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104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 275 Posterior Mediastinum: Mediastinal Organs 275 1 Internal jugular vein 2 Right vagus nerve 3 Thyroid gland 4 Right recurrent laryngeal nerve 5 Brachiocephalic trunk 6 Trachea 7 Bifurcation of trachea 8 Right phrenic nerve 9 Inferior vena cava 10 Diaphragm 11 Left subclavian artery 12 Left common carotid artery 13 Left vagus nerve 14 Aortic arch 15 Esophagus 16 Esophageal plexus 17 Thoracic aorta 18 Left phrenic nerve 19 Pericardium at the central tendon of diaphragm 20 Right pulmonary artery 21 Left pulmonary artery 22 Tracheal lymph nodes 23 Superior tracheobronchial lymph nodes 24 Bronchopulmonary lymph nodes Bronchial tree in situ (ventral aspect). Heart and pericardium have been removed; the bronchi of the bronchopulmonary segments are dissected. 1–10 = numbers of segments (cf. p. 246 and 251). 15 12 22 6 11 5 2 1 14 2 23 1 3 21 3 20 24 4 5 4 17 8 5 6 6 15 8 7 8 9 9 10 10 Relation of aorta, pulmonary trunk, and esophagus to trachea and bronchial tree (schematic drawing). 1–10 = numbers of segments (cf. p. 246 and 251). 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 276 276 Posterior Mediastinum: Mediastinal Organs Mediastinal organs (ventral aspect). The heart with the pericardium has been removed, and the lungs and aortic arch have been slightly reflected to show the vagus nerves and their branches. 1 Supraclavicular nerves 12 Right pulmonary artery 24 Left vagus nerve 2 Right internal jugular vein with ansa cervicalis 13 Right pulmonary veins 25 Left common carotid artery 3 Omohyoid muscle 14 Esophagus 26 Aortic arch 4 Right vagus nerve 15 Esophageal plexus 27 Left recurrent laryngeal nerve 5 Clavicle 16 Right phrenic nerve (divided) 28 Bifurcation of trachea 6 Right subclavian artery and recurrent 17 Inferior vena cava 29 Left pulmonary artery laryngeal nerve 18 Pericardium covering the diaphragm 30 Left primary bronchus 7 Right subclavian vein 19 Larynx (thyroid cartilage and cricothyroid muscle) 31 Descending aorta 8 Superior cervical cardiac branch of vagus nerve 20 Thyroid gland 32 Left pulmonary veins 9 Inferior cervical cardiac branch of vagus nerve 21 Left internal jugular vein 33 Branch of left vagus nerve 10 Azygos arch (divided) 22 Esophagus and left recurrent laryngeal nerve 34 Left lung 11 Right lung 23 Trachea 35 Left phrenic nerve (divided) 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 277 Posterior Mediastinum: Mediastinal Organs 277 Mediastinal organs (ventral aspect). Heart and distal part of esophagus have been removed to display the vessels and nerves of the posterior mediastinum. 1 Thyroid gland 11 Azygos vein 21 Brachiocephalic trunk 2 Right internal jugular vein 12 Thoracic duct 22 Left vagus nerve 3 Right vagus nerve 13 Posterior intercostal artery and vein 23 Aortic arch 4 Point where right recurrent laryngeal nerve (in front of the vertebral column) 24 Left recurrent laryngeal nerve is branching off the vagus nerve 14 Right phrenic nerve 25 Left bronchial artery 5 Right brachiocephalic vein 15 Inferior vena cava 26 Lymph node 6 Trachea 16 Diaphragm 27 Thoracic aorta 7 Left brachiocephalic vein (reflected) 17 Left vagus nerve 28 Esophageal plexus 8 Esophagus 18 Thyrocervical trunk 29 Left phrenic nerve 9 Right bronchial artery 19 Left subclavian artery 10 Posterior intercostal artery 20 Left common carotid artery 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 278 278 Posterior Mediastinum: Mediastinal Organs Organs of posterior mediastinum (ventral aspect, schematic drawing). Three regions in which the esophagus is narrowed are shown: A = termed upper sphincter (at the level of the cricoid cartilage); Diaphragm and organs of mediastinum (anterior aspect). Heart and lungs have been B = termed middle sphincter (at the removed; the costal margin remains in place. Note the different courses of left and right level of the aortic arch); vagus. C = termed lower sphincter (at the level of the diaphragm). 