DOCSLIB.ORG

Reconstructive

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Reconstructive RECONSTRUCTIVE Anatomical and Technical Aspects of Harvesting the Auricle as a Neurovascular Facial Subunit Transplant in Humans Betul Gozel Ulusal, M.D. Background: Auricular transplants from cadaveric sources may be a viable al- Ali Engin Ulusal, M.D. ternative for difficult auricular reconstruction once immunologic problems are Jeng-Yee Lin, M.D. largely solved. The authors report on the neurovascular anatomy and technical Bien-Keem Tan, F.R.C.S.(Ed.) details of harvesting the auricle as a single facial subunit. Chin-Ho Wong, M.R.C.S.(Ed.) Methods: Nine auricles were studied in latex-injected (n ϭ 5) and fresh ca- Colin Song, F.R.C.S.(Ed.) daveric heads (n ϭ 4). In latex-injected heads, dissection in the neck and Fu-Chan Wei, M.D. auricular region and microdissection within the substance of the auricle were Taipei, Taiwan; and Singapore performed under loupe magnification. The arterial network was exposed and measurements were taken, including the size, length, and diameters of vessels. The number of branches supplying the entire auricle was noted. Methylene blue dye was injected into fresh cadaveric heads through the posterior auricular (n ϭ 2) or superficial temporal arteries (n ϭ 2) to assess the territory supplied by each arterial system. Results: Dye injected into the superficial temporal artery stained the upper two-thirds of the anterior and posterior auricular regions; all anterior cartilag- inous eminences, except the antitragus, were homogenously stained. Dye in- jected into the posterior auricular artery stained the lobule, posterior auricular skin, and the depressed anterior auricular regions, including the cavum con- chae, scapha, and triangular fossa. Neither the superficial temporal nor the posterior auricular arteries could adequately nourish the entire auricle as single pedicles. The auriculotemporal and great auricular nerves can be included in the transplant for sensation. The temporoparietal scalp can also be reliably included to meet reconstructive requirements. Conclusions: The auricle can be reliably elevated as a transplant when nour- ished by both the superficial temporal and posterior auricular arterial sys- tems. The external jugular vein and external carotid artery can therefore be used as the vascular pedicle for auricular transplantation. (Plast. Reconstr. Surg. 120: 1540, 2007.) he auricle is a specialized and complex fa- fibrocartilage, with characteristic eminences and cial subunit that is difficult to reconstruct depressions, which is lined with thin skin and Twhen severely deformed, such as by burn, connected to its surrounding parts and external trauma, or tumor ablation, or for congenital auditory meatus by ligaments, muscles, and fi- reasons. It is composed of a thin plate of yellow brous tissues. The most common current recon- structive alternative is the autogenous rib carti- From the Department of Plastic Surgery, Chang Gung Me- laginous framework.1 If the quality of skin in the morial Hospital, Chang Gung Medical College, Chang periauricular area is poor, however, or if there is Gung University, and the Department of Plastic Surgery, a shortage of autogenous cartilage because of Singapore General Hospital. previously failed operations, the reconstruction Received for publication March 27, 2006; accepted July 18, 1–3 2006. becomes even more difficult. Auricular trans- Presented at the 18th Annual Meeting of American Society plantation from cadaveric sources might be a for Reconstructive Microsurgery, January 14 through 17, valuable alternative for such patients. Recently, 2006, in Tucson, Arizona. following the first successful composite Copyright ©2007 by the American Society of Plastic Surgeons facial/scalp4 and auricle5 allotransplantations in DOI: 10.1097/01.prs.0000287992.28125.ce animal models, the first successful clinical case of 1540 www.PRSJournal.com Volume 120, Number 6 • Auricle Transplantation in Humans human auricular allotransplantation along with ously, immediately superficial to the galea. The the cephalocervical flap was reported by Jiang et parietal branch of the superficial temporal ar- al.6 Successful composite tissue allotransplanta- tery, the superficial temporal vein, and the au- tion requires competent microsurgical free tis- riculotemporal nerve were identified and in- sue transfer techniques, thorough knowledge of cluded in the transplant. These structures were the relevant anatomy, and stringent control of ligated cephalad unless a portion of scalp was immunologic allograft rejection.7–9 required. Dissection then continued anteriorly in The anatomy of the auricle as related to vari- a caudal direction; the frontal, middle temporal, ous flap elevations has been extensively zygomaticoorbital, and transverse facial branches studied.10–12 This