferior, originates near the inferomedial angle of the orbit and then courses along its floor. In the posterior part of the orbit, it divides into two branches: one passes through the superior orbital fissure to drain into the sinus cavernosus, while the other empties into the deep facial vein, v. facie [facialis] profunda. The inferior ophthalmic vein and the deep facial vein connect the superficial and deep veins.

✵ The veins of the inner ear, vv. auditivae, include the vestibular veins of the inner ear, semicircular canal veins, and labyrinthine veins; the latter drain venous blood from the cochlea and empty into the inferior petrosal sinus.

✵ Diploeic veins, vv. diploicae, are located within the spongy substance (diploe) of the cranial vault bones (Fig. 65).

The following diploeic veins are distinguished:

✵ The frontal diploeic vein, v. diploica frontalis, connects the supraorbital vein with the superior sagittal sinus.

✵ The anterior temporal diploeic vein, v. diploica temporalis anterior, connects the deep temporal veins and anastomoses with the frontal diploeic vein of the cancellous bone.

✵ The posterior temporal diploeic vein, v. diploica temporalis posterior, connects the parietal emissary vein with the mastoid emissary vein and drains into the posterior auricular vein.

✵ The occipital diploeic vein, v. diploica occipitalis, is situated in the occipital bone and drains into the occipital emissary vein.

Along with diploeic veins, the cranium contains inconstant apertures known as emissary veins, emissariae (PNA) or vv. emissariae (Fig. 66). They connect the dural venous sinuses with the superficial (subcutaneous) veins of the head. Emissary veins include: 1) the condylar emissary vein, emissaria condylaris, which connects (via the canalis condylaris) the sinus sigmoideus with the external vertebral venous plexus, plexus venosi vertebralis externi; 2) the mastoid emissary vein, emissaria mastoidea, which connects (via the mastoid foramen of the temporal bone) the sinus sigmoideus with the v. occipitalis or v. auricularis posterior; 3) the parietal emissary vein, emissaria parietalis, which connects (via the parietal foramen) the superior sagittal sinus with the veins of the parietal region—Branches of the v. temporalis superficialis.

In addition to the aforementioned emissary veins, the cranium also features: the anterior condylar emissary vein, the emissary vein of the foramen lacerum, and the emissary vein of the foramen ovale.

Diploeic veins drain into the dural venous sinuses, whereas emissary veins anastomose with the external veins of the head. Thus, the diploeic veins, dural venous sinuses, and external veins of the head anastomose with one another via emissary veins, thereby facilitating venous outflow.

5. Meningeal veins, vv. meningiae, accompany their corresponding Arteries and drain into the sinuses. The largest veins of the cerebral dura mater are the middle meningeal veins, vv. meningeae mediae, which run in pairs alongside the artery of the same name; after emerging from the cranial cavity through the foramen spinosum, they empty into the pterygoid venous plexus, plexus pterygoideus. Consequently, the middle meningeal veins become Extracranial Tributaries of the internal jugular vein.

Fig. 65. Diploeic veins of the cranial roof (after R. D. Sinelnikov)

6. Veins of the brain, venae cerebri, are subdivided into superficial and deep cerebral veins:

The superficial cerebral veins, v. superficialis cerebri, drain venous blood from the superolateral, medial, and inferior surfaces of the brain (Fig. 67).

These include the following veins:

- Superior cerebral veins, vv. superiores cerebri;

- Superficial middle cerebral veins, vv. mediae superficiales;

- Anterior cerebral vein, v. cerebri anterior;

- Inferior cerebral veins, vv.cerebri inferiores;

- Superior cerebellar veins, vv.superiores cerebelli;

- Inferior cerebellar veins, vv.cerebelli infeńores.

Fig. 66. Veins of the head and dural venous sinuses

The deep cerebral veins, v.profundae cerebri, drain venous blood from the basal nuclei and White matter.

These include the following veins:

- Internal cerebral veins, vv.cerebri internae;

- Choroid veins, vv.choroideae;

- Vein of the septum pellucidum, vv.septi pellucidi;

- Basal vein, v.basalis.

Extracranial tributaries of the internal jugular vein:

1 V.facialis;

2. V.retromandibularis;

3. Vv.pharyngeae;

4. V.lmgualis;

5. Vv.thyroidae superiores;

6. V.thyroidae media

1. The facial vein, v.facialis (Figs. 63, 64, 66), originates near the medial angle of THE EYE AND accompanies the facial artery; upon reaching the Mandible, it courses anterior to the masseter muscle. Below the mandibular angle, it joins the retromandibular vein and drains into the internal jugular vein (v.jugulaiis interna). It receives the following tributaries:

- Angular vein, v.angularis;

- Supraorbital vein, v.supraorbitalis;

- Superior and inferior palpebral veins, vv.palpebrales supeńores et inferiores;

- Superior and inferior labial veins, vv.labiales superior et inferior;

- External nasal veins, vv.nasales externae;

- External palatine vein, v.palatina externa;

- Submental vein, v.submentalis;

- Deep facial vein, v.profunda faciei;

