Anomalous formation of external jugular vein and its clinical implication

Abstract

Introduction:The superficial veins, especially the external jugular vein (EJV), are increasingly being utilized for cannulation to conduct diagnostic procedures or intravenous therapies. EJV is also used in microsurgical procedures,used as a recipient for the free flaps.Materials and Methods:During routine dissection a variation was observed in the formation of EJV unilaterally on the left side.Result:In the anterior triangle of the neck submandibular vein joined with the anterior jugular vein to form a large venous trunk (V1). Facial vein joined this venous trunk (V1) to form another common channel (V2). The retromandibular vein divided into unusually long anterior and posterior divisions. Anterior division did not join the facial vein but drained into the common channel V2.The posterior division of retromandibular vein also drained into V2 which further continued as EJV and drained into the subclavian vein.Conclusion:The knowledge of variations in the patterns of superficial veins is important for the surgeons to avoid any intraoperative error which might lead to unnecessary bleeding.

Venous arrangement of the head and neck in humans - anatomic variability and its clinical inferences

“…Gupta, Tuli, Choudhary et al (2003) related that FV terminated in the EJV in 16 sides (five were of the right and eleven of the left side) unilaterally in 14 cadavers and bilaterally in one, without the formation of the CFV, being the latter finding also reported by Choudhary, Sharma and Singh (2010). This different pattern of variation in the FV drainage was also described on the left side of head and neck by D'Silva, Pulakunta and Potu (2008) and Chauhan, Rani, Chopra et al (2011). Interestingly, in the study done by Pai, Vadgaonkar, Prabhu et al (2008), 7,7% of 52 adult cadavers dissected (eight out of 104 sides) showed a similar pattern of termination of the FV.…”

“…This finding is a rare case of venous drainage of head and neck and it corroborates with the observation first described by Selvi and Kumar (2013) regarding the union between PDRMV and CFV. On the other hand, Chauhan, Rani, Chopra et al (2011), in an interesting research, reported that both ADRMV as PDRMV ended in a common trunk, that they will not dubbed as CFV, but as V2 venous trunk with the subsequent formation of EJV. Shankar, Chandrashekar and Chowdapurkar (2012), in turn, reported that the ADRMV formed a single vessel from its junction with PDRMV, terminating into the left subclavian vein and not in the jugular venous system.…”

“…Various applicability may be mentioned by proper knowledge of drainage patterns of the veins of the head and neck. The presence of morphological variations is determinant for health professionals such as anatomists, anesthetists, oral and maxillofacial surgeons, clinicians and radiologists (GUPTA, TULI, CHOUDHARY et al, 2003;SCHUMMER, SCHUMMER, BREDLE et al, 2004;CHAUHAN, RANI, CHOPRA et al, 2011). The external veins of the head and neck are of particular interest in the use as patches for surgery to remove plaque buildup in the carotid arteries; for oral reconstruction surgeries, where the creation of a vascular supply by anastomosis is crucial and in this case is recognized the participation of the facial vein (SABHARWAL and MUKERJEE, 1998).…”

Review of the Variations of the Superficial Veins of the Neck

“…The junction of the posterior division of the retromandibular vein and the posterior auricular vein usually form the EJV that then continues to drain into the subclavian vein [ 3 - 6 ]. The EJV is sometimes absent ipsilaterally or bilaterally, which means that the veins forming the EJV usually drain into the IJV [ 7 - 8 ].…”

“…Another variation manifests as two parallel anterior jugular vessels, one opening into the external jugular vein and one into the transverse cervical vein. Sometimes, one anterior jugular vein may open into the external jugular vein and the other into the subclavian vein but can also give a large communicating branch to the anterior division of the IJV [ 6 , 12 ]. A case was reported where the left anterior jugular vein drained into the terminal portion of the IJV and the right anterior jugular vein drained into the confluence of the subclavian vein and the IJV [ 13 ].…”