anatomical study is the first to of the superficial temporal vessels were divided. explore the feasibility of harvesting the auricle Care was taken to include the neurovascular pedi- alone as a single neurovascular facial subunit cle and small anterior auricular branches along flap. the anterior portion of the auricle emanating from the superficial temporal artery and superfi- MATERIALS AND METHODS cial temporal vein. Immediately behind the neck A total of nine auricles, five latex-injected and of the mandible, at the level of the tragus, the four fresh cadaveric, were studied. For the latex superficial temporal artery and superficial tempo- injection study, the internal carotid artery was in- ral vein penetrated deep into the substance of the jected with 10% buffered formalin (to induce la- parotid gland. Because the inclusion of the pa- tex coagulation), followed by pigmented latex. rotid gland may not be desirable in auricular trans- The heads were then kept at 4°C in refrigerators plantation, the branches of the superficial tempo- for at least 24 hours. In latex-injected heads, dis- ral artery and superficial temporal vein to the section in the neck and auricular region and mi- parotid gland and masseter muscle were divided crodissection within the substance of the auricle and the gland was dissected away. Individual dis- were performed under loupe magnification. The sections of the superficial temporal artery and su- arterial network supplying the entire auricle was perficial temporal vein continued in different tis- exposed. Measurements were taken, including the sue planes. The superficial temporal vein united size, length, and diameters of vessels (with a Ver- with the internal maxillary vein to drain into the nier caliper). The number of vascular branches posterior facial vein within the parotid gland. The was also recorded. Injection studies with methyl- posterior facial vein ran inferiorly and divided into ene blue were performed in fresh cadaveric heads its anterior and posterior branches between the using either the posterior auricular artery (n ϭ 2) ramus of the mandible and the sternocleidomas- or the superficial temporal artery (n ϭ 2) to assess toid muscle. The anterior branch was ligated and the vascular territory supplied by each arterial sys- the posterior branch preserved as it was joined by tem in isolation. the posterior auricular vein to become the exter- nal jugular vein. The external jugular vein was Relevant Anatomy therefore the principal draining vessel of the au- ricular transplant. The posterior auricular vein The main arteries supplying the auricle are the was dissected toward the auricle. The posterior superficial temporal artery and the posterior au- auricular branch of the great auricular nerve was ricular artery, which arise from the external ca- found accompanying the posterior auricular vein rotid artery. Another branch from the occipital immediately beneath the auricular lobule. This artery provides a minor contribution to the auric- 10–13 nerve was divided and included in the transplant. ular circulation. Draining veins accompany For the arterial pedicle, the superficial tem- the corresponding arteries. Sensory innervation is poral artery was dissected toward the auricle. The provided by the great auricular and lesser occipital internal maxillary artery, a terminal branch of the nerves from the cervical plexus, the auriculotem- external carotid artery, was identified and divided poral branch of the mandibular nerve, and the 13 at the level of the mandibular neck. The posterior auricular branch of the vagus nerve. auricular artery was identified, beneath the digas- tric and stylohyoid muscles and opposite the apex Technique of Harvesting an Auricular of the styloid process, originating from the exter- Transplant nal carotid artery and dividing into auricular and A circular incision was placed to include a occipital branches between the auricular cartilage 1-cm skin island surrounding the auricle. Antero- and the mastoid process. The occipital branch was superiorly, the dissection continued subcutane- ligated and the auricular branch included in the 1541 Plastic and Reconstructive Surgery • November 2007 Fig. 1. The superficial temporal artery and its auricular branches Fig. 2. The vascular pedicle of the auricular flap formed from the (arrowheads). The largest branch, which crosses the helix, is uni- superficial temporal artery and the posterior auricular artery. a to formly located superior to the tragus (upper arrowhead). Note b, Posterior auricular artery length; c to d, superficial temporal that the superficial temporal artery does not give direct artery length, from the exit of the internal maxillary artery to the branches to the lobule. a, Facial region; b, temporal region;
Load more

Recommended publications
  • Why Should We Report Posterior Fossa Emissary Veins?
