ON SUBCUTANEOUS VEINS OF THE NECK

By ELLEN PIKKIEFFMember ofthe Faculty ofNormal Anatomy at the II Leningrad Medical Institute

Head of the Faculty: PROFESSOR J. B. ZELDOWITCH

IN this work, based on the study of 96 subjects, I hope to give accuratenumerical data concerning the frequency of variation in their courses anddirection, their branches and their anastomoses, of the subcutaneous veins ofthe neck.

VENA JUGULARIS ANTERIOR

The initial branches of the vena jugularis anterior are tiny subcutaneousveins in the middle part of the neck, rarely anastomosing with the internaljugular veins. The anterior jugular vein joins the vena subclavia on its ownside medial to the entrance of the vena jugularis externa. This, the usualdescription, has been accepted by several authors (Henle, Luschka, Rauber,Quain, Poirier & Nicolas, Spalteholz and others).

The special work of Sebileau & Demoulin on the veins of the neck containsnumerical data concerning the different points where this vein takes its origin.According to my observations this vein emerges from the superficial jugularveins only in 44 cases (22.9 per cent), its initial branches beginning either in:

(1) The submental region as thin subcutaneous veins lying parallel toone another at some trifling distance from the central line of the neck (Fig. 1)and so descending to the fossa jugularis where they sometimes form ananastomosis-arcus venosus juguli: at other times they anastomose a littlehigherup or on a level with the prominentia laryngea, or they do not anastomoseat all. Twenty-four such non-anastomosing veins occurred (12.5 per cent).

(2) Besides the origin of the vena jugularis anterior just described, I haveobserved that it takes its origin from the subcutaneous veins in the anteriorregion of the neck, i.e. in the trigonum colli mediate (Fig. 2). In addition tothe trifling anastomosis in the submental region, there were subcutaneousbranches along the anterior margin of the m. sterno-cleido-mastoideus andothers collecting blood from the small subcutaneous veins of the internaltriangle of the neck, which united together and followed the usual directionto the vena subclavia on its own side. This arrangement was observed 20 times,or 10-4 per cent.

Ellen Pikkieff

In addition to the above the following were observed:In 27 cases vena jugularis externa.In 6 cases vena jugularis interna.In 1 case vena thyreoidea superior.In 34 cases the vena jugularis anterior vena facialis anterior.In 17 cases> received branches arising vena facialis communis.In 3 cases from vena facialis posterior.In 20 cases glandula parotis.In 19 cases glandula submaxillaris.In 8 cases isthmus glandula thyreoidea.

Short venous trunks coming from adjacent regions open into this vein; thus(1) from deep layers of trigonum caroticum in 49 cases,(2) from regio submentalis in 22 cases,(3) from the region of trigonum omotrachealis in 9 cases.

I particularly noted all the venous trunks, which entered the anteriorjugular veins; in several cases instead of one trunk, several venous trunksentered the anterior jugular veins; they emerged from different regions of theneck, and this is why their total sum resulted in figures exceeding 100 per cent.The anterior jugular trunks themselves were arranged as follows-only in39 cases (40 per cent) did they follow the textbook pattern, i.e.

(1) Parallel straight venous trunks lying beside the medial plane: (a) ofequal size, on both sides and symmetrically placed (Fig. 1); an inferior or asuperior anastomosis may be present, or they may be completely independentof each other. Parallel uniform anterior jugular veins were observed 16 times(16.6 per cent). (b) In 23 subjects (23.9 per cent) the anterior jugular veinswere identical in course but differed in size. (c) In 18 per cent the right wasthe larger. (d) In 5 (2 per cent) the left was the larger (Fig. 4).

(2) In 10 (10.4 per cent) the disposition of the anterior jugular veins wasdifferent; their course lay near the medial border of the m. sterno-cleido-mastoideus which they followed: also their origins were dissimilar. Out ofthese 20 anterior jugular veins (Fig. 5):

6 venae jugulares anteriores emerged from the glandula parotis togetherwith vena jugularis externa.

4 venae jugulares anteriores emerged from the glandula submaxillaris.5 venae jugulares anteriores were the direct continuation of the vena

facials communism.4 venae jugulares anteriores began from the vena facialis anterior.1 vena jugularis anterior departed from the vena jugularis interna on the

level with the upper third part of the m. sterno-cleido-mastoideus.(3) In 18 subjects (18.7 per cent) I observed a multiple origin of the

anterior jugular vein (Fig. 6) from the subcutaneous and from the deep veinsof the neck as well; many small venous trunks were to be observed on both

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On Subcutaneous Veins of the Neck

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121

Ellen Pikkieff

sides in the vicinity of the trigonum colli mediale in the medial or lower partof the neck. These veins unite so as to form two anterior jugular trunks.

