MULTIPLE VARIATIONS OF THE SUPERFICIAL JUGULAR VEINS: CASE REPORT AND CLINICAL RELEVANCE

The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.

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Posture-induced changes in the vessels of the head and neck: evaluation using conventional supine CT and upright CT

Scientific Reports ◽

10.1038/s41598-020-73658-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Kenzo Kosugi ◽

Yoshitake Yamada ◽

Minoru Yamada ◽

Yoichi Yokoyama ◽

Hirokazu Fujiwara ◽

...

Keyword(s):

Head And Neck ◽

Jugular Vein ◽

Venous Drainage ◽

Craniocervical Junction ◽

External Jugular Vein ◽

Venous System ◽

Upright Posture ◽

Cross Sectional ◽

Postural Changes ◽

The Right

Abstract Since the venous system is affected by gravity, upright computed tomography (CT) in addition to conventional supine CT has great potential for evaluating postural changes in the venous system. We evaluated the morphological differences in the head and neck vessels by performing a contrast CT study in both the supine and the sitting positions. In this study, the 20 included participants (10 men and 10 women) were healthy adults aged 30 to 55 years. The cross-sectional area of the cervical vessels, craniocervical junction veins, and intracranial vessels were obtained quantitatively. Venous sinuses and venous plexuses that were difficult to measure were evaluated qualitatively. The average change in areas from a supine to an upright posture was − 77.87 ± 15.99% (P < 0.0001) in the right internal jugular vein (IJV), − 69.42 ± 23.15% (P < 0.0001) in the left IJV, − 61.52 ± 12.81% (P < 0.0001) in the right external jugular vein (EJV), and − 58.91 ± 17.37% (P < 0.0001) in the left EJV. In contrast, the change in the anterior condylar vein (ACV) from a supine to an upright posture was approximately + 144% (P < 0.005) on the right side and + 110% (P < 0.05) on the left side. In addition, according to the qualitative analysis, the posterior venous structures including the anterior condylar confluence (ACC) of the craniocervical junction became more prominent in an upright posture. Despite these changes, the intracranial vessels showed almost no change between postures. From a supine to an upright position, the IJVs and EJVs above the heart collapsed, and venous channels including the ACCs and ACVs opened, switching the main cerebral venous drainage from the IJVs to the vertebral venous system. Upright head CT angiography can be useful for investigating physiological and pathophysiological hemodynamics of the venous system accompanying postural changes.

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Undivided Retromandibular Vein Leading to the Absence of External Jugular Vein

Journal of Morphological Sciences ◽

10.1055/s-0038-1675760 ◽

2018 ◽

Vol 35 (04) ◽

pp. 225-228

Author(s):

Y. Rao ◽

Vaishnavi Ballal ◽

B. Murlimanju ◽

Mangala Pai ◽

Mamatha Tonse ◽

...

Keyword(s):

Emergency Physician ◽

Jugular Vein ◽

Preoperative Evaluation ◽

Venous Drainage ◽

External Jugular Vein ◽

Venous System ◽

Common Trunk ◽

Facial Vein ◽

Male Cadaver ◽

The Right

AbstractWe report a case of undivided retromandibular vein (RV) that was associated with the absence of external jugular vein (EJV). This variation in the jugular venous system was observed on the right side of the neck of a male cadaver. The posterior auricular vein drained into the RV, which joined the facial vein resulting in a common trunk. This common trunk then drained directly into the internal jugular vein (IJV) thus bypassing the whole venous drainage area of the EJV. It is believed that the knowledge about the venous variations, as in the present case, is enlightening to the clinicians. The preoperative evaluation of the venous system is essential to prevent complications like catastrophic bleeding and embolism. The knowledge may guide the emergency physician for a quicker cannulation of the veins.

