Facial-cavernous anastomoses

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The facial-cavernous anastomoses are the communications of the facial and deep facial veins with the cavernous sinus.

Gross anatomy

At the medial canthus of the eye there is a communication with the ophthalmic veins, which drain into the cavernous sinus. Blood from the frontal scalp normally flows via the facial vein, however if flow via this passageway is occluded (e.g. due to thrombosis or pressure) blood above the obstruction will flow through the orbit into the cavernous sinus.

A second communication is via the pterygoid plexus. The deep facial vein passes between the facial vein and drains into the pterygoid plexus anterior to the masseter muscle. The pterygoid plexus in the infratemporal fossa receives an emissary vein from the cavernous sinus in the middle cranial fossa through the foramen ovale.

Variant anatomy

If present, the pterygoid plexus receives a vein from the venous foramen of Vesalius, a small hole medial to the foramen ovale.

Related pathology

The danger area of the face lies between the deep facial and angular veins.

Infection of the upper lip, vestibule of the nose and eyelids spread by way of the angular, supraorbital and supratrochlear veins to the ophthalmic veins which drain directly into the cavernous sinus.

Peritonsillar abscesses, osteomyelitis of the maxilla and deep cervical abscesses may spread by the pterygoid plexus or by direct extension to the internal jugular vein.

Anatomy: Head and neck

Anatomy: Head and neck