Fig. 67. Superficial cerebral veins, superior sagittal sinus, and lateral lacunae

2. The retromandibular vein, v.retromandibularis (Figs. 64, 66), is a paired vessel that runs anterior to the auricle within the parenchyma of the parotid gland, lateral to the a.carotis externa and posterior to the ramus of the mandible; at the level of the mandibular angle, it turns anteriorly and empties into the v.jugularis interna. The retromandibular vein receives the following tributaries:

- Anterior auricular veins, vv.auriculares anteriores;

- Superficial temporal veins, vv.temporales superficialis;

- Middle temporal vein, v.temporalis media;

- Deep temporal veins, vv.temporalis profundae;

- Temporomandibular articular veins, vv.articularis-temporomandibularis;

- Pterygoid plexus, pl.pterygoideus, and its tributaries: vv.meningeae mediae, vv.parotideae, vv.tympanicae.

3. Pharyngeal veins, vv.pharingeae, originate from the pharyngeal venous plexus, descend along its posterior wall, accompany the a.pharyngea ascendens, and drain into the internal jugular vein.

4. The lingual vein, v.lingualis, forms near the ROOT of the tongue, accompanies the a.lingualis to the anterior margin of the m.hyoglossus, and empties into the internal jugular vein or the v.facialis. It receives the following tributaries:

- Dorsal lingual vein, v.dorsalis linguae;

- Deep lingual vein, v.profunda linguae;

- Sublingual vein, v.sublingualis.

5. Superior thyroid veins, vv.thyroidae superiores, represented by two trunks, originate from the thyroid venous plexus, then merge into a single trunk and empty into the internal jugular vein or the lingual vein. They anastomose with the laryngeal veins.

6. The middle thyroid vein, v.thyroidea media (Fig. 68 A), arises from two trunks originating from the isthmus of The Thyroid Gland and drains into the internal jugular vein.

External Jugular Vein

The external jugular vein, v.jugularis externa (Fig. 68), is the largest superficial vessel located in the neck. It is formed below the auricle at the level of the mandibular angle by the union of the posterior auricular vein, v.auricularis posterior, and the occipital vein, v.occipitalis, with the retromandibular vein, v.retromandibularis. It runs anteroinferiorly and obliquely across the superficial surface of the m.sternocleidomastoideus, covered by the platysma. In the supraclavicular region, it pierces the superficial Cervical fascia and empties into the subclavian vein, or the internal jugular vein, and occasionally into the venous angle. Along its course, the external jugular vein receives the transverse cervical veins, vv.transversae colli, the suprascapular vein, v.suprascapularis, and the Anterior jugular vein, which drains blood from the anterior cervical region.

Anterior Jugular Vein

The anterior jugular vein, v.jugularis anterior, is the largest tributary of the external jugular vein (Fig. 68 B). It originates from veins in the submental region, runs along the midline of the neck, pierces the Deep Layer of the proper cervical fascia, and enters the suprasternal interaponeurotic space (spatium interaponeuroticum suprasternale). Within this space, the right and left anterior jugular veins anastomose with each other, forming the jugular venous arch, arcus venosus juguli. This arch empties into the external jugular vein of the corresponding side. In addition to the main trunk type of Structure, a reticular STRUCTURE OF THE anterior jugular vein is also observed (O. M. Maksymenkov) (Fig. 69 A, B).

Subclavian Vein

The subclavian vein, v.subclavia (Figs. 63, 70), is the direct continuation of the axillary vein. It passes through the scalene hiatus (spatium antescalenum) and lies in the subclavian groove of the first rib. Posterior to the sternoclavicular articulation, the subclavian vein unites with the v.jugularis interna to form the brachiocephalic vein. At the junction site, the venous angle (Pirogov's angle) is formed. The Thoracic duct empties into the left venous angle, whereas the Right lymphatic duct empties into the right one. In clinical practice, medicinal solutions are administered into the subclavian vein.

Valves of the Cervical Veins

The veins of the neck generally lack valves. They are located in the region of the venous angle (angulus venosus), which is formed by the jugular and subclavian veins. The number of valves here can vary due to the structural CHARACTERISTICS OF THE cervical veins. In cases where a reticular venous structure is present along with a high density of anastomoses between the superficial and deep veins, valves are found at the orifices of all veins draining into the venous angle. Typically, a single valve is situated in the inferior section of the v. jugularis interna. The v. jugularis externa features 2–3 valves located in close proximity to one another. Furthermore, 2–3 valves are observed in the v. transversa scapulae, v. transversa coli, and the plexus venosus juguli. Their number may increase when these veins are doubled (O. M. Maksymenkov)*.

In cases where a main-stem (magistral) type of venous structure is observed and the veins appear as single trunks, the number of valves decreases significantly. As a rule, the v. jugularis interna has no valves, whereas the v. subclavia contains 2–3 valves, and there is one valve in each of the following: v. jugularis externa, v. transversa scapulae, v. transversa coli, and v. cephalica. The presence of well-developed valves in the veins of this neck region indicates their continuous functional activity (O. M. Maksymenkov).