Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review
Abstract
:1. Introduction
2. Origin and Drainage of the External Jugular Vein
2.1. Topography of the External Jugular Vein
2.1.1. Relations of External Jugular Vein with Cervical Nerves
2.1.2. Relation of the External Jugular Vein to Neck Muscles
2.1.3. Relation of the External Jugular Vein with Lymph Nodes
2.2. Morphology of the External Jugular Vein
2.3. The External Jugular Vein’s Tributaries
3. Anastomoses of the External Jugular Vein
4. Anatomical Variations of the External Jugular Vein
4.1. Duplication and Fenestration of the External Jugular Vein
4.1.1. Fenestrations Reported as Duplicated External Jugular Veins
4.1.2. Unidentified Duplications of the External Jugular Vein
4.1.3. False Duplications of the External Jugular Vein Reported as True Ones
4.1.4. Triplication of EJV
4.1.5. External Jugular Vein’s Fenestration
4.1.6. Successive EJV Fenestrations/Double Fenestrated EJV
4.1.7. Retromandibular Vein’s Fenestrations
4.1.8. Bifurcated External Jugular Vein
4.2. Complex Venous Design on the Sternocleidomastoid Muscle
4.3. Absent External Jugular Vein
4.4. Aberrant Origin or Course of the External Jugular Vein
4.5. Hypoplastic External Jugular Veins
4.6. Various Topography of the External Jugular Vein
4.7. Multiple External Jugular Veins
4.8. Internal Jugular Vein Drainage of the External Jugular Vein
5. Clinical Applications
5.1. External Jugular Vein Cannulation
5.2. External Jugular Vein Phlebectasia
5.3. External Jugular Vein Aneurysm
5.4. External Jugular Vein Phlebectasia and Aneurysm
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gray, H.; Standring, S.; Anand, N.; Birch, R.; Collins, P.; Crossman, A.; Gleeson, M.; Jawaheer, G.; Smith, A.L.; Spratt, J.D.; et al. Gray’s Anatomy: The Anatomical Basis of Clinical Practice; Elsevier: London, UK, 2016. [Google Scholar]
- Lengele, B.; Hamoir, M.; Scalliet, P.; Gregoire, V. Anatomical bases for the radiological delineation of lymph node areas. Major collecting trunks, head and neck. Radiother. Oncol. 2007, 85, 146–155. [Google Scholar] [CrossRef] [PubMed]
- Rusu, M.C.; Radoi, P.M.; Toader, C. The transcerebral laterocavernous vein, a form of persisting primitive tentorial sinus. Surg. Radiol. Anat. 2022, 44, 1471–1474. [Google Scholar] [CrossRef] [PubMed]
- Minca, D.I.; Rusu, M.C.; Radoi, P.M.; Hostiuc, S.; Toader, C. Transcallosal and Pericallosal Courses of the Anterior Cerebral Artery. Medicina 2022, 58, 1365. [Google Scholar] [CrossRef] [PubMed]
- Minca, D.I.; Rusu, M.C.; Radoi, P.M.; Hostiuc, S.; Toader, C. A New Classification of the Anatomical Variations of Labbe’s Inferior Anastomotic Vein. Tomography 2022, 8, 2182–2192. [Google Scholar] [CrossRef] [PubMed]
- Choudhry, R.; Tuli, A.; Choudhry, S. Facial vein terminating in the external jugular vein. An embryologic interpretation. Surg. Radiol. Anat. 1997, 19, 73–77. [Google Scholar] [CrossRef] [PubMed]
- Manta, M.D.; Jianu, A.M.; Rusu, M.C.; Popescu, S.A. Launay’s External Carotid Vein. Medicina 2021, 57, 985. [Google Scholar] [CrossRef] [PubMed]