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Communicating vein between the right external and internal jugular veins: a case report

Anatomy (International Journal of Experimental and Clinical Anatomy) ◽

10.2399/ana.20.835484 ◽

2021 ◽

Vol 15 (1) ◽

pp. 84-87

Author(s):

Eleni Patera ◽

Abduelmenem Alashkham

Keyword(s):

Case Report ◽

Jugular Vein ◽

Thyroid Cartilage ◽

Radical Neck Dissection ◽

Neck Region ◽

External Jugular Vein ◽

Jugular Veins ◽

The Right ◽

Internal Jugular Veins ◽

Communicating Vein

The external jugular vein is a superficial vein that has a relatively diagonal to vertical course in the neck region and runs superficial to the sternocleidomastoid muscle. This vein is formed by the union of the posterior division of the retromandibular vein with the posterior auricular vein and it is responsible for draining most of the scalp and face as well. Sound knowledge of variations of the external jugular veins and the internal jugular veins, is important as these veins are used or targeted in specific medical procedures such as external jugular vein cannulation or radical neck dissection, respectively. During routine postgraduate dissection of the neck region in a 58-year-old female cadaver, the right external jugular vein was seen communicating with the right internal jugular vein via a communicating vein. The communicating vein was located approximately at the lower border of the thyroid cartilage and the upper border of the cricoid cartilage. A thorough understanding of anatomical variations is important in various medical disciplines and more specifically to anatomists, radiologists, and surgeons. This case report does not solely aim to increase awareness regarding variations of the jugular veins that can be possibly encountered during a neck endovascular procedure, but also contribute to the identification of the prevalence rate of this variation.

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The “branching external jugular vein”: an unreported clinically significant anatomic variation

Annals of Pediatric Surgery ◽

10.1186/s43159-020-00059-3 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Mohamed Sameh Shalaby

Keyword(s):

Success Rate ◽

Clinical Relevance ◽

Jugular Vein ◽

Anatomic Variation ◽

Venous Catheter ◽

Anatomical Variations ◽

External Jugular Vein ◽

Anterior Branch ◽

The Times ◽

The Right

Abstract Background The reported overall success rate for central venous catheter (CVC) insertion into the external jugular vein (EJV) is less than other central veins. A contributing factor for this might be the well-documented anatomical variations of the EJV. However, there are no reports correlating these anatomical variations with successful CVC insertion. Our aim was to evaluate the EJV anatomical variations and their clinical relevance. Results All CVCs inserted over the study period were prospectively recorded with emphasis on the times the EJV was accessed, operative difficulties and any anatomical variations with their influence on CVC insertion. Over 15 months, 36 CVCs were inserted, 17 (47%) into EJV. For EJV line insertions, age is 39 days–14 years, 9 into right EJV. Operative difficulty was encountered in 4 patients (24%) where the catheter was inserted into EJV but failed to thread into a satisfactory position. In all 4 patients, further dissection revealed EJV branching into a bigger anterior branch which follows the course of main EJV yet not leading to the right atrium (RA) and a smaller posterior branch leading to RA. Regarding the 4 cases of “the branching EJV”, age is 2–14 years, 3 males:1 female and 3 left:1 right EJV. The overall success rate for CVC insertion through the EJV in this study was 100% including the 4 cases with “the branching EJV”. Conclusions This is the first report describing “the branching EJV” and its clinical relevance to CVC insertion.

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Internal jugular vein reconstruction: application of conventional type A and novel type K methods

The Journal of Laryngology & Otology ◽

10.1017/s0022215110003038 ◽

2011 ◽

Vol 125 (6) ◽

pp. 643-648 ◽

Cited By ~ 4

Author(s):

