The supratrochlear vein originates in the anterior part of the head resulting from the junction of a scalp venous network, which is connected to the tributaries of the frontal superficial temporal vein (Fig. 3.2). The supratrochlear veins descend close and parallel to the midline and reach the surface of the nose, where they are joined by the nasal arch and subsequently joined by the supraorbital vein. These veins may anastomose and separate subsequently to form the facial veins. The supratrochlear veins diverge laterally and form the facial vein near the medial canthus.

This vein originates near the zygomatic process of the frontal bone and runs medially above the orbit until it reaches the supratrochlear vein to form the facial vein near the medial canthus. A branch through the supraorbital notch anastomoses with the superior ophthalmic vein (Figs. 3.3, 3.4).

The facial vein is formed by the junction of the supratrochlear and supraorbital veins. It descends obliquely near the side of the nose (also called angular vein at this level), turning posterolateral under the orbit, passing downwards and backwards behind the facial artery, until it reaches the mandible angle, where it is joined by the retromandibular vein (Figs. 3.3, 3.4). The facial vein joins the internal jugular vein near the greater horn of the hyoid bone. The facial vein is connected to the cavernous sinus by the superior ophthalmic vein (Figs. 3.3, 3.4) or its supraorbital tributary, or by the deep facial vein to the pterygoid plexus, and, hence, to the cavernous sinus. The main tributaries in the face are the superior ophthalmic vein (Figs. 3.3, 3.4), the deep facial vein from the pterygoid venous plexus, the inferior palpebral vein, and the superior and inferior labial veins. The main tributaries below the mandible are the submental, tonsillar, external palatine (peritonsillar), and submandibular veins. The vena comitans of the hypoglossal nerve and the pharyngeal and superior thyroid veins are also tributaries at the level below the mandible.

This vein originates in the venous network of the scalp. This venous network is drained by the supratrochlear, supraorbital, posterior auricular, and occipital veins. Anterior and posterior tributaries join above the zygoma to form the superficial temporal vein and are joined by the middle temporal vein. The middle temporal vein joins the maxillary vein forming the retromandibular vein. Main tributaries are the parotid veins, temporomandibular joint rami, anterior auricular veins, transverse facial vein, and orbital veins.

Main tributaries are the sphenopalatine, deep temporal, pterygoid, masseteric, buccal, dental, greater palatine, and middle meningeal veins, and branches from the inferior ophthalmic artery. The plexus connects with the facial vein through the deep facial vein and with the cavernous sinus through the sphenoidal emissary foramen, foramen ovale, and foramen lacerum (Figs. 3.4, 3.5, 3.6).

This is a short vein that accompanies the first part of the maxillary artery. It represents the confluence of veins from the pterygoid plexus with the superficial temporal vein to form the retromandibular vein (Figs. 3.3, 3.4).

This vein is within the parotid gland, between the external carotid artery and, superficially, the facial nerve. It has an anterior branch forward that joins the facial vein and a posterior branch backward that forms the external jugular vein after joining the posterior auricular vein.

The posterior auricular vein is formed in the parieto-occipital network and drains also the occipital and superficial temporal veins. It has a path of descent behind the auricle and joins the posterior division of the retromandibular vein. The vein receives tributaries from the auricle and stylomastoid vein.

The occipital vein originates in the posterior venous network of the scalp and, through anastomoses, joins the deep cervical and vertebral veins. The vein is a tributary of the internal jugular vein.

The external jugular vein drains mainly the scalp and face but also some deeper tissues. It results from the union of the posterior division of the retromandibular and posterior auricular veins near the angle of the mandible. It descends superficially, covered by the platysma, superficial fascia, and skin. It ends in the subclavian vein. Main tributaries are the posterior external cervical vein, and the transverse cervical, suprascapular, and anterior jugular veins.

The posterior external jugular vein originates in the occipital scalp and drains the skin and muscles. It joins the middle part of the external jugular.

The anterior jugular vein starts near the hyoid bone from the junction of the superficial submandibular veins. It descends in a direction parallel to the midline. Distally it turns lateral and deep and joins the end of the external jugular vein. It receives the laryngeal veins and a small thyroid vein. The anterior jugular vein is usually connected to the contralateral anterior jugular vein, distally by the jugular arch, receiving thyroid tributaries. Both veins may be replaced by a midline trunk.