    Diagn Interv Radiol 2014; 20:78–81 NEURORADIOLOGY © Turkish Society of Radiology 2014 PICTORIAL ESSAY Why should we report posterior fossa emissary veins? Yeliz Pekçevik, Rıdvan Pekçevik ABSTRACT osterior fossa emissary veins pass through cranial apertures and par- Posterior fossa emissary veins are valveless veins that pass ticipate in extracranial venous drainage of the posterior fossa dural through cranial apertures. They participate in extracranial ve- sinuses. These emissary veins are usually small and asymptomatic nous drainage of the posterior fossa dural sinuses. The mas- P toid emissary vein, condylar veins, occipital emissary vein, in healthy people. They protect the brain from increases in intracranial and petrosquamosal sinus are the major posterior fossa emis- pressure in patients with lesions of the neck or skull base and obstructed sary veins. We believe that posterior fossa emissary veins can internal jugular veins (1). They also help to cool venous blood circulat- be detected by radiologists before surgery with a thorough understanding of their anatomy. Describing them using tem- ing through cephalic structures (2). Emissary veins may be enlarged in poral bone computed tomography (CT), CT angiography, patients with high-flow vascular malformations or severe hypoplasia or and cerebral magnetic resonance (MR) venography exam- inations results in more detailed and accurate preoperative aplasia of the jugular veins. They are associated with craniofacial syn- radiological interpretation and has clinical importance. This dromes (1, 3). Dilated emissary veins may cause tinnitus (4, 5). pictorial essay reviews the anatomy of the major and clini- We aim to emphasize the importance of reporting posterior fossa em- cally relevant posterior fossa emissary veins using high-reso- lution CT, CT angiography, and MR venography images and issary veins prior to surgeries that are related to the posterior fossa and discusses the clinical importance of reporting these vascular mastoid region.
    [Show full text]
  • Neck Dissection Using the Fascial Planes Technique
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY NECK DISSECTION USING THE FASCIAL PLANE TECHNIQUE Patrick J Bradley & Javier Gavilán The importance of identifying the presence larised in the English world in the mid-20th of metastatic neck disease with head and century by Etore Bocca, an Italian otola- neck cancer is recognised as a prominent ryngologist, and his colleagues 5. factor determining patients’ prognosis. The current available techniques to identify Fascial compartments allow the removal disease in the neck all have limitations in of cervical lymphatic tissue by separating terms of accuracy; thus, elective neck dis- and removing the fascial walls of these section is the usual choice for management “containers” along with their contents of the clinically N0 neck (cN0) when the from the underlying vascular, glandular, risk of harbouring occult regional metasta- neural, and muscular structures. sis is significant (≥20%) 1. Methods availa- ble to identify the N+ (cN+) neck include Anatomical basis imaging (CT, MRI, PET), ultrasound- guided fine needle aspiration cytology The basic understanding of fascial planes (USGFNAC), and sentinel node biopsy, in the neck is that there are two distinct and are used depending on resource fascial layers, the superficial cervical fas- availability, for the patient as well as the cia, and the deep cervical fascia (Figures local health service. In many countries, 1A-C). certainly in Africa and Asia, these facilities are not available or affordable. In such Superficial cervical fascia circumstances patients with head and neck cancer whose primary disease is being The superficial cervical fascia is a connec- treated surgically should also have the tive tissue layer lying just below the der- neck treated surgically.