K Kamizono ◽

M Ejima ◽

M Taura ◽

M Masuda

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Type A ◽

External Jugular Vein ◽

Reconstruction Procedure ◽

Jugular Veins ◽

Type K ◽

Conventional Type ◽

Internal Jugular Veins ◽

Fatal Complications

AbstractBackground:During neck dissection, the current practice is to preserve the internal jugular vein in the majority of cases. However, sacrifice of bilateral internal jugular veins is required in rare cases. Simultaneous excision of both internal jugular veins is known to frequently cause fatal complications. Even if staged, bilateral internal jugular vein sacrifice still occasionally leads to fatal complications (in 2 per cent). We report two different methods of unilateral internal jugular vein reconstruction, in two cases requiring excision of bilateral internal jugular veins, and we review the significance of this reconstruction procedure.Method:The first patient underwent conventional type A reconstruction (using Katsuno's classification): end-to-end anastomosis of the internal jugular vein to the external jugular vein. For the second patient, we anastomosed the internal jugular vein to the anterior jugular vein, preserving the flow of the external jugular vein. This method, termed type K, had two main expected benefits: facial drainage via the preserved external jugular vein; and provision of a built-in safeguard in the case of occlusion (via the preserved venous networks between the internal jugular vein and the external jugular vein, e.g. the facial vein).Results:In both cases, the reconstructed internal jugular vein was patent and the post-operative course was uneventful, with no severe complications.Conclusion:The current and previous findings strongly indicate that the reconstruction of at least one internal jugular vein is highly recommended for patients requiring bilateral internal jugular vein sacrifice. Our type K method may represent a useful technique for this procedure.

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Facial Vein Variation: A Cadaveric Study

International Archives of Medicine ◽

10.3823/2547 ◽

2018 ◽

Vol 11 ◽

Author(s):

Humberto Ferreira Arquez

Keyword(s):

Head And Neck ◽

Jugular Vein ◽

Anatomical Variation ◽

Neck Region ◽

External Jugular Vein ◽

Head And Neck Region ◽

Facial Vein ◽

Variable Distance ◽

The Right ◽

The University

Background: The veins of the head and neck have a complex developmental pattern which predisposes them to variations in formation and drainage. Superficial veins of the head and neck are utilized for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology. Aims: The aim of the present study was to describe anatomical variation and determined the position of the facial vein in relation to neighboring structures. Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 16 males and 2 females, i.e. 36 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 34 sides (94.5 %) of the cases the facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The facial vein on two sides (5.5 %) was found to drain into the external jugular vein with different degree of angulations and variable distance from the angle of the mandible. On the right side, the facial vein was draining into external jugular vein (EJV), 63.6 mm below the angle of the mandible. On the left side, the facial vein was draining into EJV, 42.4 mm below the angle of the mandible. The length of the neck was 137.8 mm. The mean distance of the superior and inferior labial veins, deep facial vein, and angular vein from the inferior orbital margin was 41.89 ± 3.01, 52.31 ± 3.72, 26.85 ± 3.55 and 6.25 ± 0.65 mm, respectively. Conclusion: A sound knowledge on variation of the course and termination of facial vein is very useful for oral and maxillofacial surgeons, plastic surgeons, otorrhinologists and radiologists, is essentially important in the clinical examination and surgical procedures of the head and neck region.

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Surgical review of the anatomical variations of the internal jugular vein: an update for head and neck surgeons

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0185 ◽

2019 ◽

Vol 101 (1) ◽

pp. 2-6 ◽

Cited By ~ 6

Author(s):

S Mumtaz ◽

M Singh

Keyword(s):

Head And Neck ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Case Reports ◽

Anatomical Variations ◽

Neck Surgery ◽

Extensive Review ◽

Patient Cohort ◽

Important Landmark

Background The internal jugular vein is one of the major vessels of the neck. The anatomy of this vessel is considered to be relatively stable. It is an important landmark for head and neck surgeons as well as the anaesthetists for both diagnostic and therapeutic purposes. Methods We present two case reports of the posterior tributary of the internal jugular vein and review the surgical literature regarding anatomical variations of the vein. Findings A total of 1197 patients from 27 published papers were included in this review. Of these patients, 99.6% had neck surgery and the rest were cadaveric dissections. Anatomical variations of the internal jugular vein were found in 2% of the patient cohort (n = 40). The majority of these patients had either bifurcation or fenestration of the vein. The posterior tributary of the internal jugular vein is unusual and is scarcely reported in the literature (three cases). Knowledge of variations in the anatomy of the internal jugular vein assists surgeons in avoiding complications during neck surgery and preventing morbidity. Two rare cases of posterior branching of the internal jugular vein and experience of other surgeons are demonstrated in this extensive review.