(4) In 13 subjects (13.5 per cent) the anterior jugular vein was single;in 11 cases the right one only was present (Fig. 7), and in two cases the leftone only.

(5) Three subjects were absolutely without anterior jugular veins on eitherside (Fig. 9); no small subcutaneous venous branches in the region of themiddle triangle were present. The lower ends of the internal jugular veinswere very near each other, but there was no anastomosis between them.

The external jugular veins are of average size and follow their usual course.

Tributaries entering the vena jugularis anteriorThe anterior jugular vein receives branches from the neighbouring regions

both from deep as well as superficial tissues. The tributaries of 140 (72.9 percent) anterior jugular veins were enumerated.

(1) 51 (26.5 per cent) anterior jugular veins coming from the deep layersof the neck had side branches:

(a) 29 times (15.1 per cent) they were veins deriving from the vena facialisanterior.

(b) 4 times (2 per cent) they were veins deriving from the vena facialiscommunes.

(c) 18 times (9.3 per cent) they were veins deriving from deep layers ofthe neck.

(2) 50 anterior jugular veins (26 per cent) received only thin branchescoming from the superficial parts of the neck.

(3) 39 anterior jugular veins (20.3 per cent) had branches emerging fromsuperficial as well as deeper layers of the neck.

(4) A complete absence of side branches in the anterior jugular vein wasto be observed 46 times, or in 24 per cent of the cases.

VENA MEDIANA COLLI

The vena mediana colli or the central vein of the neck which lies along thelinea mediana colli and which is rarely found, was observed by me in 6 subjects(6.2 per cent).

The origin of this central vein in 5 cases was in the regio submentalis; inone case this vein (Fig. 10) branched off from the vena facialis anterior dextra.

In three cases these veins entered the vena subclavia sinistra after passingbehind the m. sterno-cleido-mastoideus; once this vein entered the venasubclavia dextra joining with the end of the vena jugularis externa dextranear its termination (Fig. 11); and twice the trunk of the odd vena medianacolli was divided into two large venous trunks each of which opened into theanterior jugular vein on the same side.

This central vein took the following course: in two cases (Fig. 12) it ranfor a short distance along the central line of the neck, and divided into two

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On Subcutaneous Veuns of the Neck 123

trunks of almost the same size as the original vein; these then joined with theanterior jugular veins. In one case (Fig. 13) the vena mediana colli lay alongthe middle line of the neck and had no side branches except a considerableanastomosis with the vena facialis anterior dextra, which opened into theinternal jugular vein. In one case the vena mediana colli (Fig. 11) anastomosedwith the vena thyreoidea superior dextra and was accompanied by an anteriorjugular vein, present only on the left side. The vena mediana colli (Fig. 14)which carries the blood from the regio submentalis receives also a large veinfrom the glandula parotis sinistra.

VENA JUGULARIS EXTERNA

The vena jugularis external or vena jugularis externa posterior or venacutanea colli posterior emerges always from the substance of the glandulaparotis, and descends under cover of the m. platysma over the external surfaceof the m. sterno-cleido-mastoideus lying in the lower lateral third of the neckand passing through the deep layers to enter the vena subclavia.

The different origins of the vena jugularis externa were:(1) 4 times it commenced from the venae faciales anterior et posterior

(Fig. 15).(2) The vein appeared from under the lateral border of the m. sterno-

cleido-mastoideus, 5 times on the right and 4 times on the left; in 3 cases outof 9 this occurred on both sides, in 3 other on one side only: twice on the rightand once on the left side (Fig. 1).

(3) In 2 cases the vena jugularis externa was completely absent on theleft side.

(4) In one case the vena jugularis externa started from the substance ofthe submaxillary gland.

The following peculiarities were observed in the disposition of the venajugularis externa:

(1) In 2 cases the vein (Fig. 16) emerging from the glandula parotis ranalong the lateral border of the m. sterno-cleido-mastoideus towards thetrigonum colli mediale to the fossa jugularis; in the fossa jugularis betweenthese veins was noticed a large anastomosis into which opened also two thinanterior jugular veins. The trunk of the vena jugularis externa is usuallysingle, but double trunks occurred in 15 cases (7.8 per cent): such doubletrunks occurred on the right side in 6, on the left side in 9 cases. When suchdouble trunks were found, two independent veins emerged from the glandulaparotis. These veins either opened separately into the vena subclavia (6 cases)(Fig. 17), or (Fig. 3) the two trunks united to form one vein (9 cases) just belowwhere the branches of the plexus cervicalis appear behind the m. sterno-cleido-mastoideus. This single vein opened at the usual point into the venasubelavia.

