Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Journal of the Anatomical Society of India

Unusual Venous Drainage Pattern of Face: A Case Report

Author(s): Mehra,S. Kaul J.M. and Das S.

Vol. 52, No. 1 (2003-01 - 2003-12)

Department of Anatomy, Maulana Azad Medical College, N. Delhi INDIA

Abstract

During rountine dissection in the department of Anatomy an unusual drainage pattern of the veins of the right side of theface was observed. The superficial temporal vein united with the maxillary vein to form the retromandibular vein within the substance of theright parotid gland. The facial vein joined with the submental vein and formed a common venous channel that joined with the retromandibularvein near the angle of mandible to form the common facial vein that drained into the internal jugular vein. A vein connected the anterior jugularand common facial veins. The possible developmental basis for this variation suggests persistence of the embryonic pattern observed in the18 mm stage of the embryo. Knowledge of such variations is important for surgeons performing head and neck microvascular surgeries. Facial veins are often grafted into the carotid during endarterectomy. The retromandibular vein is used as a guide to expose the facial nervebranches in superficial parotidectomy and in the open reduction of mandibular condylar fractures.

Key words: Facial vein; Retromandibular vein.

Introduction:

The complex embryological development of the vascular system often results in a myriad of clinically relevant anomalies. Variations in the drainage pattern of the veins of the face have been observed in the past (Kopuz et al, 1995b; Choudhry et al, 1997; Peuker et al, 2001). The standard anatomical description of the veins of the face is of the superficial temporal vein uniting with the maxillary vein to form the retromandibular vein (RMV) within the substance of the parotid gland. The RMV divides into its anterior and posterior divisions before emerging out at the apex of the gland. The anterior division joins with the facial vein (FV) slightly inferior and anterior to the angle of the mandible to form the common facial vein that drains into the internal jugular vein. The posterior division unites with the posterior auricular vein to form the external jugular vein. The relevance and importance of varied drainage patterns of the veins of the head and neck warrant attention for their use in surgeries involving microvascular anastomosis.

Case report:

The following variations were observed in the drainage of the right RMV during routine dissection in an adult male cadaver aged 52 years. The facial vein was found running downards and backwards at the anterior border of masseter. It united with the submental vein to form a common venous channel. The RMV was dissected out of the substance of the right parotid gland. The common venous channel (length 1.5cm) united with the RMV at the angle of the mandible to form the common facial vein which united with the internal jugular vein after running a length of 2.7 cm. The common facial vein was joined by a venous channel which ran inferior to the submandibular gland. This venous channel was found to be originating from the right anterior jugular vein. The length of RMV from its formation (union of maxillary vein and superficial temporal vein) till its union with the common venous channel measured 3.8cm. Moreover, the RMV did not divide into its customary anterior or posterior divisions (Figs 1,2). A thin venous channel was observed running down from the scalp in the position occupied by posterior auricular vein, and drained into the subclavian vein. The drainage pattern on the left side of the face was found to be normal.

Discussion:

The RMV has been reported (Kopuz et al, 1995b) to unite with the facial vein at a higher level in the right parotid gland. A case of the right facial vein draining into the superficial temporal vein 5 mm cranial to an undivided RMV has been reported by Peuker et al (2001). However, the termination of the RMV has not been described by these authors. Facial vein terminating into the external jugular vein has also been reported in literature (Choudhry et al, 1997). There is a preponderance of venous variations on the right side of the face as observed in literature and is also seen in the present case.