    [Show full text]
  • Download PDF Correlations Between Anomalies of Jugular Veins And
    Romanian Journal of Morphology and Embryology 2006, 47(3):287–290 ORIGINAL PAPER Correlations between anomalies of jugular veins and areas of vascular drainage of head and neck MONICA-ADRIANA VAIDA, V. NICULESCU, A. MOTOC, S. BOLINTINEANU, IZABELLA SARGAN, M. C. NICULESCU Department of Anatomy and Embryology “Victor Babeş” University of Medicine and Pharmacy, Timişoara Abstract The study conducted on 60 human cadavers preserved in formalin, in the Anatomy Laboratory of the “Victor Babes” University of Medicine and Pharmacy Timisoara, during 2000–2006, observed the internal and external jugular veins from the point of view of their origin, course and affluents. The morphological variability of the jugular veins (external jugular that receives as affluents the facial and lingual veins and drains into the internal jugular, draining the latter’s territory – 3.33%; internal jugular that receives the lingual, upper thyroid and facial veins, independent – 13.33%, via the linguofacial trunk – 50%, and via thyrolinguofacial trunk – 33.33%) made possible the correlation of these anomalies with disorders in the ontogenetic development of the veins of the neck. Knowing the variants of origin, course and drainage area of jugular veins is important not only for the anatomist but also for the surgeon operating at this level. Keywords: internal jugular vein, external jugular vein, drainage areas. Introduction The ventral pharyngeal vein that receives the tributaries of the face and tongue becomes the Literature contains several descriptions of variations linguofacial vein. With the development of the face, the in the venous drainage of the neck [1–4]. primitive maxillary vein expands its drainage territories The external jugular drains the superficial areas of to those innervated by the ophtalmic and mandibular the head, the deep areas of the face and the superficial branches of the trigeminal nerve, and it anastomoses layers of the posterior and lateral parts of the neck.
    [Show full text]
  • Venous Arrangement of the Head and Neck in Humans – Anatomic Variability and Its Clinical Inferences
    Original article http://dx.doi.org/10.4322/jms.093815 Venous arrangement of the head and neck in humans – anatomic variability and its clinical inferences SILVA, M. R. M. A.1*, HENRIQUES, J. G. B.1, SILVA, J. H.1, CAMARGOS, V. R.2 and MOREIRA, P. R.1 1Department of Morphology, Institute of Biological Sciences, Universidade Federal de Minas Gerais – UFMG, Av. Antonio Carlos, 6627, CEP 31920-000, Belo Horizonte, MG, Brazil 2Centro Universitário de Belo Horizonte – UniBH, Rua Diamantina, 567, Lagoinha, CEP 31110-320, Belo Horizonte, MG, Brazil *E-mail: [email protected] 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.
    [Show full text]
  • Redalyc.Termination of the Facial Vein Into the External Jugular Vein: An
    Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil D'Silva, Suhani Sumalatha; Pulakunta, Thejodhar; Potu, Bhagath Kumar Termination of the facial vein into the external jugular vein: an anatomical variation Jornal Vascular Brasileiro, vol. 7, núm. 2, junio, 2008, pp. 174-175 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245016526015 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative CASE REPORT Termination of the facial vein into the external jugular vein: an anatomical variation Terminação da veia facial na veia jugular externa: uma variação anatômica Suhani Sumalatha D’Silva, Thejodhar Pulakunta, Bhagath Kumar Potu* Abstract Resumo Different patterns of variations in the venous drainage have been Padrões distintos de variações na drenagem venosa já foram observed in the past. During routine dissection in our Department of observados. Durante a dissecção de rotina em nosso Departamento Anatomy, an unusual drainage pattern of the veins of the left side of de Anatomia, observou-se um padrão incomum de drenagem das veias the face of a middle aged cadaver was observed. The facial vein do lado esquerdo da face de um cadáver de meia idade. A veia facial presented a normal course from its origin up to the base of mandible, apresentava curso normal de sua origem até a base da mandíbula, e and then it crossed the base of mandible posteriorly to the facial artery.
    [Show full text]
  • A Rare Variation of Superficial Venous Drainage Pattern of Neck Anatomy Section
    ID: IJARS/2014/10764:2015 Case Report A Rare Variation of Superficial Venous Drainage Pattern of Neck Anatomy Section TANWI GHOSAL(SEN), SHABANA BEGUM, TANUSHREE ROY, INDRAJIT GUPta ABSTRACT jugular vein is very rare and is worth reporting. Knowledge Variations in the formation of veins of the head and neck of the variations of external jugular vein is not only important region are common and are well explained based on their for anatomists but also for surgeons and clinicians as the embryological background. Complete absence of an vein is frequently used for different surgical procedures and important and major vein of the region such as external for obtaining peripheral venous access as well. Keywords: Anomalies, External jugular vein, Retromandibular vein CASE REPOrt the subclavian vein after piercing the investing layer of deep During routine dissection for undergraduate students in the cervical fascia [1]. Apart from its formative tributaries, the Department of Anatomy of North Bengal Medical College, tributaries of EJV are anterior jugular vein, posterior external Darjeeling, an unusual venous drainage pattern of the head jugular vein, transverse cervical vein, suprascapular vein, and neck region was found on the right side in a middle aged sometimes occipital vein and communications with internal female cadaver. The right retromandibular vein (RMV) was jugular vein [Table/Fig-4]. formed within the parotid gland by the union of right maxillary During embryonic period, superficial head and neck veins and superficial temporal vein. The RMV which was wider than develop from superficial capillary plexuses which will later facial vein continued downwards and joined with the facial form primary head veins.
    [Show full text]
  • American Academy of Otolaryngology — Head and Neck Surgery, 5
    Index A lesser occipital nerve, 40 sternohyoid muscle, 39 levator scapulae muscle, 42 sternothyroid muscle, 39 American Academy of lingual artery, 47, 52 strap muscles, 37 Otolaryngology — Head and lingual nerve, 46 stylohyoid muscle, 45 Neck Surgery, 5 lingual vein, 47, 49 stylomandibular ligament, 48 American approach to neck lymphatics, 26 sublingual artery, 47 dissection, 1 deep, 26 submandibular ganglion, 48 American Society for Head and Neck deep anterior chain, 28 submandibular gland, 47 Surgery, 5 internal jugular chain, 26 submandibular nodes, 26 Anatomy jugular trunk, 28 submandibular triangle, 33, 45 ansa cervicalis, 40 left thoracic duct, 28 submental nodes, 26 anterior jugular nodes, 26 right lymphatic duct, 28 submental triangle, 33 anterior jugular vein, 36 spinal accessory chain, 28 superficial temporal artery, 52 anterior triangle, 33 superficial, 26 superior laryngeal artery, 52 ascending pharyngeal artery, 52 transverse cervical chain, 28 superior thyroid artery, 52 brachial plexus, 44 marginal nerve, 40, 48 superior thyroid veins, 49 brachiocephalic trunk, 50 mastoid nodes, 26 supraclavicular nerve, 40 carotid artery, 50 maxillary artery, 52 surgical, 35 carotid sheath, 24, 49 middle thyroid vein, 49 sympathetic trunk, 54 carotid sinus, 50 muscular triangle, 35 thyrohyoid muscle, 39 carotid triangle, 35 mylohyoid muscle, 45 thyrolinguofacial trunk, 49 cervical fascia, 23 nodal groups, 28 topographic, 33 deep, 24 disadvantages, 31 vagus nerve, 50, 53 superficial, 24 subzones, 30 Anesthesia, 64 cervical plexus, 39 occipital
    [Show full text]
  • 7. Internal Jugular Vein the Internal Jugular Vein Is a Large Vein That Receives Blood from the Brain, Face, and Neck
    د.احمد فاضل Lecture 16 Anatomy The Root of the Neck The root of the neck can be defined as the area of the neck immediately above the inlet into the thorax. Muscles of the Root of the Neck Scalenus Anterior Muscle Scalenus Medius Muscle The Thoracic Duct The thoracic duct begins in the abdomen at the upper end of the cisterna chyli. It enters the thorax through the aortic opening in the diaphragm and ascends upward, inclining gradually to the left. On reaching the superior mediastinum, it is found passing upward along the left margin of the esophagus. At the root of the neck, it continues to ascend along the left margin of the esophagus until it reaches the level of the transverse process of the seventh cervical vertebra. Here, it bends laterally behind the carotid