THE VEINS OF THE NECK 719 



The middle thyroid vein (Fig. 483) collects the blood from the lower part of the 

 lateral lobe of the thyroid gland, and after being joined by some veins from the 

 larynx and trachea, terminates in the lower pa 1 c of the internal jugular vein. Often 

 in place of the middle thyroid vein there are two veins, the superior and inferior 

 accessory thyroid. These veins pass into the internal jugular. 



The facial and occipital veins have been described on pages 712 and 715. 



Applied Anatomy. The internal jugular vein occasionally requires ligation in cases of septic 

 thrombosis of the lateral sinus from suppuration of the middle ear. This is done in order to 

 prevent septic emboli being carried into the general circulation. This operation has been per- 

 formed in a number of cases, with satisfactory results. The cases are generally those of chronic- 

 disease of the middle ear, with discharge of pus which perhaps has existed for many years. 

 The patient is seized with acute septic inflammation, spreading to the mastoid cells, and, con- 

 sequent on this,eeptic thrombosis of the lateral sinus extending to the internal jugular vein. 

 Such cases are always extremely grave, for there is danger that a portion of the septic clot will 

 be detached and cause septic embolism in the thoracic viscera. If thrombophlebitis of the 

 sinus is suspected the mastoid should be opened and cleansed and the sinus should be at once 

 exposed and explored. If the sinus is found to be thrombosed the surgeon should at once pro- 

 ceed to ligate the internal jugular vein, by an incision along the anterior border of the sterno- 

 mastoid, the centre of which is on a level with the greater cornu of the hyoid bone. The vein 

 ^hould be ligated in two places or opened between. After the vessel has been secured and 

 divided the lateral sinus is to be thoroughly pWrpd nut, and, by removing the ligature from the 

 upper end of the divided vein, all septic clots may be removed by syringing from the sinus through 

 the vein. If hemorrhage occurs from the distal end of the sinus, it can be arrested by careful 

 plugging with gauze. 



The internal jugular vein is also surgically important, because it is surrounded by a larpe 

 number of the deep chain of cervical lymph nodes: and when these are enlarged in tuberculous 

 or malignant disease,, they are liable to become adherent to the vessel, rendering their removal 

 difficult and often dangerous. The proper course to pursue in these cases is to lifmtp the vessel 

 above and below the glandular mass, and resect the included portion together with the nodes. 



Cardiac pulsation is often demonstrable in the internal jugular vein at the root of the neck. 

 There are no valves in the innominate veins or superior vena cava; in consequence, the systole 

 of the right auricle causes a wave to pass up these vessels, and when the conditions are favorable 

 this wave appears as a somewhat feeble flicker over the internal jugular vein at the root of the 

 neck, quite distinct from, and just preceding, the more forcible impulse transmitted from the 

 mderlying common carotid artery and due to the ventricular systole. 1 This auricular systolic 

 enous impulse is much increased in conditions in which the right auricle is abnormally distended 

 dth blood or is hypertroptiied, as is often the case in disease of the mitral valves. In Stokes- 

 Vdams' disease (p. 568) it is this pulsation which gives evidence of the fact that the auricles are 

 >eating faster often two or three times faster than the ventricles. 



The vertebral vein (v. vertebralis) (Fig. 500) is formed in the suboccipital 

 riangle, from numerous small tributaries which spring from the intraspinal venous 

 )lexuses (plexus venosi vertebrales) and issue from the vertebral canal above the 

 )osterior arch of the atlas. They unite with small veins from the deep muscles at 

 ;he upper and back part of the neck, and form a vessel which passes outward 

 and enters the foramen in the transverse process of the atlas, and descends, forming 

 a dense plexus around the vertebral artery, in the canal formed by the foramina 

 n the transverse processes of the cervical vertebrae. This plexus unites at the 

 ower part of the neck into a single trunk, which emerges from the foramen in the 

 ransverse process of the sixth cervical vertebra, and terminates at the root of 

 he neck in the back part of the innominate vein near its origin, its mouth being 

 guarded by a pair of valves. On the right side, it crosses the first part of the sub- 

 clavian artery. 



Tributaries. In its course the vertebral vein communicates with a vein trans- 

 mitted from the lateral sinus of the skull through the posterior condylar foramen. 

 It anastomoses with the occipital vein and receives muscular veins from the muscles 

 n the prevertebral region; intraspinal veins, from the back part of the cervical 

 )ortion of the vertebral column; meningorachidian veins, from the interior of 



1 The Interpretation of the Venous Pulse, by G. Bachmann, Amer. Jour. Med. Sci., November, 1908. 