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

Journal of Morphological Sciences ◽

10.4322/jms.093815 ◽

2016 ◽

Vol 33 (01) ◽

pp. 022-028 ◽

Cited By ~ 2

Author(s):

M. Silva ◽

J. Henriques ◽

J. Silva ◽

V. Camargos ◽

P. Moreira

Keyword(s):

Head And Neck ◽

Surgical Planning ◽

Jugular Vein ◽

Diagnostic Procedures ◽

External Jugular Vein ◽

Jugular Veins ◽

Morphological Variations ◽

Facial Vein ◽

The Face ◽

The Common

Abstract Introduction: The knowledge of morphological variations of the veins of the head and neck is essential for health professionals, both for diagnostic procedures as for clinical and surgical planning. This study described changes in the following structures: retromandibular vein and its divisions, including the relationship with the facial nerve, facial vein, common facial vein and jugular veins. Material and Methods: The variations of the veins were analyzed in three heads, five hemi-heads (right side) and two hemi-heads (left side) of unknown age and sex. Results: The changes only on the right side of the face were: union between the superficial temporal and maxillary veins at a lower level; absence of the common facial vein and facial vein draining into the external jugular vein. While on the left, only, it was noted: posterior division of retromandibular, after unite with the common facial vein, led to the internal jugular vein; union between the posterior auricular and common facial veins to form the external jugular and union between posterior auricular and common facial veins to terminate into internal jugular. The absence of the anterior and posterior divisions of retromandibular vein was observed on both sides of the face. Conclusion: These findings provide relevant informations about important vessels of the head and neck and will contribute to the appropriate clinical and / or surgical planning, aiming at the preservation of important structures.

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Primary Cutaneous Granulomatous Phlebitis of the External Jugular Vein

Phlebology The Journal of Venous Disease ◽

10.1177/026835550201600309 ◽

2002 ◽

Vol 16 (3) ◽

pp. 125-127

Author(s):

S. Shetty ◽

S. Gupta ◽

P. Makhija ◽

S. Hasan

Keyword(s):

Jugular Vein ◽

Inflammatory Diseases ◽

Histopathological Examination ◽

Granulomatous Inflammation ◽

Neck Surgery ◽

Neck Mass ◽

External Jugular Vein ◽

College Hospital ◽

Medical College ◽

The Right

Design: Case report. Setting: Department of Otolaryngology and Head and Neck Surgery, St. John's Medical College Hospital, India. Patient: A 22-year-old man with a cord-like neck mass of 6 months' duration. Investigations and intervention: Investigations included Doppler ultrasound of the neck, which showed thrombosis of the right external jugular vein. Wedge biopsy revealed a granulomatous inflammation with focal necrosis completely replacing the vessel. Serological testing for vasculitides was negative. Transcervical excision of the vein was carried out after identifying normal vessel distally and proximally. Histopathological examination of the vein proved the lesion consistent with primary cutaneous granulomatous phlebitis (PCGP). Conclusion: Isolated venous inflammatory diseases with neither identifiable active vasculitis nor arteritis are rarely seen. PCGP is distinctly unusual. We report a case of PCGP of the external jugular vein presenting as an elongated cord-like nodular lesion in the lateral neck of insidious onset.

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Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

Otolaryngology ◽

10.1177/0194599819846458 ◽

2019 ◽

Vol 161 (1) ◽

pp. 3-5

Author(s):

Andrés M. Bur ◽

Richard M. Rosenfeld

Keyword(s):

Clinical Practice ◽

American Academy ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Current Knowledge ◽

Clinical Care ◽

Neck Surgery ◽

Head And Neck Surgery ◽

The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

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