- Aboudib Junior, J.H.; de Castro, C.C. Anatomical variations analysis of the external jugular vein, great auricular nerve, and posterosuperior border of the platysma muscle. Aesthetic Plast. Surg. 1997, 21, 75–78. [Google Scholar] [CrossRef]
- Singh, R. Abnormal Formation of External Jugular Vein and its Repercussions. J. Craniofacial Surg. 2020. [Google Scholar] [CrossRef]
- Ono, K.; Yoshioka, N.; Hage, D.; Ibaragi, S.; Tubbs, R.S.; Iwanaga, J. Duplication of the external jugular vein: A language barrier of database search in classic anatomical studies. Surg. Radiol. Anat. 2021, 43, 1721–1728. [Google Scholar] [CrossRef]
- Shenoy, V.; Saraswathi, P.; Raghunath, G.; Karthik, J.S. Double external jugular vein and other rare venous variations of the head and neck. Singap. Med. J. 2012, 53, e251–e253. [Google Scholar]
- Paraskevas, G.; Natsis, K.; Ioannidis, O.; Kitsoulis, P.; Anastasopoulos, N.; Spyridakis, I. Multiple variations of the superficial jugular veins: Case report and clinical relevance. Acta Med. (Hradec Kral.) 2014, 57, 34–37. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Deslaugiers, B.; Vaysse, P.; Combes, J.M.; Guitard, J.; Moscovici, J.; Visentin, M.; Vardon, D.; Becue, J. Contribution to the study of the tributaries and the termination of the external jugular vein. Surg. Radiol. Anat. 1994, 16, 173–177. [Google Scholar] [CrossRef] [PubMed]
- Murphy, R.; Dziegielewski, P.; O’Connell, D.; Seikaly, H.; Ansari, K. The great auricular nerve: An anatomic and surgical study. J. Otolaryngol. Head. Neck Surg. 2012, 41 (Suppl. S1), S75–S77. [Google Scholar] [PubMed]
- McKinney, P.; Katrana, D.J. Prevention of injury to the great auricular nerve during rhytidectomy. Plast. Reconstr. Surg. 1980, 66, 675–679. [Google Scholar] [CrossRef] [PubMed]
- Tubbs, R.S.; Loukas, M.; Salter, E.G.; Oakes, W.J. Wilhelm Erb and Erb’s point. Clin. Anat. 2007, 20, 486–488. [Google Scholar] [CrossRef]
- Landers, J.T.; Maino, K. Clarifying Erb’s point as an anatomic landmark in the posterior cervical triangle. Dermatol. Surg. 2012, 38, 954–957. [Google Scholar] [CrossRef]
- Bechmann, S.; Rahman, S.; Kashyap, V. Anatomy, Head and Neck, External Jugular Veins. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2022. [Google Scholar]
- Saito, H.; Tsuda, G.; Ohtsubo, T.; Noda, I.; Fujieda, S.; Saito, T. Platysma myocutaneous flap including the external jugular vein with special reference to neck dissection. ORL J. Otorhinolaryngol. Relat Spec. 1998, 60, 218–223. [Google Scholar] [CrossRef]
- Agarwal, A.; Schneck, C.D.; Kelley, D.J. Venous drainage of the platysma myocutaneous flap. Otolaryngol. Head Neck Surg. 2004, 130, 357–359. [Google Scholar] [CrossRef]
- Kadletz-Wanke, L.; Oberndorfer, F.; Grabner, E.; Kenner, L.; Schrogendorfer, K.F.; Heiduschka, G. Evaluation of the External Jugular Vein Overlying the Sternocleidomastoid Muscle as Venous Lymph-Node Flap. J. Clin. Med. 2022, 11, 1812. [Google Scholar] [CrossRef]
- Visconti, G.; Constantinescu, T.; Araki, J.; Salgarello, M.; Chen, H.C. The venous lymph node flap for the treatment of peripheral lymphedema: Preliminary evidence. Microsurgery 2017, 37, 86–87. [Google Scholar] [CrossRef] [Green Version]