(2) In 12 cases (6-2 per cent) division of the venae jugularis externae trunkon the right side was observed 3 times, on the left side, 9 times. The single

Ellen Pikkieff

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On Subcutaneous Veins of the Neck

trunk of the external jugular vein emerging from the thick layers of theglandula parotis, and divides into two trunks of somewhat lesser size than theoriginal one directly after leaving the gland. Both trunks descend togetheralong the external surface of the m. sterno-cleido-mastoideus and unite againbelow the cutaneous branches of the cervical plexus into one trunk of the samediameter as' before the division.

Numerous veins from neighbouring superficial as well as deeper tissuesjoin the external jugular vein, which receives also anastomotic branches ofthe anterior jugular vein. In 29 cases (15.1 per cent) the veins which joinedthe jugular external vein emerged from the deeper tissues.

(1) 23 times (12 per cent) they were derived from the vena facialis anterior.On the left side of the neck a short middle-sized branch of the external jugularvein, emerging from the medial aspect of the glandular parotis below the angleof the jaw, entered the vena facialis anterior, this being of similar size to thevena jugularis externa.

(2) Twice the vena jugularis externa was seen to join the vena facialiscommunis. The vena facialis communis connected with the vena jugularisinterna, and in the upper third part of the m. sterno-cleido-mastoideus enteredthe vena jugularis externa (Fig. 15).

(3) In 4 cases these deep branches were trunks, arising from the glandulasubmaxillaris (Fig. 8). A short trunk, without any side branches and of thesame size as the vena jugularis externa, was seen to emerge below the mandi-bulae angle from the glandula submaxillaris and enter the vena jugularisexterna, which took its origin from the glandulae parotis.

The superficial lateral branches of the external jugular veins in 154 cases(79-1 per cent) could be subdivided into the three following groups:

(1) Veins from the anterior part of the neck reached the external jugularveins in 33 cases (17.2 per cent). These veins, their number varying from1 to 3, gathered the blood in the region of the anterior triangle of the neck andentered at different levels the external jugular vein.

(2) 64 external jugular veins (33.3 per cent) received tributaries from thelateral and posterior surface of the neck. These veins, like the veins of thepreceding group, were of different size but never exceeding the size of thetrunk of the vena jugularis externa itself. They opened at different levels intothe vena jugularis externa.

(3) 55 external jugular veins (28.6 per cent) received branches from theanterior, posterior and lateral surfaces of the neck. In 38 cases (20 per cent)the external jugular vein had neither branches nor anastomoses (Fig. 5).

In these cases the vena jugularis externa took its origin from under thelower margin of the glandula parotis, and followed its course along the externalsurface of the m. sterno-cleido-mastoideus parallel with the nervi auricularismagni, crossing the lateral margin of the muscle below its middle; the veinfollowed its course without receiving any branches.

The external jugular vein anastomoses rather frequently with the adjoining

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126 Ellen Pikkieff

anterior jugular vein. Such anastomoses were observed in 54 cases (28.1 percent). These connecting venous trunks pass under cover of the m. subcutaneouscolli at different levels along the external surface of the m. sterno-cleido-mastoideus.

(1) Very rarely, only in 4 cases, the anastomosis between the vena jugularisexterna and vena jugularis anterior was to be observed at the upper part ofthe above-mentioned muscle (Fig. 4). From the upper third of the externaljugular vein a venous trunk, smaller than the vein itself, ascends obliquely andjoins the most lateral initial branch of the anterior jugular.

(2) More frequently, in 17 cases (9 per cent), the anastomosis was seen inthe lower part of the m. sterno-cleido-mastoideus (Fig. 19). In front of thelower third of the m. sterno-cleido-mastoideus passes either a straight or anarched venous trunk, which unites the ends of the external and the anteriorveins.

(3) The most frequent, in 33 cases (17-1 per cent), anastomoses betweenthe external and the anterior vein is by veins which cross transversely themiddle part of the m. sterno-cleido-mastoideus.