sheath. On reaching the medial border of the scalenus anterior, it turns 1 downward and drains into the beginning of the left brachiocephalic vein. It may, however, end in the terminal part of the subclavian or internal jugular veins. Main Nerves of the Neck Cervical Plexus Brachial Plexus The brachial plexus is formed in the posterior triangle of the neck by the union of the anterior rami of the 5th, 6th, 7th, and 8th cervical and the first thoracic spinal nerves. This plexus is divided into roots, trunks, divisions, and cords. The roots of C5 and 6 unite to form the upper trunk, the root of C7 continues as the middle trunk, and the roots of C8 and T1 unite to form the lower trunk.
    [Show full text]
  • Original Article Venous Variations of the Neck and the Inferior Vena Cava: Two Cadaveric Case Reports
    Int J Clin Exp Med 2019;12(7):9273-9276 www.ijcem.com /ISSN:1940-5901/IJCEM0091907 Original Article Venous variations of the neck and the inferior vena cava: two cadaveric case reports Yan-Ru Zhang1, Kaka AA Katiella2, Ge-Chen Zhang2 1Institute of Orthopedics of Henan Polytechnic University, Jiaozuo 454000, Henan Province, China; 2Medical College of Zhengzhou University, Zhengzhou 450051, Henan Province, China Received January 27, 2019; Accepted April 11, 2019; Epub July 15, 2019; Published July 30, 2019 Abstract: Anatomical variations in the venous system of the head and neck remain important for clinicians and also for radiologists and surgeons. This paper reports a case of a unilateral cervical vein variation and a disproportion of the inferior vena cava to the aorta observed in two adult male cadavers. Out of twenty well preserved dissected cadavers, these findings are rare, even in the medical literature. The left external jugular vein was formed by three proximal tributaries draining to it. The left internal jugular vein bears lymph nodes and was smaller in diameter than the right pair. As a normal pattern, the right and left subclavian veins drained to the superior vena cava. In the sec- ond cadaver, the inferior vena cava was found to be abnormal prior to its opening to the right atrium. Keywords: Veins of the neck, inferior vena cava, variations, cadavers Introduction cipital, posterior external jugular, anterior jugu- lar and transverse cervical veins [5]. Yadav et The veins draining the regions of the face and al. [2] said that the external jugular vein is used neck establish their identity only after the de- as a venos manometer and for catheterization velopment of the skull.
    [Show full text]
  • Venous Anatomy of the Cavernous Sinus and Relevant Veins
    Journal of Neuroendovascular Therapy Advance Published Date: August 12, 2020 DOI: 10.5797/jnet.ra.2020-0086 Venous Anatomy of the Cavernous Sinus and Relevant Veins Shuichi Tanoue,1 Masaru Hirohata,2 Yasuharu Takeuchi,2 Kimihiko Orito,2 Sosho Kajiwara,2 and Toshi Abe1 The cavernous sinus (CS) is a dural sinus located on each side of the pituitary fossa. Neoplastic and vascular lesions, such as arteriovenous fistulas, frequently involve the CS. This sinus plays a role as a crossroad receiving venous blood flow from the facial, orbital, meningeal, and neural venous tributaries. The relationship between these surrounding relevant veins and the CS, as well as the CS itself, varies anatomically. For safe and effective surgical and endovascular treatment of lesions involving the CS, knowledge of the anatomy and variations of the CS and the relevant surrounding veins is highly important. In this section, the anatomy and variations of the CS and the relevant surrounding veins are outlined. Keywords▶ cavernous sinus, laterocavernous sinus, anatomy, relevant veins Introduction this section, the functions and imaging anatomy of the CS and relevant surrounding veins are reviewed. The cavernous sinus (CS) is the dural sinus that lies on the bilateral sides of the pituitary fossa of the sphenoidal body. Basis Anatomy of the CS and It functions as a venous channel receiving many types of Its Variations venous structures, including facial and orbital veins, men- ingeal veins, pituitary veins, and cerebral superficial and Basic anatomy deep veins. These surrounding venous structures present The CS is a dural sinus located between the superior orbital complex anatomy, and the CS can be affected by neo- fissure and the petrous apex of the temporal bone at the plasms and vascular disease.
