Anatomic variability in the relation between the retromandibular vein and the facial nerve: a case report, literature review and classification

Abstract

Knowledge of anatomic variations concerning head and neck veins is important to surgeons performing interventions in these regions (Folia Morphol 2013; 72, 4: 371-375)

Variable relationship of retro-mandibular vein to the facial nerve, a finding during parotid surgery: a rare case report

“…1,3 In our case it comes under type IId, and other case reported by Astik et al the only other case report (cadaveric) from India comes under type IVb, according to this classification system. 1 Incidentally the variation…”

“…Intraoperative encounter of variable anatomy in parotid surgery is rarely reported in literature. Till now only two surgical case reports were there in literature by Bhattacharya et al and Babademez et al 2,4 The usual location of retro-mandibular vein is medial to facial nerve as described in many classical text books is around 88% as mentioned by Piagkou M et al 1 Toure and Vacher proposed a classification system for this variable anatomy based on their cadaveric study which was later updated by Piagkou et al in their review may help surgeons in reporting these anomalies and using a common international language. 1,3 In our case it comes under type IId, and other case reported by Astik et al the only other case report (cadaveric) from India comes under type IVb, according to this classification system.…”

“…As retro mandibular vein is used by surgeons to expose facial nerve branches during parotid surgery and by radiologists to localize parotid lesions preoperatively. 1 The most feared complication of any parotid surgery is facial nerve injury. [1][2][3] Many anatomy and surgical textbooks described the relation as facial nerve is superficial to the retro mandibular vein but some cadaveric studies showed there is significant incidence of variability.…”

“…1 The most feared complication of any parotid surgery is facial nerve injury. [1][2][3] Many anatomy and surgical textbooks described the relation as facial nerve is superficial to the retro mandibular vein but some cadaveric studies showed there is significant incidence of variability. 1 Only two surgical case reports were found in literature till date.…”

“…Of course, till now only one cadaveric case report was reported from India. 1 It is very important for a surgeon to know the possible variable relations between the two structures to prevent injury to the facial nerve and its branches. Unexpected anomalous anatomy during surgery may lead to grave complications.…”