Forgot your password? Sign in with Facebook. Sign in with Apple. Description The retromandibular vein temporomaxillary vein, posterior facial vein , formed by the union of the superficial temporal and maxillary veins, descends in the substance of the parotid gland, superficial to the external carotid artery but beneath the facial nerve, between the ramus of the mandible and the sternocleidomastoideus muscle.
It divides into two branches: an anterior , which passes forward and joins anterior facial vein, to form the common facial vein, which then drains into the internal jugular vein. This definition incorporates text from a public domain edition of Gray's Anatomy 20th U.
Subscribe now Discover our subscription plans Subscribe. Illustration of variant venous pattern in the present case. The retromandibular vein is absent, resulting in the division of maxillary vein, abnormal formation of the external jugular vein, and persistence of an anomalous vein. Head and neck veins exhibiting variations or malformations are important during clinical applications such as reconstructive microsurgeries and diagnostic procedures.
Therefore, knowledge of the possible anatomical variants of these veins helps to avoid misinterpretations or misidentifications during conventional radiographic procedures such as angiography and venous catheterization [ 3 ]. Among the superficial veins of the head and neck, the EJV often shows variation both in its pattern of origin and termination.
Because of its known and frequent variability, it is likely improbable to determine the normal pattern of this vein [ 4 ]. Though variations in superficial veins of the head and neck are uncommon, the RMV is exceptional, with some authors reporting that it may show variations in its division pattern [ 2 , 3 ].
However, to the best of our knowledge, no study has reported its total absence. Venous patterns of the head and neck develop immediately following skull development. Venous pattern development is a complex process initiated by formation and eventual regression of the cephalic veins and is associated with formation of interconnecting venous spaces, giving the appearance of a plexiform arrangement.
Upon further development, selective "retention" and "regression" of some network channels results in a definitive venous pattern [ 5 ]. Thus, the EJV and RMV develop as secondary channels from a capillary plexus derived from a tributary of the cephalic vein in tissues of the neck and temporal region, respectively [ 6 ].
Developmental errors during crucial stages of venous formation result in an abnormal venous pattern or the absence of a particular venous channel. In cases of an undivided RMV, it most often continues as the EJV [ 2 , 7 , 8 ], or it may join the facial vein to form the common facial vein [ 3 ]. An undivided RMV is found in 1 out of cases [ 9 ].
When the RMV is undivided and there is no common facial vein, the RMV may join with the internal jugular vein and interfere with blood drainage from the anterior face. Variant patterns of superficial head and neck veins are vulnerable to profuse bleeding during neck surgery.
Hence, it is advisable to have knowledge of an abnormality before performing any clinical or radiological procedures in this region. The RMV is used as a guide to expose the branches of the facial nerve during superficial parotidectomy and open reduction of mandibular condylar fractures [ 10 ]. In these procedures, using the RMV as a guide to expose the branches of the facial nerve is identical to the procedure for exposing the condyle and elevating the superficial lobe of parotid gland, thus minimizing surgical stress [ 11 ].
The superficial course of the EJV is easier to follow with a venous manometer as it is more readily accessible than the internal jugular vein. The EJV is also used in catheterization for hemodialysis as it involves a simple, short procedure without any severe complications [ 12 ].
An abnormal pattern of the EJV, particularly variant formation and termination, may interfere with this approach. In conclusion, variant patterns of venous drainage from the head and neck region are uncommon. This is the first report showing complete absence of an RMV with abnormal division of the maxillary vein and formation of an atypical EJV. National Center for Biotechnology Information , U. Lateral circumflex femoral vein Medically reviewed by the Healthline Medical Network.
Popliteal artery Medically reviewed by the Healthline Medical Network. Inferior vena cava. Medically reviewed by Dr. Payal Kohli, M. Brachial Artery. Medically reviewed by Deborah Weatherspoon, Ph. Arcuate artery of the foot Medically reviewed by the Healthline Medical Network. Anterior circumflex humeral artery Medically reviewed by the Healthline Medical Network. Jejunum Overview. No hassles. Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review.
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Only selected articles should find a place in it. An yearly reward for the best article authored can also incentivize the authors.
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Rajendra Kumar Ghritlaharey "I wish to thank Dr. Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines.
Important Notice. Assistant Professor, Department of Anatomy, M. Ramaiah Medical College, Bangalore. Karnataka, , India.
The clinical, surgical and embryological significance of these variations have been emphasised. Retromandibular vein, Variations, External jugular vein, Internal jugular vein, Facial vein. The standard anatomical description of the veins of the face is 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 the anterior and the posterior divisions. The anterior division joins with the facial vein, inferior to the angle of the mandible, to form the common facial vein that drains into the internal jugular vein. The posterior division joins with the posterior auricular vein to form the external jugular vein which drains into the subclavian vein 1 , 2.
The knowledge on the varied drainage patterns of the veins of the head and neck is important and relevant, as they are often used for cannulation in intravenous infusions, central venous pressure monitoring and in microvascular anastomosis. The surgeons can also avoid any unnecessary bleeding during the intraoperative trial and error procedures 3. RMV is an important anatomical element in radiology which can be used to localize a tumour in the parotid gland in relation to the facial nerve and in surgery, as a landmark to dissect the facial nerve and its branches.
Ramaiah Medical College, variations of the major veins of the head and neck region were observed in a 60yr old male cadaver. The part was neatly dissected and photographs were taken. The anterior division joined with the maxillary vein to form the RMV. The posterior division joined with the posterior auricular vein to form the external jugular vein which drained into the subclavian vein. The RMV divided into the anterior and the posterior divisions at the angle of the mandible.
A connecting venous channel-V1 which measured 3. About 2. Further, the anterior division continued and joined the posterior division of the RMV to form asingle vein at the junction of the lower and the middle third of the sternocleidomastoid, and drained into the left subclavian vein.
The RMV trifurcated at the angle of the mandible. The anterior division received the facial vein and the submandibular vein. The middle division continued downwards and forwards and it joined with the anterior jugular vein, which is a single vein and it drained into the subclavian vein.
The posterior division drained into the internal jugular vein. Discussion The venous drainage of the head and neck region gets established after the formation of the skull.
The ventral pharyngeal vein receives tributaries from the face and the tongue and it becomes the linguofacial vein. The external jugular vein arises from the neck region from a tributary of the cephalic vein 1. The variations in the size and the pattern of the veins of the neck are quite common 2. There have been cases which have been reported, where the facial vein terminated into the external jugular vein 4 ; the RMV unitedwith the facial vein at a higher level in the parotid gland 5 ; the facial vein drained into the superficial temporal vein with an undivided RMV; the right facial vein drained into the superficial temporal vein, about 5mm above an undivided RMV 6 ; and the common trunk of the RMV joined with the anterior facial vein to form the common facial veins, with the absence of the external jugular vein bilaterally.
The superficial temporal vein and the RMV have been used as guides to expose the facial nerve branches in the parotid gland in superficial parotidectomy and also in cases of open reductions of the mandibular condyle fractures 8.
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