eISSN 1308-4038
International Journal of Anatomical Variations (2013) 6: 140–142
Case Report
Variant formation of external jugular vein and branching pattern of external
carotid artery
Published online September 11th, 2013 © http://www.ijav.org
Porwal SATISHKUMAR S
Bidwe ARCHANA S
Joshi DEEPAK S
Department of Anatomy, S. R. T. R. Medical College,
Ambajogai, Maharashtra, INDIA.
Dr. Porwal Satishkumar S.
Assistant Professor
Department of Anatomy
S. R. T. R. Medical College
Ambajogai 431517
Dist. Beed, Maharashtra, INDIA.
+91 244 6244326
satish27181@ yahoo.co.in
Received June 21th, 2012; accepted March 27th, 2013
Abstract
Vascular variations in the face and neck region are quiet common. These variations are
important for clinicians, surgeons and radiologists while performing diagnostic and therapeutic
procedures.
In the present study the right retromandibular vein continuing as external jugular vein instead
of dividing into anterior and posterior division. The facial vein was opening into external jugular
vein at the level of angle of mandible. The external jugular vein drained into internal jugular vein.
The course of internal jugular vein was as usual.
At the same time on left external carotid artery gave a common trunk at the level of tip of greater
horn of hyoid bone which was 5-7 mm in length. This common trunk later divided into superior
thyroid artery, lingual artery and facial artery. The course and distribution of these arteries
showed no variation. Formation, division, termination of veins was normal. Right side showed
usual branching pattern of external carotid artery.
© Int J Anat Var (IJAV). 2013; 6: 140–142.
Key words [external jugular vein] [external carotid artery] [common trunk]
Introduction
Variations in the blood vessel are not uncommon and are seen
more frequently in vein than in arteries. Still these variations
have immense clinical importance. The external jugular vein
drains most of the blood from the face and neck. Normally the
external carotid artery gives six branches into the side of neck
at various levels and terminates by dividing into superficial
temporal and maxillary arteries behind the neck of mandible
[1]. The retromandibular vein usually divides into the anterior
and the posterior divisions within the substance of the
parotid gland. The anterior division joins with the anterior
facial vein to form the common facial vein and it drains into
the internal jugular vein. The posterior division, after union
with the posterior auricular vein, continues as the external
jugular vein, which drains into the subclavian vein [1].
The present case reports the anatomical variations of external
jugular vein on right side and external carotid artery on left
side.
Case Report
During routine dissection for first M.B.B.S. students we
observed the following vascular variations in an adult female
cadaver.
On right side of face and neck, division of retromandibular was
absent. Retromandibular vein continued as external jugular
vein. The right facial vein opened into external jugular vein
at the level of angle of mandible. The external jugular vein
opened into the ipsilateral internal jugular vein. The course of
internal jugular vein was as usual (Figure 1).
On left side of neck the common carotid artery divided into
external carotid artery and internal carotid artery at the level
of upper border of thyroid cartilage. The external carotid
artery gave a common trunk at the level of tip of greater horn
of hyoid bone, which later divided into superior thyroid artery,
lingual artery and facial artery after a short course. Further
course and distribution of these branches and other branches
of external carotid artery showed no variation. Origin, course,
branching pattern and distribution of carotid arteries was as
usual on right side of neck (Figure 2).
Discussion
The blood vessels of the neck vary considerably in their
connection with each other, branching pattern and in their
termination. The external jugular vein is known to exhibit
variants regarding its formation and course.
Variant vessels of the neck
141
1
2
7
3
8
3
2
4
6
1
4
5
5
6
Figure 2. Common trunk for superior thyroid, lingual and facial
arteries. (1: common carotid artery; 2: internal carotid artery; 3:
external carotid artery; 4: common trunk; 5: superior thyroid artery;
6: lingual artery; 7: facial artery; 8: submandibular gland)
7
Figure 1. Unusual formation and termination of external jugular
vein. (1: superficial temporal vein; 2: maxillary vein; 3: retromandibular
vein; 4: external jugular vein; 5: facial vein; 6: internal jugular vein; 7:
subclavian vein)
Bertha and Suganthy studied 35 specimens and reported
various types of variation as follows [2]:
• Bilateral drainage of common facial vein into subclavian
and bilateral absence of external jugular vein.