ANASTOMOSES BETWEEN THE VEINS OF OPPOSITE SIDES

Between the anterior jugular veins a transverse venous anastomosis occursat different levels. The anastomosis, which occurs in the region of the fossaejugularis (the arcus venosus juguli), is the one usually mentioned in textbooks.Different authors, including Sebileau & Demoulin, mention one other lessfrequent anastomosis between the upper parts of the anterior veins by meansof transverse vessels, in front of the membrane thyreo-hyoidea. The frequencyof this anastomosis was not mentioned by the authors. In 56 cases (58.3 percent) an anastomosis occurred between the anterior jugular veins in the lowerpart of the neck above the incisura jugularis by means of a vein, usuallycalled arcus venosus juguli.

(1) In 34 cases (17-5 per cent) only one anastomosis occurred between theanterior jugular veins.

(2) In the remaining 22 cases (11.5 per cent) the anastomosis was double,i.e. beside the anastomosis in the lower part there was one other transversevessel.

(a) In 2 cases the arcus venosum juguli was accompanied by a secondanastomosis also in the lower part of the neck, but lying a little higher thanthe first (Fig. 6).

(b) In 10 cases the anastomosis of the lower part, the arcus venosus jugiiliwas accompanied by an anastomosis in the upper part, the upper anastomosisbeing at the level of the laryngeal prominence (Fig. 20).

(c) In 9 cases (Fig. 4) a second anastomosis was present in the hyoid region.(d) In 1 case the anastomosis occurred a little lower than the laryngeal

prominence.

On Subcutaneous Veins of the Neck

In 9 cases (5.5 per cent) the anastomosis between the anterior jugularveins in the lower part of the neck was absent, and only the anastomosis of theupper part was present.

In 4 cases this upper anastomosis was above the laryngeal prominence(Fig. 2), in two at the same level, and in three just below (Figs. 22, 23).

In 24 cases (25 per cent) there were no traces of anastomoses between theveins of the right and those of the left side:

In 3 cases the anterior jugular veins were absent (Fig. 14); in 2 casesthe anterior jugular vein was present only on the left side (Fig. 8); in 3 casesthe vena mediana colli was present and opened into the vena subclavia sinistra(Fig. 9); in 6 cases two parallel anterior jugular veins were present withoutany connecting vessels between them.

In 6 cases small veins from the left side entered the anterior jugular veinof the right side, but the vena jugularis anterior on the left side was absent(Fig. 24). In one case I noticed in the lower part an anastomosis between twoanterior jugular veins, which were connected with some branches of the venamediana colli (Fig. 11).

CONCLUSIONS

1. The cutaneous veins of the neck are not only anastomosing, but alsocollecting trunks.

2. Notwithstanding the variability of the cutaneous veins, a certainregularity in the course of the superficial jugular veins can be affirmed.

3. A complete absence of the different veins is very rare.4. The vena mediana colli is a very infrequent vessel (6 per cent).5. In 40 per cent of the cases studied, the picture of the cutaneous jugular

veins corresponded to the usual elementary textbook description.

I am happy to express my thanks to Prof. J. B. Zeldowitch for the themegiven and the kind guidance obtained from him.

REFERENCESLuscTED, H. (1862). Die Anatomie de8 menschlichen Halie8.- (1862). Die Venen de8 Hal8e8.

KRA&usE, W. (1876). Varietdten der K6rpervenen.DUVAL (1891). Veine8 jugulaire8 8uperficiefle8 anormalea.MAuCLAIRE, M. (1892). Anomalie8 de8 veines jugulaires antdrieure et externe du cMtM droit.SEBILEAJU & DEMOULIN (1892). Comment il faut comprendre le sys~tme des veine8 jugulaires

anterieures.GRUBER, W. (1878). Beide Venae facials anteriores als Aeste einer abnorM starken Vena super-

ficialis coUi anterior dextra. Arch. path. Anat. Bd. LXXIV, S. 444.(1872). Anomalie der Venajugularis anterior. Arch. path. Anat. Bd. LIV, S. 188.(1872). Verlauf eines der starken Enddste einer am Anfange und am Ende gablig getheilten

Vena jugularis externa (posterior). Arch. path. Anat. Bd. LIV, S. 188.(1887). Vena mediana coUi veraunicavon enormer Dicke. Arch. path. Anat. Bd. xcVm, S.431.

TICHOMOFF (1891). Die Varietdten der Arterien und Venen des menwchlichen K6rpers.SHAVLOVSIU, P. (1891). K. morfologie ven verkhner konechnosti i 8hei. 8vo. St Petersburg.FEDOROFF, W. W. (1912). Zur Morphologie und Entwicklung der Venen des Halses.

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