Variations of the external veins of the face and neck – especially the facial and the external jugular veins are not common. There is a report of facial vein draining into superficial temporal vein
2. A study of dissection of 89 cadavers has revealed facial vein draining into external jugular vein in 9% of the specimens
3. In another study of head and neck dissections of 40 cadavers of Indian origin to detect variations of the external jugular vein showed facial vein draining into external jugular vein in 5% of the cases
4. In the current study the facial vein drained into external jugular vein in 1.3% of the specimens. The common facial vein draining into external jugular vein and low formation of external jugular vein has not been reported in the literature. The variations of the superficial veins of the face and neck are of particular importance for different surgical procedures. These veins may be used as patches for carotid endarterectomy and for oral reconstruction
5. In the latter case the facial vein is often needed for microvascular anastomosis. The external jugular vein is increasingly being utilized for cannulation to conduct diagnostic procedures or intravenous therapies. The retromandibular vein is used as a guide to expose the facial nerve branches in superficial parotidectomy and in the open reduction of mandibular condylar fractures. Remembering the varying venous patterns in the head and face region and to avoid an intraoperative ‘trial-and-error’ procedure it is important to evaluate preoperatively the course and branching patterns of the respective vessels, e.g. by means of Doppler ultrasonography
6.
The anomalous drainage of veins is of great significance for vascular surgeons, who are required to command a wide range of anatomical knowledge. In surgery such as carotid endarterectomy, the carotid sheath is opened along the anterior border of the internal jugular vein; the common facial vein, which joins the internal jugular vein just above the carotid bifurcation, provides a useful landmark for the location of the carotid bifurcation. Knowledge of anomalous drainage of the facial vein is therefore important to avoid an inappropriate dissection which may cause severe damage.
The development of reconstructive microsurgery has paralleled the discovery of the true nature of the circulation of the skin. The robust circulation of the head and neck region permits the design of many cutaneous flaps such as the platysma flap or a sternocleidomastoid myocutaneous flap. Venous anomalies and variations of the superficial venous system are therefore important to know, to avoid damage to fascia and ensure survival of the flap7.
Knowledge of variations in the external jugular vein is of great importance as this is an important drainage site for shunt procedures involving the lateral ventricle in hydrocephalus surgery. Various other applications e.g., percutaneous central vein cannulation, maxillo-facial surgery, biocompatibility studies for synthetic materials for prostheses, total parentral nutrition in critically ill patients, invasive monitoring, etc. all make use of this vein. A sound anatomic knowledge of the formation, course and tributaries of the external jugular vein is essential to the success of surgical procedures in this region.
There are reports of lateral position of external carotid artery8–10. In a study lateral position of the external carotid artery was seen in 17 cases (4.3%), of which 13 cases were on the right side and 4 cases on the left8. It is necessary to know the lateral position of the external carotid artery for the correct diagnosis by intravenous digital subtraction angiography (IVDSA) and doppler scanning. During bleeding from terminal branches of external carotid artery occasionally it is necessary to consider ligation of the artery. It is very important to ensure that the artery being ligated is indeed the external carotid artery rather than internal carotid as ligation of latter causes a high risk of hemi paresis. An unusual case of peripheral hypoglossal nerve palsy, caused by lateral position of the external carotid artery and an abnormally high carotid bifurcation has been reported11. Improvement followed ligation and cutting of the external carotid artery at its origin. The present variation may be of particular interest to surgeons and anatomists.
Knowledge of variations of the external carotid artery and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endoplasty for the treatment of carotid stenosis12,13 or extracranial-intracranial arterial bypass for the treatment of patients with occlusive cerebrovascular disease, skull-base tumors or aneurysms14.