- Stickle, B.R.; McFarlane, H. Prediction of a small internal jugular vein by external jugular vein diameter. Anaesthesia 1997, 52, 220–222. [Google Scholar] [CrossRef] [PubMed]
- Feneis, H.; Dauber, W. Pocket Atlas of Human Anatomy: Based on the International Nomenclature; Thieme: Stuttgart, Germany; New York, NY, USA, 2000. [Google Scholar]
- Pernkopf, E. Atlas of Topographical and Applied Human Anatomy; Lippincott Williams and Wilkins: Philadelphia, PA, USA, 1980. [Google Scholar]
- Gupta, V.; Tuli, A.; Choudhry, R.; Agarwal, S.; Mangal, A. Facial vein draining into external jugular vein in humans: Its variations, phylogenetic retention and clinical relevance. Surg. Radiol. Anat. 2003, 25, 36–41. [Google Scholar] [CrossRef] [PubMed]
- Vollala, V.R.; Bolla, S.R.; Pamidi, N. Important vascular anomalies of face and neck–a cadaveric study with clinical implications. Firat Tip Derg. 2008, 13, 123–126. [Google Scholar]
- Itoo, M.S.; Banoo, S.; Bhat, G.M.; Shah, B.A.; Itoo, O.B.; Akhter, F.; Makdomi, M.A. Anatomical variations in the superficial veins of head and neck and their clinical significance. Int. J. Basic Appl. Sci. 2013, 2, 319. [Google Scholar] [CrossRef]
- Vaida, M.A.; Niculescu, V.; Motoc, A.; Bolintineanu, S.; Sargan, I.; Niculescu, M.C. Correlations between anomalies of jugular veins and areas of vascular drainage of head and neck. Rom. J. Morphol. Embryol. 2006, 47, 287–290. [Google Scholar] [PubMed]
- Pai, M.; Vadgaonkar, R.; Prabhu, L.; Shetty, P. The different termination patterns of the facial vein: A cadaveric study. Fırat Tıp Derg. 2008, 13, 32–34. [Google Scholar]
- Bergman, R.A.; Tubbs, R.S.; Shoja, M.M.; Loukas, M. Bergman’s Comprehensive Encyclopedia of Human Anatomic Variation; John Wiley & Sons: Hoboken, NJ, USA, 2016. [Google Scholar]
- Dalip, D.; Iwanaga, J.; Loukas, M.; Oskouian, R.J.; Tubbs, R.S. Review of the Variations of the Superficial Veins of the Neck. Cureus 2018, 10, e2826. [Google Scholar] [CrossRef] [Green Version]
- Watanabe, K.; Shoja, M.M.; Loukas, M.; Tubbs, R.S. Anatomy for Plastic Surgery of the Face, Head and Neck; Thieme: New York, NY, USA, 2016. [Google Scholar]
- Dubhashi, S.P.; Subnis, B.M.; Sindwani, R.D. Theodor e. Kocher. Indian J. Surg. 2013, 75, 383–384. [Google Scholar] [CrossRef] [Green Version]
- Satheesha Nayak, B.; Soumya, K. Abnormal formation and communication of external jugular vein. Int. J. Anat. Var. 2008, 1, 15–16. [Google Scholar]
- Healey, J.E. Surgical Anatomy; B.C. Decker Inc.: Hamilton, ON, Canada, 1990. [Google Scholar]
- Agur, A.M.; Dalley, A.F. Grant’s Atlas of Anatomy; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2009. [Google Scholar]
- Gray, H. Anatomy of the Human Body; Lea & Febiger: Philadelphia, PA, USA, 1918. [Google Scholar]
- Bulbul, E.; Yanik, B.; Demirpolat, G.; Koksal, V.J.S.; Anatomy, R. Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography. Surg. Radiol. Anat. 2015, 37, 1191–1194. [Google Scholar] [CrossRef]
