36 Jugular Veins 



over the sterno-mastoid, turns down behind the clavicular origin of 

 that muscle to empty into the subclavian vein. Near its termination 

 it receives the transverse cervical (posterior scapular) and the supra- 

 scapular veins, which form an important plexus over the front of the 

 third part of the subclavian artery, and perhaps also the anterior 

 jugular vein. 



The course of the external jugular vein is marked by a line from 

 the angle of the jaw to the back of the clavicular origin of the sterno- 

 mastoid. Thus it runs almost parallel with the fibres of the platysma. 



The anterior jugular begins by the confluence of some submental 

 veins ; descending in a superficial course near the middle line of the 

 neck, it pierces the deep fascia just above the manubrium, and, passing 

 outwards beneath the sterno-mastoid, ends in the external jugular or 

 subclavian vein. In tenotomy of the clavicular part of the sterno- 

 mastoid there is risk of wounding the anterior jugular (p. 4). Short 

 transverse branches connect the two anterior jugular veins across the 

 middle line. 



The internal jugular vein begins just below the posterior lace- 

 rated foramen by the confluence of the inferior petrosal and lateral 

 sinuses (p. 39). Thence it descends by the outer side of the internal 

 and common carotid arteries to join the subclavian vein in the forma- 

 tion of the innominate vein. Its relations are very similar to those of 

 the internal and common carotid arteries. 



Lying in the carotid sheath, the vein is apt to overlap the common 

 carotid artery, and especially so upon the left side (p. 35) ; on the 

 right the end of the vein inclines somewhat to the outer side of the 

 artery. The end of the vein passes in front of the subclavian artery 

 in the first part of its course. 



The tributaries of the internal jugular are the pharyngeal, facial, 

 lingual, superior and middle thyroid, and the occipital. 



The occipital veins begin in a plexus at the back of the head, and, 

 running with the occipital artery, end in the internal jugular vein. 



Cut throat. The man who draws a razor across his throat with 

 suicidal intent, being probably right-handed, gashes the left side. If 

 the brunt of the shock is received by the thyroid cartilage, as often 

 happens, no serious harm may ensue. But if he happen to hit off the 

 thyro-hyoid space there is little to hinder the progress of the blade. 

 Thus, in addition to the skin, platysma, anterior jugular vein, cutaneous 

 nerves, and the deep fascia, the anterior part of the sterno-mastoid 

 may be traversed, and, more deeply, the external carotid, or its superior 

 thyroid or lingual branch, and the corresponding vein. The sterno- 

 hyoid, omo-hyoid, and the thyro-hyoid muscle and membrane and the 

 superior laryngeal nerve, might also be cut, and possibly the incision 

 might pass into the pharynx, wounding also the epiglottis. 



To arrest the bleeding is the first treatment, and after that the man 

 must be propped up in bed with his head brought forward. Sutures 