The internal jugular vein drains most of the blood from the skull, brain, and superficial and deep parts of the face and neck. It originates at the jugular foramen at the cranial base, in continuation with the sigmoid sinus. The vessel is dilated at the beginning and is called the superior bulb. The vein descends along the neck in the carotid sheath, reaching the subclavian vein posteriorly to the sternal end of the clavicle, thereby forming the brachiocephalic vein. At the end, the vein is dilated at the level of the valve and is called inferior bulb (Fig. 3.7). The internal jugular vein is directly anterior and lateral to the carotid artery. The landmark used to locate the distal portion of the internal jugular vein is the apex of the bifurcation of the two heads of the sternocleidomastoid muscle (Fig. 3.8). The triangle formed by the two heads of this muscle exposes the jugular vein for percutaneous puncture (Fig. 3.9). Knowledge of this anatomic relationship is important for internal jugular vein puncture and catheterization. Fig. 3.10 shows the anatomic relationship of the internal jugular veins and the common carotid artery, viewed with the patient in the head-to-toe position, with the operator positioned at the head of the patient ready for internal jugular access. The distribution of the location of the internal jugular vein in relation to the artery is given in a clock-dial configuration and percentages shown as seen in 188 patients, who were candidates for an internal jugular puncture. The most frequent location of the left internal jugular vein is at 10 o’clock (71.27%) and of the right internal jugular vein is at 2 o’clock (75.53%).

Main tributaries of the internal jugular vein are the inferior petrosal sinus, and facial, lingual, pharyngeal, and superior and middle thyroid veins (Fig. 3.11). On the left, the thoracic duct opens near the union of the left subclavian vein and internal jugular vein. The right lymphatic duct ends at the same site on the right.

The inferior petrosal sinus leaves the skull through the anterior part of the jugular foramen and joins the superior jugular bulb (Figs. 3.12, 3.13).

There are two main lingual veins (see Chapter 2, Fig. 2.12B). The dorsal lingual vein drains the dorsum and sides of the tongue and joins the lingual vein, which follows the lingual artery. It is a tributary of the internal jugular vein.

The deep lingual vein begins at the tip of the tongue and runs posteriorly along the inferior surface of the tongue. At the base of the tongue it is joined by the sublingual vein from the salivary gland, forming the vena comitans nerve hypoglossi until it joins the facial, internal jugular, or the lingual veins.

The pharyngeal veins begin at the pharyngeal plexus external to the pharynx. These veins receive meningeal veins
and a vein from the pterygoid canal. The pharyngeal veins end in the internal jugular vein, but sometimes may end in the facial, lingual, or superior thyroid veins.

The superior thyroid vein corresponds to the branches of the superior thyroid artery. It is formed by deep and superficial tributaries and is joined by the superior laryngeal and cricothyroid veins. It is a tributary of the internal jugular vein or facial vein (Figs. 3.7, 3.11).

The middle thyroid vein drains the inferior part of the thyroid gland and receives some veins from the larynx and trachea. It crosses anterior to the common carotid artery and is a tributary of the distal part of the internal jugular vein (Figs. 3.7, 3.11).

The inferior thyroid veins drain caudally the thyroid gland, and arise from the venous network that communicates with the middle and superior thyroid veins. These veins form a plexus in front of the trachea, and, from this plexus, the left vein arises and joins the left brachiocephalic vein, whereas the right vein descends to the right and joins the right brachiocephalic vein at the junction with the superior vena cava. Frequently, a common trunk opens in the vena cava or brachiocephalic vein (Figs. 3.7, 3.11).

The vertebral vein is formed from numerous small tributaries from the internal vertebral plexuses, which arise from the vertebral canal above the posterior arch of the atlas. There are anastomoses with small veins from the muscles, and they form a vein that enters the foramen in the transverse process of the atlas and descends as a plexus around the vertebral artery. This plexus ends as a vein in the vertebral vein, which emerges from the transverse foramen of the sixth cervical vertebra, descends posterior to the artery, and opens in the posterior aspect of the brachiocephalic vein. Main tributaries are branches from the occipital vein, muscular veins, veins from the internal and external vertebral plexus, and also the anterior vertebral and deep cervical veins. Sometimes the first intercostal vein opens in the vertebral vein.