Summary: The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.

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Multiple variations of the superficial jugular veins: case report and clinical relevance.

Different patterns of variations in the venous drainage have been observed in the past. During routine dissection in our Department of Anatomy, an unusual drainage pattern of the veins of the left side of the face of a middle aged cadaver was observed. The facial vein presented a normal course from its origin up to the base of mandible, and then it crossed the base of mandible posteriorly to the facial artery. Thereafter, it joined with the anterior division of retromandibular vein to form the common facial vein, which drained into the external jugular vein directly. Sound anatomic knowledge of the above variation in facial veins is essential to the success of surgical procedures in this region.

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Termination of the facial vein into the external jugular vein: an anatomical variation

Superficial veins of the head and neck are utilised for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology. Hence, although variations in these vessels are common, a sound knowledge of such variations becomes clinically important to surgeons, radiologists and interventional anaesthetists. We report a rare case of a left-sided double external jugular vein where the common facial vein continued as the second external jugular vein, and where there was a communicating channel between the internal jugular vein on the same side and the anterior jugular vein.

Double external jugular vein and other rare venous variations of the head and neck.

Variations in drainage veins of the face and neck are important not only for the anatomist but also surgeon. In view of this significance a total of 13 cadavers with different age groups were used for this study. The head and neck region (26 sides) were dissected carefully and photographed in the Morphology Laboratory at the University of Pamplona. Anatomical variation and unusual pattern of drainage was found in a 75-year-old male cadaver with unilateral absence of external jugular vein. The lingual vein and the superior thyroid vein had transverse venous connections which drained into an arch venous located between the primitive carotid artery and the superior thyroid artery. This arch venous draining above in the common facial vein and down into the internal jugular vein. Knowledge of anatomic and morphologic variations in the superficial veins of the head and neck is essential to carry out successful surgical procedures.

Unusual venous drainage of the head and neck.

The study of the variations in the superficial veins of head and neck and their draining pattern is very important due to the complexity in their developmental pattern. A total of 32 cadavers of both sexes were used for the study and the head and neck region were dissected carefully and photographed in the department of anatomy, Vinayaka Mission Kirupananda Variyar Medical College & Hospital, Salem. We observed one cadaver presenting with undivided retromandibular vein on its right side draining into internal jugular vein after receiving anterior facial vein and posterior auricular vein with absence of external jugular vein. Second cadaver showed a common facial vein draining into external jugular vein and also doubling of External jugular vein. Third specimen presented with termination of anterior division of retromandibular vein into external jugular vein and occipital vein into internal jugular vein. Hence, Knowledge on variations of veins of head and neck were important for clinicians, radiologist and surgeon for planning the operative procedures.

Variations in the venous drainage pattern of face and neck

Facial region has enormous blood supply. The maxillary vein, facial vein and superficial temporal vein are chief venous draining channels. There are numerous reports of unusual venous system of face, in the present case, retromandibular vein divides into anterior and posterior division soon after its formation, external carotid artery lying lateral to retromandibular vein, formation of common venous channel between internal jugular vein and anterior jugular vein where facial, lingual and submental vein drain.

Unusual venous drainage of face: a case report.

Port-based central venous catheters may remain indwelling for years with subsequent fibrosis resulting in a "stuck" catheter. At time of removal, this can lead to complications such as catheter fracture or require additional operative techniques for safe extraction. We present a case utilizing a protocol wherein a J-tip guidewire is placed to assist in removal. We believe this serves the following beneficial functions: Mechanically, as the catheter stretches and collapses upon retraction it distributes the force circumferentially along the length of the catheter as well as reduces angular kinking, mitigating stress points of fracture. Second, in case of fracture, the distal portion should remain intubated by the J-tip guidewire, reducing embolic potential. Third, it allows more facile percutaneous transvenous retrieval if indicated. Though this does not represent a perfect solution to the "stuck" catheter problem, this technique increases safety and efficacy of removal with easy application at minimal additional cost.

Use of a Guide-wire as an Adjunct for the Safe Removal of a 'Stuck' Indwelling Central Venous Catheter at Risk for Breaking.

Preduodenal portal vein (PDPV) is a rare congenital anomaly in which the portal vein lies anterior to the duodenum rather than its normal posterior position. It is a known rare cause of duodenal obstruction and can be associated with other anomalies such as malrotation with or without jejunal atresia. Presented is an incidentally found PDPV causing partial duodenal obstruction during exploration for the resection of a gastric mass and placement of open gastrostomy tube for feeding. This was managed with duodenoduodenostomy, re-creating normal anatomy with portal.

Incidental Preduodenal Portal Vein Causing Partial Duodenal Obstruction and Hypertrophied Pre-Pyloric Gastric Polyp.

A level 1 pediatric trauma registry database was examined for all non-accidental trauma (NAT) emergency department visits between 2016 and 2021, and average injury severity score assigned to those patients with physical injuries over 2019-2021. There was a decline in NAT visits in 2020 (267) from prior years (343 visits average over 2016-2019), with subsequent increase in 2021 (548). Injury severity score increased (ISS) in 2020 (7.3) when compared to 2019 (5.71), with a decline in average ISS in 2021 (5.42). This data highlights the potential for missed abuse during closures with increased detection following reopening. Our data regarding ISS demonstrates the pediatric population is at risk of more severe abuse during times of familial stress. We need increased awareness that periods of vulnerability to NAT exist, as seen during the COVID-19 pandemic.

Sounmya Bhattacharya

Papers

Unusual venous drainage of face: a case report.

Use of a Guide-wire as an Adjunct for the Safe Removal of a 'Stuck' Indwelling Central Venous Catheter at Risk for Breaking.

Incidental Preduodenal Portal Vein Causing Partial Duodenal Obstruction and Hypertrophied Pre-Pyloric Gastric Polyp.

Changes in Pediatric Non-accidental Trauma Emergency Department Visits During and Following the COVID-19 Lockdown