- Rouviere, H.; Delmas, A. Anatomie Humaine. In Tête et cou; Masson: Paris, France, 1985. [Google Scholar]
- Snoj, Z.; Cvetko, E. A case of unilateral fenestration and duplication of the external jugular vein. Int. J. Morphol. 2013, 31, 107–109. [Google Scholar] [CrossRef] [Green Version]
- Thomas, A.J.; Germanwala, A.V.; Vora, N.; Prevedello, D.M.; Jovin, T.; Kassam, A.; Horowitz, M. Dual origin extracranial vertebral artery: Case report and embryology. J. Neuroimag. 2008, 18, 173–176. [Google Scholar] [CrossRef]
- Polguj, M.; Podgorski, M.; Jedrzejewski, K.; Topol, M.; Majos, A. Fenestration and duplication of the vertebral artery: The anatomical and clinical points of view. Clin. Anat. 2013, 26, 933–943. [Google Scholar] [CrossRef] [PubMed]
- Comert, E.; Comert, A. External jugular vein duplication. J. Craniofacial Surg. 2009, 20, 2173–2174. [Google Scholar] [CrossRef]
- Olabu, B.O.; Loyal, P.K.; Matiko, B.W.; Nderitu, J.M.; Misiani, M.K.; Ogeng’o, J.A. Variant anatomy of the external jugular vein. Anat. J. Afr. 2015, 4, 518–527. [Google Scholar]
- Pillay, P.; Ishwarkumar, S.; Satyapal, K. Variations of the external and internal jugular veins: A fetal study. Int. J. Morphol. 2018, 36, 145–148. [Google Scholar] [CrossRef] [Green Version]
- Singla, R.K.; Singla, S.; Sachdeva, K. Partial duplication of external jugular vein forming a venous ring around supraclavicular nerve: A case report. J. Clin. Diagn. Res. JCDR 2011, 5, 859–861. [Google Scholar]
- Gerard, N.O., III; Tubbs, R.S.; Iwanaga, J. Duplicated transverse cervical nerve and external jugular vein. Anat. Cell Biol. 2021, 54, 404–406. [Google Scholar] [CrossRef]
- Cvetko, E. A case of left-sided absence and right-sided fenestration of the external jugular vein and a review of the literature. Surg. Radiol. Anat. 2015, 37, 883–886. [Google Scholar] [CrossRef]
- Cvetko, E. A case of unilateral fenestration of the external jugular vein, through which the cervical branch of the facial nerve passes. Anat. Sci. Int. 2013, 88, 151–152. [Google Scholar] [CrossRef]
- Ponnambalam, S.B.; Karuppiah, D.S. Unilateral external jugular vein fenestration with variant anatomy of the retromandibular and facial vein. Anat. Cell Biol. 2020, 53, 117. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sugiyama, S.; Iwai, T.; Tohnai, I. Empty fenestration of the external jugular vein: A rare variant. J. Anat. Soc. India 2017, 66, S1–S3. [Google Scholar] [CrossRef]
- Eskell, M.J.; Bickerton, R.D.; Guy, I.A.; Jefferies, B.J. A case of unilateral fenestration of the external jugular vein in a male cadaver with a review of existing literature. Int. J. Case Rep. Images 2019, 10, 101048Z101001ME102019. [Google Scholar]
- Vani, P.C.; Rajasekhar, S.; Gladwin, V. Unusual and multiple variations of head and neck veins: A case report. Surg. Radiol. Anat. 2019, 41, 535–538. [Google Scholar] [CrossRef]
- Téllez-Hernández, L.V.; Tibaduiza-Rodriguez, I.A.; Ferreira-Arquez, H. Unilateral anatomical variation in the venous drainage of face and neck. Int. J. Pharm. Res. 2019, 11, 1152–1155. [Google Scholar]
- Prigge, L.; Bosenberg, A.T.; van Schoor, A.N. External jugular vein pierced by supraclavicular branches in a neonatal cadaver: A case report. Anat. Sci. Int. 2021, 96, 564–567. [Google Scholar] [CrossRef]
- Ccorahua-Rios, M.S.; Ccahuantico-Choquevilca, L.A.; Bernaola-Sanchez, J.B.; Miranda-Solis, F.; Choque-Velasquez, J. Supraclavicular nerve entrapment by the external jugular vein: An unreported finding. Morphologie 2022, 106, 52–55. [Google Scholar] [CrossRef]
- Rao, S.; Pandey, S.; Kumar, Y.; Rao, S. Bifurcation of external jugular vein: An anatomical variation during neck dissection. Oral Maxillofac. Surg. 2018, 22, 475–476. [Google Scholar] [CrossRef]
- Patil, J.; Kumar, N.; Swamy, R.S.; D’Souza, M.R.; Guru, A.; Nayak, S.B. Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region. Anat. Cell Biol. 2014, 47, 135–137. [Google Scholar] [CrossRef] [Green Version]
- Balachandra, N.; Padmalatha, K.; Prakash, B.; Ramesh, B. Variation of the veins of the head and neck—External jugular vein and facial vein. Int. J. Anat. Var. 2012, 5, 99–101. [Google Scholar]
- Sakthivel, S.; Verma, S. Concomitant Occurrence of Fenestrated Internal Jugular Vein and Sub-omohyoid External Jugular Vein: A Case Report. Acad. Anat. Int. 2018, 4, 7–9. [Google Scholar] [CrossRef] [Green Version]
- Oguzkurt, L. Ultrasonography study on the segmental aplasia of the great saphenous vein. Phlebology 2014, 29, 447–453. [Google Scholar] [CrossRef]
- Caggiati, A.; Mendoza, E. Segmental hypoplasia of the great saphenous vein and varicose disease. Eur. J. Vasc. Endovasc. Surg. 2004, 28, 257–261. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moore, K.L.; Dalley, A.F. Clinically Oriented Anatomy; Wolters Kluwer India Pvt Ltd.: Chandigarh, India, 2018. [Google Scholar]
- Pikkieff, E. On subcutaneous veins of the neck. J. Anat. 1937, 72, 119. [Google Scholar]
- Casey, W.J., 3rd; Rebecca, A.M.; Smith, A.A.; Craft, R.O.; Buchel, E.W. The cephalic and external jugular veins: Important alternative recipient vessels in left-sided microvascular breast reconstruction. Microsurgery 2007, 27, 465–469. [Google Scholar] [CrossRef]
- Deipolyi, A.; Karaosmanoglu, A.; Habito, C.; Brannan, S.; Wicky, S.; Hirsch, J.; Oklu, R. The role of bilateral inferior petrosal sinus sampling in the diagnostic evaluation of Cushing syndrome. Diagn. Interv. Radiol. 2012, 18, 132–138. [Google Scholar] [CrossRef] [Green Version]
- Peterson, K.A.; Burnette, C.D.; Fargen, K.M.; Brown, P.A.; West, J.L.; Tatter, S.B.; Wolfe, S.Q. External jugular venous sampling for Cushing’s disease in a patient with hypoplastic inferior petrosal sinuses. J. Neurosurg. 2020, 132, 1–4. [Google Scholar] [CrossRef] [PubMed]
- Bingger, W.; Mitchell, R.H.; Harron, D.W.G.; McKaigue, J.P.; McAloney, R.B. Real time analysis of Valsalva’s Maneuver. Comput. Biol. Med. 1989, 19, 319–329. [Google Scholar] [CrossRef] [PubMed]
- Matsuba, H.M.; Thawley, S.E.; Smith, P.G. Internal jugular phlebectasia. Head Neck Surg. 1985, 7, 431–433. [Google Scholar] [CrossRef]
- Al-Shaikhi, A.; Kay, S.; Laberge, J.M. External jugular venous aneurysm: An unusual cause of a neck mass in a young child. J. Pediatr. Surg. 2003, 38, 1557–1559. [Google Scholar] [CrossRef]
- Kim, S.W.; Chang, J.W.; Lee, S. Unusual Presentation of a Cervical Mass Revealed as External Jugular Venous Aneurysm. Vasc. Spec. Int. 2016, 32, 205–207. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Essa, R.A.; Ahmed, S.K.; Bapir, D.H.; Rasul, S.A.; Abubakr, C.P.; Hamad, S.Q. Thrombosed external jugular vein aneurysm mimics to a branchial cyst: A novel case from Iraq and review of the literature. Ann. Med. Surg. (Lond.) 2021, 67, 102533. [Google Scholar] [CrossRef] [PubMed]
- Mohanty, D.; Jain, B.K.; Garg, P.K.; Tandon, A. External jugular venous aneurysm: A clinical curiosity. J. Nat. Sci. Biol. Med. 2013; 4, 223–225. [Google Scholar]
- Fisher, C.B.; Mattox, D.E.; Zinreich, J.S. Patency of the internal jugular vein after functional neck dissection. Laryngoscope 1988, 98, 923–927. [Google Scholar] [CrossRef] [PubMed]
- Leontsinis, T.G.; Currie, A.R.; Mannell, A. Internal jugular vein thrombosis following functional neck dissection. Laryngoscope 1995, 105, 169–174. [Google Scholar] [CrossRef]
- Beale, T.J.; Smedley, F.H.; Knee, G. Thrombosis within an external jugular venous aneurysm. J. R. Coll. Surg. Edinb. 1996, 41, 181–182. [Google Scholar]
- Neto, T.; Balhau, R.; Coelho, L.; Pinto, I.; Correia-Sa, I.; Silva, A. Thrombosed Aneurysm of the External Jugular Vein: A Rare Cause of Cervical Mass. J. Craniofacial Surg. 2016, 27, e36–e37. [Google Scholar] [CrossRef]
- Ioannou, C.V.; Kostas, T.; Tsetis, D.; Georgakarakos, E.; Gionis, M.; Katsamouris, A.N. External jugular vein aneurysm: A source of thrombotic complications. Int. Angiol. 2010, 29, 284–285. [Google Scholar]
- Verma, R.K.; Kaushal, D.; Panda, N.K. External jugular vein aneurysm with thrombus presenting as painful neck mass: A case report. Oman Med. J. 2013, 28, 278–280. [Google Scholar] [CrossRef]
- Hopsu, E.; Tarkkanen, J.; Vento, S.I.; Pitkäranta, A. Acquired jugular vein aneurysm. Int. J. Otolaryngol. 2009, 2009, 535617. [Google Scholar] [CrossRef]
- Schatz, I.J.; Fine, G.J. Venous aneurysms. N. Engl. J. Med. 1962, 266, 1310–1312. [Google Scholar] [CrossRef]
- Uzun, C.; Taskinalp, O.; Koten, M.; Adali, M.K.; Karasalihoglu, A.R.; Pekindil, G. Phlebectasia of left anterior jugular vein. J. Laryngol. Otol. 1999, 113, 858–860. [Google Scholar] [CrossRef] [PubMed]
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Rusu, M.C.; Tudose, R.C.; Vrapciu, A.D.; Toader, C.; Popescu, Ş.A. Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review. Medicina 2023, 59, 622. https://doi.org/10.3390/medicina59030622
Rusu MC, Tudose RC, Vrapciu AD, Toader C, Popescu ŞA. Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review. Medicina. 2023; 59(3):622. https://doi.org/10.3390/medicina59030622
Chicago/Turabian StyleRusu, Mugurel Constantin, Răzvan Costin Tudose, Alexandra Diana Vrapciu, Corneliu Toader, and Şerban Arghir Popescu. 2023. "Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review" Medicina 59, no. 3: 622. https://doi.org/10.3390/medicina59030622