• Absence of division of retromandibular vein. The
retromandibular vein joined with anterior facial vein to
form common facial which drained into internal jugular
vein.
• Opening of common facial vein into external jugular vein.
Rajanigandha et al. reported a case in which retromandibular
vein joined with facial vein to form common facial vein. After
a short course common facial vein divided into anterior
and posterior divisions. The posterior division opened into
internal jugular vein through a connecting vein. The anterior
division continued as a variant external jugular vein up to
the jugular notch, where it crossed the midline to drain into
opposite subclavian vein [3].
Sanjeev et al. studied 37 formalin preserved head and neck
specimens. They found following variations [4]:
• Higher division of common carotid artery (16.22% cases)
• Lower division of common carotid artery (27.02% cases)
• Common trunk of superior thyroid artery and lingual artery
(2.7%)
• Common trunk of lingual artery and facial artery (18.92%)
• Common trunk of occipital artery and ascending pharyngeal
artery (24.32%)
• Common trunk of occipital artery and posterior auricular
artery (2.7%).
Troupis et al. performed dissection on 15 human cadavers.
They observed a common trunk of lingual and facial artery
from the right external carotid artery in 6% cases [5].
Chitra reported a case of trifurcation of right common carotid
artery [6].
Delic et al. studied MRI carotid angiograms of 91 patients.
They found that superior thyroid and lingual artery originate
as a common trunk from external carotid artery in one case
(1.09%); lingual and facial artery originate as a common trunk
from external carotid artery (3.09%) [7].
The present study showed variations different as compared to
available literature. Such vascular variations do occur due to
appearance and disappearance of various vascular channels
during development.
External jugular vein is used for measurement of jugular
venous pressure, which reflects pressure in the right
atrium. Cannulation of external jugular vein is done for
Satishkumar et al.
142
performing various procedures such as transvenous liver
biopsy, transvenous pacemaker insertion, caval filter
placement. External jugular vein is used as a patch for carotid
endarterectomy [2, 8]. Knowledge of course and branching
pattern of carotid arteries is essential to prevent vascular
trauma during surgeries like thyroidectomy, glossectomy,
laryngectomy and ligation of external carotid artery in severe
epistaxis.
Knowledge of these variations is essential for physicians,
radiologists and surgeons while performing various diagnostic
and therapeutic procedures in face and neck regions so as to
prevent misdiagnosis and misadventures.
References
[1]
Standring S, ed. Gray’s Anatomy. The Anatomical Basis of Clinical Practice. 39th Ed., New
York, Elsevier Churchill Livingstone. 2006; 543–547, 551–552.
[2]
Bertha A, Suganthy R. Anatomical variations in termination of common facial vein. J Clin
Diagn Res. 2011; 5: 24–27.
[3]
[4]
Rajanigandha V, Rajalakshmi R, Ranade AV, Pai MM, Prabhu LV, Ashwin K, Jiji PJ. An
anomalous left external jugular vein draining into right subclavian vein: A case report. Int
J Morphol. 2008; 26(4): 893-895.
Sanjeev IK, Anita H, Ashwini M, Mahesh U, Rairam GB. Branching pattern of external carotid
artery in human cadavers. J Clin Diagn Res. 2010; 4: 3128–3133.
[5]
Troupis TG, Dimitroulis D, Paraschos A, Michalinos A, Protogerou V, Vlasis K, Troupis
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[6]
Chitra R. Trifurcation of right common carotid artery. Indian J Plast Surg. 2008; 41:
85–88.
[7]
Delic J, Savkovic A, Bajtarevic A, Isavkovic E. Variations of ramification of external carotid
artery- common trunks of collateral branches. Period Biol. 2010; 112: 117–119.
[8]
Greenfield LJ, Zocco J, Wilk J, Schroeder TM, Elkins RC. Clinical experience with the KimRay Greenfield vena caval filter. Ann Surg. 1977; 185: 692–698.