1 Right subclavian artery 11 Sternal part of diaphragm 23 Superior and inferior lingular bronchi 2 Right recurrent laryngeal nerve 12 Costal part of diaphragm 24 Esophageal plexus of left vagus nerve 3 Right brachiocephalic vein 13 Falciform ligament of liver 25 Descending aorta 4 Superior cervical cardiac nerve 14 Liver (quadrate lobe) 26 Central tendon of diaphragm 5 Inferior cervical cardiac nerves 15 Left common carotid artery covered with pericardium and pulmonary branches 16 Left recurrent laryngeal nerve 27 Left phrenic nerve (divided) 6 Bifurcation of trachea 17 Esophageal branches of left vagus 28 Costal margin 7 Esophagus (thoracic part) nerve and esophagus 29 Liver, left lobe 8 Bronchi of lateral and medial segments 18 Trachea 30 Pharynx of middle lobe 19 Aortic arch 31 Secondary bronchi 9 Esophageal plexus and branches of 20 Left vagus nerve 32 Esophagus (abdominal part) right vagus nerve 21 Left recurrent laryngeal nerve with 33 Diaphragm 10 Inferior vena cava and inferior cardiac nerve 34 Abdominal aorta right phrenic nerve (cut) 22 Left primary bronchus 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 279 Posterior Mediastinum: Mediastinal Organs 279 Veins of the posterior wall of thoracic and abdominal cavity (schematic drawing). 1 Right vagus nerve 2 Thyroid gland and trachea 3 Intercostal nerve 4 Aortic arch 5 Azygos vein 6 Posterior intercostal artery 7 Greater splanchnic nerve 8 Diaphragm 9 Liver 10 Proper hepatic artery and hepatic plexus 11 Left recurrent laryngeal nerve 12 Inferior cervical cardiac nerves Organs of posterior mediastinum (anterior aspect). 13 Left vagus nerve and left recurrent laryngeal nerve 14 Left primary bronchus 15 Thoracic aorta and left vagus nerve 16 Esophagus and esophageal plexus 17 Thoracic duct 18 Spleen 19 Anterior gastric plexus and stomach (divided) 20 Splenic artery and splenic plexus 21 Celiac trunk and celiac plexus 22 Pancreas 23 Ramus communicans 24 Sympathetic trunk and sympathetic ganglion 25 Posterior intercostal vein and artery and intercostal nerve 26 Right brachiocephalic vein 27 Superior vena cava 28 Ascending lumbar vein 29 Lumbar veins 30 Right external iliac vein 31 Trachea 32 Accessory hemiazygos vein 33 Posterior intercostal veins 34 Hemiazygos vein 35 Inferior vena cava 36 Median sacral vein Inferior segment of posterior mediastinum (anterior aspect). 37 Internal iliac vein 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 280 280 Posterior Mediastinum: Mediastinal Organs Mediastinal organs (right lateral aspect). Right lung and pleura of right half of the thorax have been removed. 1 Posterior intercostal arteries 7 Esophageal plexus (branches 14 Right phrenic nerve 2 Ganglion of sympathetic trunk of right vagus nerve) 15 Inferior cervical cardiac branches 3 Sympathetic trunk 8 Pulmonary veins of vagus nerve 4 Vessels and nerves of the intercostal space 9 Posterior intercostal vein 16 Aortic arch (from above: posterior intercostal vein and 10 Azygos vein 17 Superior vena cava artery and intercostal nerve) 11 Esophagus 18 Right pulmonary artery 5 Right primary bronchus 12 Greater splanchnic nerve 19 Heart with pericardium 6 Ramus communicans of sympathetic trunk 13 Right vagus nerve 20 Diaphragm 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 281 Posterior and Superior Mediastinum: Mediastinal Organs 281 25 26 27 16 28 13 20 24 29 30 31 32 33 23 Main branches of descending aorta (schematic drawing). 24 24 Organs of posterior and superior mediastinum (left lateral aspect). 