 Good day everybody. Dr. Sanjay Sanyal, professor of department chair. So this is supine cadaver. We're demonstrating the right side of the neck I'm standing on the right side. The camera person is on the right side This is going to be a demonstration of the cervical facial veins So we have completely dissected out the right side of the neck and the face. Let's take out this vein here This is the facial vein which forms on the Middle canthus of the eye by the combination of the supra orbital and the supra trochlear veins and it descends down And this is accompanied by the facial artery here at the border of the mandible you can see it is receiving this Communication this is a submental vein and then the facial vein is descending down It is going just lateral to this big gland here This is an enlarged submandible or salivary gland and here we can see it is opening into the internal juggler vein on The right side and it's also opening into the internal juggler vein by yet another communication And if I were to lift this up we can see that it is receiving a communication from the lingual vein Communication with the lingual vein is a well-described entity Normally the facial vein as described in the textbooks is supposed to unite with the anterior division of the retromandibular vein To form the common facial vein, but in this case we see that there is no anterior division of the retromandibular vein So therefore the facial vein is directly opening into the internal juggler vein But it does communicate with the lingual vein and it is also got a separate opening into the internal juggler vein Again as per the textbook descriptions the facial vein often has a communication with the anterior juggler vein But here we can see there is no communication with anterior juggler vein. So this is the facial vein I would like to draw your attention to this communication from the facial vein Which I have lifted up here and we can see the communication is going deep inside the intratemporal fossa This is known as the deep facial vein and this deep facial vein communicates with the pterigoid venous plexus and pterigoid venous plexus then communicates by means of evolutionary veins with the cavernous sinus So this can be a root of spread of infection from this region of the face to the cavernous sinus producing cavernous sinus thrombosis So therefore this region of the face is described as the danger triangle of the face This is a pictorial representation of the danger triangle of face by which facial vein can communicate with the cavernous sinus Now let's shift our focus to this vein here under the chain. We can see these veins These are the sub-mental veins these sub-mental veins unite to form what is known as the anterior juggler vein And we can see the anterior juggler vein on the right side and as I mentioned a little while back It also gives a communication which opens into the actual vein Same thing will happen on the other side and we can see anterior juggler vein is formed on the left side also The two side anterior juggler veins They descend down on either side of the neck and this is located in the superficial fascia which we have removed This is the sternum hyoid muscle so it is located superficial to the sternum hyoid muscle and in this particular case We can see that this vein is thrombosed while this vein is also partially thrombosed the two anterior juggler veins They descend down in the anterior cervical region in the Omo trachea triangle or the muscular triangle in the suprasternal space of burns which is the juggler notch We can see that the two anterior juggler veins is giving a communication here And if you zoom the camera closely you can see this communication. It's a form of an arch This is called the juggler venous arch This juggler venous arch is located in the juggler notch And it is located between the two layers of the investing layer of deep cervical fascia Which attach to the anterior and posterior margins of the maribyrum sternum And this juggler venous arch is located in this facial space Which is known as the suprasternal space of burns and thereafter we can see that one vein is going towards the right side and one vein is going towards the left side This is the continuation of the anterior juggler vein proper on the right side This is the continuation of the anterior juggler vein on the left side And this anterior juggler vein then crosses over like this and it opens into the external juggler vein And we can see this opening here in the external juggler vein As I mentioned a little while back anterior juggler vein quite often has a communication with the facial vein But in this case on the right side, there is no communication left side We have not completely dissected out yet that brings me to the external juggler vein itself So for that we will shift our focus to the lateral cervical region just to bring up to speed This is the cut portion of the right sternocleidomastoid This other portion of the sternocleidomastoid and we can see a vein running on the surface of the right sternocleidomastoid This vein is continuation of the retromandibular vein. How has this retromandibular vein formed? Let's lift up the parotid gland and once we lift up the parotid gland, we can see two veins are uniting here One is this one and the other is this one This is the superficial temporal vein The superficial temporal vein runs from the temporal region of the scalp in this particular cadaver the temporal region Superficial temporal veins are highly thrombosed It runs through the parotid gland and then it meets with this other vein Which is the maxillary vein Maxillary vein drains the tericoid venous plexus and these two veins then unite inside the parotid gland and we can see that uniting and It forms the retromandibular vein Why is this called the retromandibular vein because it runs behind the ramus of the mandible and once it comes out of the parotid gland ideally This retromandibular vein is supposed to divide into an anterior division and a posterior division in this cadaver We can notice that it is not dividing at all Instead the whole retromandibular vein is continuing posteriorly As I mentioned a little while back the anterior division is supposed to unite with the facial vein to form the common facial vein But here there is no division and therefore there is no union So this whole vein is continuing the posterior division of the retromandibular vein is supposed to unite with the posterior Auricular vein to form the external jugular vein But here again we can see that there is no such communication Instead the whole retromandibular vein itself is continuing and is becoming known as the external jugular vein The external jugular vein is called external jugular because it runs on the surface of the sternocleidomastoid and we can see it is running here This is the other end of the cut portion because it is highly thrombosed and it continues down It becomes known as external jugular vein here and it opens into the subclavian vein Very close to its termination Which is the venous angle and we can see that opening here So this is the termination of the external jugular vein External jugular vein near its termination Receives three tributaries one tributary. I mentioned a little while back. That is the anterior jugular vein This is the cut portion. It continues and opens here The second tributary is this one here This is transverse cervical vein which is opening into the external jugular vein and the third tributary is this one here This is the supra scapular vein and we can see the supra scapular vein is running with the supra scapular artery and the supra scapular nerve And it goes towards the scapular notch So these are the three tributaries of the external jugular vein now Let's mention a few clinical correlations of all these cervical facial veins. So we have described the facial vein We have described the anterior jugular vein. We have described the external jugular vein These veins are notorious for variations and Bergman has comprehensively Illustrated all the possible variations of these cervical facial veins and we also have noticed quite a few variations in this particular Dissection this external jugular vein as it runs on the surface of the sternocleomastoid Can get injured from a superficial injury of the neck and because it runs vertically down and it opens into the subclavian vein This vein can produce air embolism a virtue of what is known as Bernoulli's principle And also by virtue of the fact that as it runs on the surface of the sternocleomastoid It pierces the investing layer of deep cervical fascia and in that position It is attached to the margins of the deep fascia and therefore it cannot collapse So therefore air can be sucked inside. So that is with respect to the external jugular vein These cervical facial veins can get encouraged when there's a thoracic Inlets in Rome that is then there's an obstruction of thoracic inlet these cervical facial veins are used for intravenous Mungture and intravenous hyperalimentation and these cervical facial veins can also be used as a conduit for Autogenous graft in carotid angioplasty in this connection I would like to mention that the facial vein when it opens into the internal jugular vein It is very close to the bifurcation of the common carotid artery, which is located just behind here So therefore if we need to take a piece of the vein for Autogenous graft We can do it in the same surgical sitting without any extra maneuvers So these are some of the points about the cervical facial veins Anatomical variations and their clinical correlations. Thank you very much for watching. Dr. Sanjay Sanyal signing out Mr. Kendall Kambrabatch is the camera person. If you have any questions or comments, please put them in the comment section below Have a nice day