Embryological Hypothesis

The veins draining regions of the face and neck establish their identity only after the development of the skull. The first identifiable vein is the ventral pharyngeal vein (VPV) which drains the mandibular and hyoid arches. The VPV drains into the common cardinal vein. As the neck of the growing embryo (10 mm stage, Fig. 3) elongates, the termination of VPV is transferred to the cranial part of the precardinal vein which later becomes the internal jugular vein (Williams et al, 1985.) The VPV receives tributaries from the face and tongue to be now known as linguofacial vein. A second venous channel situated superolateral to VPV, termed primitive maxillary vein, anastomoses with linguofacial vein to form the anterior facial vein (Frazer, 1931). A strong tributary draining the temporal region termed the RMV drains into the linguofacial vein (18mm stage of the embryo) to form a common trunk named the common facial vein which drains into the precardinal vein (Fig. 4). At about 22 mm stage of embryo the external jugular vein appears from the tissue of the neck and anatomoses with anterior facial vein (Padgett, 1957). In the normal course of development, the external jugular vein has an anterior connection with facial vein and a posterior connection with the RMV. The posterior auricular vein drains into the posterior connection. The anterior connection later retrogresses and the RMV drains into the internal jugular vein via the common facial vein. In the present case, a hypothesis can be resurrected by the fact that the external jugular vein failed to develop its posterior connection with the RMV with the persistence of the connection between the common facial and precardinal veins as seen in the 18mm stage of the embryo. Probably the posterior auricular vein, which drains into the posterior connection of the external jugular vein, remained as a single channel draining into the subclavian vein.

Knowledge of the varying venous patterns in the region of the face is important for the surgeons in order to avoid any intra-operative trial and error procedures which might lead to unnecessary bleeding (Nagase et al, 1997). The superficial temporal and the retromandibular veins have been reported to be used as guides to expose facial nerve branches in the parotid gland in cases of open reduction of mandibular condyle fractures and also for superficial parotidectomy (Kawakami et al, 1994; Kopuz et al, 1995a). These veins are usually grafted into the carotid during endarterectomy and for surgery involving microvascular anastomosis especially in oral reconstruction procedures (Sabharwal & Mukherjee, 1998).

References:

  1. Choudhry R., Tuli A.,Choudhry S. (1997); Facial vein terminating in the external jugular vein. An embryological interpretation. Surgical Radiological Anatomy 19 : 73-77.
  2. Frazer J.E. A manual of embryology : The development of the human body. Bailiere Tindall and Cox. London, p 321. (1931)
  3. Kawakami S., Tsukada, S., Taniguchi W. (1994): The superficial temporal and retromandibular veins as guides to expose the facial nerve branches. Annals of Plastic Surgery 32(2) : 295-299.
  4. Kopuz C., llgi S., Yavuz S., Onderoglu S. (1995a) : Morphology of the retromandibular vein in relation to the facial nerve in the parotid gland. Acta Anatomica (Basel) 152(1) : 6 68.
  5. Kopuz C., Yavuz, S., Cumhur M.,Tftik S., llgi S. (1995b) : An unusual coursing of the facial vein. Kaibogaku Zasshi 70 : 20-22
  6. Nagase T., Kobayashi S., Sekiya S., Ohmori K. (1997) : Anatomical evaluation of the facial artery and vein using color Doppler ultrasonography. Annals of Plastic Surgery 39 : 64 67.
  7. Padgett D.H. (1957) : The development of the cranial venous system in man, from the viewpoint of comparative anatomy. Contributions to Embryology 247 : 79-140.
  8. Peuker E.T., Fischer G., Filler T.J. (2001) : Correspondence - Facial vein terminating in the superficial temporal vein : a case report. Journal of Anatomy 198 : 509-510.
  9. Sabharwal P., Mukerjee D. (1998) : Autogenous common facial vein or external jugular vein patch for carotid endarterectomy. Cardiovascular Sugery 6 : 594-597.
  10. Williams P.L. Warwick R., Dyson M., Bannister L.H. : Gray's Anatomy In : Angiology 36th edn.; Churchill Livingstone. Edinburg. p 196 (1985).

Missing Image

Figure 1

Photograph of dissected right side of the face showing:

1, retromandibular vein;
2, facial vein;
3, submental vein;
4, common venous channel;
5, common facial vein;
6, internal jugular vein;
7, vein from anterior jugular vein;
8,submandibular gland;
9, parotid gland;
10, masseter

Missing Image

Figure 2

Line diagram representative of Figure 1.

Missing Image

Figure 3 : Venous drainage pattern of face and neck in a 10 mm long human embryo.

PMV-Premaxillary vein;
VPV Ventral Pharyngeal vein;
CCV-Common Cardinal Vein;
PCV-Precardinal vein.
(Modified from Padgett, 1957)

Missing Image

Figure 4 : Changes in the venous drainage pattern in 18mm stage of human embryo.

RMV, retromandibular vein ; LFV, linguofacial vein

[Modified from Padgett (1957)]

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica