Head and Neck Anatomy: Veins and Lymphatics

• The facial artery is the highest of the three branches from the anterior aspect of the external carotid artery.
• It passes upwards on the side wall of the pharynx
• It hooks downwards over the posterior belly of digastric and contacts the upper surface of the submandibular gland.
• The facial artery hooks upwards over the inferior border of the mandible at the anterior border of the masseter muscle.
• It follows a tortuous course towards the medial angle of the eye, deep to the dilator muscles radiating from the lips.
• The facial artery is visible only between the zygomatic and risorius muscles.
• The labial branches (one for each lip) divide into two, running across the lip beneath the red margin and anastomose end to end at the midline, causing severed arteries to spurt from both ends.
• The superficial temporal artery, a terminal branch of the external carotid, supplies the temple.
• At its beginning, the superficial temporal artery gives off the transverse facial artery, running across the cheek above the parotid duct.
• The supraorbital and supratrochlear branches of the ophthalmic artery supply the forehead from the orbit.
• These branches anastomose freely with the superficial temporal artery in the scalp, which establishes communication between the internal and external carotid systems.

Venous Return of the Face

• Venous return from the face is normally superficial.
• The supraorbital and supratrochlear veins pass from the forehead to the medial canthus, uniting to form the angular vein which becomes the facial vein, accompanying the facial artery.
• In the neck, the facial vein pierces the investing layer of the deep fascia and is joined by the anterior branch of the retromandibular vein, before emptying into the internal jugular.
• Blood from the temple is collected into tributaries of the superficial temporal vein.
• The superficial temporal vein is joined by the maxillary veins from the pterygoid plexus to form the retromandibular vein.
• The retromandibular vein passes downwards in the parotid gland and divides into anterior and posterior branches at its lower border.
• The anterior branch joins the facial vein, sometimes receiving the superior thyroid vein and the vena comitans of the hypoglossal nerve.
• The posterior branch pierces the investing layer of deep cervical fascia and is joined by the posterior auricular vein to form the external jugular vein.
• The external jugular vein courses down over the sternocleidomastoid muscle and pierces the investing layer of deep cervical fascia above the midpoint of the clavicle, emptying into the subclavian vein, and it has valves about 4 cm above the clavicle.

Deep Venous Anastomoses

• The facial vein communicates with the cavernous sinus.
• At the medial canthus, there is a communication with the ophthalmic veins, which drain directly into the cavernous sinus.
• If the facial vein is blocked, blood from the forehead will flow through the orbit into the cavernous sinus, which creates a 'danger area' for infection in the upper lip and cheek.
• The deep facial vein passes in front of the masseter muscle, between the facial vein and the pterygoid plexus.
• The pterygoid plexus receives a vein from the cavernous sinus through the foramen ovale or the venous foramen (of Vesalius).
• The danger area of the face lies between the angular and deep facial veins.

Lymph Drainage of the Face

• The face drains into three superficial groups of nodes from three wedge-shaped blocks of tissue.
• The chin and tip of the tongue drain into submental nodes.
• A wedge of tissue above this drains to submandibular nodes.
• This wedge extends from the central forehead and frontal sinuses through the anterior half of the nose and maxillary sinuses to the upper lip and lower part of the face, and includes the tongue and the floor of the mouth.
• Beyond the second wedge, the forehead, temple, orbital contents, and cheek drain to the preauricular group.
• All lymph eventually reaches deep cervical nodes.

Overview of the veins and lymphatic drainage of the head and neck region. This lesson explores the path of the external jugular vein, facial vein, and deep facial vein. It also looks at the lymphatic drainage from the tongue and associated nodes.