1 Subclavian artery 12 Scapula (divided) 23 Posterior intercostal artery and 2 Subclavian vein 13 Posterior intercostal arteries vein and intercostal nerve 3 Clavicle (divided) 14 White ramus communicans of 24 Diaphragm 4 Left vagus nerve sympathetic trunk 25 Common carotid artery 5 First rib (divided) 15 Sympathetic trunk 26 Subclavian artery 6 Left superior intercostal vein 16 Aortic arch 27 Highest intercostal artery 7 Left atrium with pericardium 17 Left vagus nerve and left recurrent 28 Bifurcation of trachea 8 Left phrenic nerve and pericardiacophrenic laryngeal nerve 29 Celiac trunk artery and vein 18 Left pulmonary artery 30 Renal artery 9 Esophageal plexus (branches derived 19 Left primary bronchus 31 Superior mesenteric artery from left vagus nerve) 20 Thoracic aorta 32 Inferior mesenteric artery 10 Apex of heart with pericardium 21 Pulmonary vein 33 Common iliac artery 11 Brachial plexus 22 Esophagus (thoracic part) 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 282 282 Diaphragm 1 Superior vena cava 2 Right atrium 3 Right ventricle 4 Costal part of diaphragm 5 Costal margin 6 Position of costodiaphragmatic recess 7 Lateral arcuate ligament 8 Medial arcuate ligament 9 Right crus of lumbar part of diaphragm 10 Quadratus lumborum muscle 11 Ascending aorta 12 Pulmonary trunk 13 Left ventricle 14 Pericardium, diaphragm 15 Esophageal hiatus and abdominal part of esophagus (cut) 16 Lumbar part of diaphragm 17 Aortic hiatus 18 Psoas major muscle 19 Lumbar vertebra Diaphragm in situ (anterior aspect). Anterior walls of thoracic and abdominal cavities have been removed. Natural position of the heart above the central tendon on the diaphragm is shown. Changes in the position of the diaphragm and thoracic cage during respiration. Left: lateral aspect; right: anterior aspect. During inspiration the diaphragm moves downwards and the lower part of the thoracic cage expands forward and laterally, causing the costodiaphragmatic recess (R) to enlarge (cf. dotted arrows). 104750_S_265_290_Kap_4:_ 05.01.2010 10:43 Uhr Seite 283 Diaphragm 283 1 Azygos venous arch 2 Right pulmonary artery 3 Superior vena cava 4 Right pulmonary vein 5 Fossa ovalis 6 Hepatic veins 7 Inferior vena cava 8 Right crus of lumbar part of diaphragm 9 Medial arcuate ligament 10 Psoas major muscle 11 Left brachiocephalic vein 12 Terminal crista 13 Right atrium 14 Right auricle 15 Central tendon of diaphragm 16 Esophagus 17 Celiac trunk and superior mesenteric artery 18 Aorta 19 Costal part of diaphragm 20 Costal margin 21 Transversus abdominis muscle Diaphragm.
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  • Unusual Venous Drainage of the Common Facial Vein. a Morphologycal Study ORIGINAL

    Unusual Venous Drainage of the Common Facial Vein. a Morphologycal Study ORIGINAL

    International INTERNATIONAL ARCHIVES OF MEDICINE 2018 Medical Society SECTION: HUMAN ANATOMY Vol. 11 No. 29 http://imedicalsociety.org ISSN: 1755-7682 doi: 10.3823/2570 Unusual Venous Drainage of the Common Facial Vein. A Morphologycal Study ORIGINAL Sergio Ivan Granados-Torres1, Humberto Ferreira-Arquez2 1 Medicine student sixth Semester, University of Pamplona, Norte de Abstract Santander, Colombia, South America 2 Professor Human Morphology, Medicine Background: Anatomical knowledge of the facial vasculature is cru- Program, University of Pamplona, Morphology Laboratory Coordinator, cial not only for anatomists but also for oral and maxillofacial surgery, University of Pamplona. plastic surgeon, otorhinolaryngologists. Access pathways, pedicled and free flap transfer, and explantation and transplantation of total Contact information: faces are based on the proper assessment and use of the facial veins and arteries. The anatomical variations reported in the present study Ivan Granados-Torres. confirms the need for preoperative vascular imaging for sure good Address: University Campus, Kilometer venous outflow for the free flap survival. 1. Via Bucaramanga. Norte de Santander, Colombia. Suramérica, Pamplona Zip code: Aims: The aim of the present study was to describe a rare anato- 543050 Tel: 573176222213 mical variation of the common facial vein which not been previously described. [email protected] Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 15 males and 2 females, i.e. 34 sides, embal- med adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 33 sides (97 %) of the cases the anterior facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic des- cription.