    [Show full text]
  • Prevalence of Clinically Important Posterior Fossa Emissary Veins On
    Published online: 2019-09-26 Original Article Prevalence of clinically important posterior fossa emissary veins on CT angiography Yeliz Pekcevik, Hilal Sahin, Ridvan Pekcevik1 Department of Radiology, Izmir Tepecik Training and Research Hospital, Gaziler, Yenişehir, 1Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, BasinSitesi, Karabaglar, Izmir, Turkey ABSTRACT Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT) angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64‑slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV) was not identified in 37 (22.3%) patients. It was found bilaterally in 82 (49.4%) and unilaterally in 47 (28.3%) patients. Only six patients had more than one MEV that were very small (<2 mm), and only five patients had very large (>5 mm) veins. The posterior condylar vein (PCV) was not identified in 39 (23.5%) patients. It was found bilaterally in 97 (58.4%) and unilaterally in 30 (18.1%) patients. Only 15 patients had a very large (>5 mm) PCV. The petrosquamosal sinus (PSS) was identified only in one patient (0.6%) on the left side. The occipital sinus was found in two patients (1.2%). Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region. Key words: Anatomy, angiography, blood vessels, computed tomography, emissary vein, posterior fossa Introduction syndromes.[4,5] The prevalence of the posterior fossa emissary veins on computed tomography (CT) Emissary veins are valveless veins that pass through angiography in the general population has not been cranial apertures.
    [Show full text]
  • Unusual and Multiple Variations of Head and Neck Veins: a Case Report
    Surgical and Radiologic Anatomy (2019) 41:535–538 https://doi.org/10.1007/s00276-019-02203-0 ANATOMIC VARIATIONS Unusual and multiple variations of head and neck veins: a case report P. C. Vani1 · S. S. S. N. Rajasekhar1 · V. Gladwin1 Received: 14 July 2018 / Accepted: 1 February 2019 / Published online: 18 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract We report an unusual and multiple variation involving the right head and neck veins which were found during routine dissec- tion in a 50-year-old male cadaver, facial vein draining into both external and internal jugular veins, fenestration in external jugular vein transmitting the supraclavicular nerve trunk, the anterior division of the retromandibular vein draining into anterior jugular vein and the absence of the common facial vein. The knowledge about these variations is important during various surgical and diagnostic procedures involving head and neck region. Keywords Common facial vein · External jugular vein · Facial vein · Fenestration · Retromandibular vein Introduction carotid endarterectomy [14]. The EJV has been known to have multiple uses. It is used for the insertion of temporary Head and neck region is drained by both superficial and deep hemodialysis catheter [9], as a draining site for shunt proce- veins. The superficial veins mainly receive the blood from dures involving hydrocephalus surgery [2] and as a recipi- face as well as scalp and drain into deep veins. Some of the ent vessel in head and neck reconstruction using free flap superficial veins of the head and neck region include the transfers [20]. The variations involving the FV is important facial vein (FV), retromandibular vein (RMV), anterior jugu- during reconstructive surgeries and knowledge about these lar vein (AJV) and external jugular vein (EJV).
    [Show full text]