A case of right partial and double internal jugular veins

We present a very rare case of right partial and double internal jugular veins, found in an 86-year-old Japanese female cadaver during a student dissection practice session in 2002 at Osaka Dental University. In this case, the right internal jugular vein separated into medial and lateral branches at a level with the middle of the fifth cervical vertebra. Both branches had the same thickness as an internal jugular vein and poured into the right subclavian vein. A slender venous space slit was formed by these two branches and the right subclavian vein. The inferior belly of the right omohyoid muscle and the inferior root of the right ansa cervicalis passed through the superior region in this venous space. To our knowledge, this case has never been reported previously. Therefore, we attempted to investigate the incidence based on existing references for similar cases and speculated on the development based on our findings. We considered the medial branch was the right internal jugular vein and the lateral branch was the communicating branch between the external and internal jugular veins.     

High duplication of the internal jugular vein: clinical incidence in the adult and surgical consequences,a report of three clinical cases

Duplication of the internal jugular vein (IJV) is a rare malformation. Three intraoperative cases are reported. In our personal experience, the clinical incidence of the anomaly is approximately 4 per 1,000 unilateral neck dissections. The venous duplication is at a variable height, affecting the superior part of the IJV. The lateral branch of the accessory nerve (XI) always passes medially to the anterior vein and laterally to the posterior vein, between the venous duplication. This is most often unilateral but sometimes bilateral. The IJV may be normal, dilated or ectatic. The discovery of this anatomical variation has practical implications during cervical lymph node clearance, either functional or radical, during oncological surgery necessitating viewing the IJV and its affluents and the lateral branch of the accessory nerve. The embryological explanation suggests a topographical "conflict" between the development of the IJV and the lateral branch of the accessory nerve. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0020-y.     

Study on inferior petrosal sinus and its confluence pattern with relevant veins by MSCT

Objective  

To explore the anatomic route of inferior petrosal sinus (IPS) after going out of the cranium and its confluence patterns with internal jugular vein (IJV), anterior condylar vein (ACV) and lateral condylar vein (LCV), and to supply knowledge about typing of IPS–IJV junction, so as to provide reference evidence for evaluation of transvenous access route in the diagnosis and treatment of skull base and cavernous sinus lesions.     

Anatomical considerations of the anterior approach for central venous catheter placement

Central venous catheterization (CVC) entails the catheterization of the superior vena cava via either the subclavian or the internal jugular vein (IJV). This study looked at the frequency in which a needle was inserted into the IJV using the anterior CVC approach, which entails inserting the needle into the apex of Sedillot's triangle, formed by the sternal and clavicular heads of sternocleidomastoid (SCM). The ipsilateral distances from the apex of Sedillot's triangle to the superior aspect of the sternoclavicular joint and the diameter of the IJV were also measured. A needle was inserted into the apex of Sedillot's triangle in 36 adult cadavers with mean age of 62 +/- 19 years (mean +/- SD), mean height of 1.6 +/- 0.18 m, and a mean weight of 55 +/- 16 kg. Subsequent dissections of this area revealed the relation of the needle to the IJV. Results indicate that on the right, the needle was inserted into the IJV in 97.14% of the cases. On the left, the needle entered the IJV in 78.79% of the cases. From the sternoclavicular joint, the apex of Sedillot's triangle was found to be 40.87 +/- 1.62 mm and 38.73 +/- 6.34 mm on the right and left, respectively. The IJV diameter was 17.29 +/- 1.07 mm on the right and 15.30 +/- 0.25 mm on the left. We conclude that the anterior CVC approach is an anatomically accurate technique. It is furthermore important to realize that when performing any invasive procedure, a sound anatomical knowledge of the region is extremely important, as complications are often due to lack of understanding or misunderstanding of the relevant anatomy.     

Relations of the accessory nerve with the internal jugular vein: surgical implications in cervical lymph node clearances

The position of the lateral branch of the accessory nerve in relation to the internal jugular vein is given variously by different authors. In surgery of the neck, and especially in conservative cervical lymph node clearances, the lateral branch of the accessory nerve is protected when it is situated lateral to the vein. However, when the nerve is medial to the vein there is a risk of damage to the internal jugular vein. A prospective peroperative study of 123 cervical lymph node clearances, as well as a dissection study of 5 fresh subjects, was carried out to determine the position of the lateral branch of the accessory nerve in relation to the internal jugular vein. The surgical study showed that the lateral branch of the nerve was anterior and lateral to the vein in 122 of the 123 clearances, while the cadaveric study found the nerve always anterior and lateral to the vein. Thus the risk of injuring the internal jugular vein during cervical lymph node clearances is very small. The differences observed by authors may be explained by collapse of the internal jugular vein observed during cadaveric dissections.     

Altered collagen expression in jugular veins in multiple sclerosis

IntroductionVenous abnormalities have been associated with different neurological conditions, and the presence of a vascular involvement in multiple sclerosis (MS) has long been anticipated. In view of the recent debate regarding the existence of cerebral venous outflow impairment in MS due to abnormalities of the azygos or internal jugular veins (IJVs), we have studied the morphological and biological features of IJVs in MS patients.MethodsWe examined (a) IJVs specimens from MS patients who underwent surgical reconstruction of the IJV and specimens of the great saphenous vein used for surgical reconstruction, (b) different vein specimens from an MS patient dead of an unrelated cause, and (c) autoptical and surgical IJV specimens from patients without MS. Collagen deposition was assessed by means of Sirius red staining followed by polarized light examination. The expression of collagen type I and III, cytoskeletal proteins (α-smooth muscle actin and smooth muscle myosin heavy chains), and inflammatory markers (CD3 and CD68) was investigated.ResultsThe extracranial veins of MS patients showed focal thickenings of the wall characterized by a prevailing yellow–green birefringence (corresponding to thin, loosely packed collagen fibers) correlated to a higher expression of type III collagen. No differences in cytoskeletal protein and inflammatory marker expression were observed.DiscussionThe IJVs of MS patients presenting a focal thickening of the vein wall are characterized by the prevalence of loosely packed type III collagen fibers in the adventitia. Further studies are required to determine whether the observed venous alterations play a role in MS pathogenesis.     

Phlebectasia of the external jugular vein associated with duplication of the internal jugular vein

The most common cause of a neck mass that increases in size on the Valsalva maneuver is laryngocele. Jugular phlebectasia is a congenital dilation of the jugular vein, which is extremely rare in adults, may present similarly. Duplication of the internal jugular vein (IJV), which is usually encountered coincidentally, is another rare anatomic variation. Isolated cases or cases associated with IJV ectasia have been reported. We report on an adult patient with coexisting external jugular phlebectasia and internal jugular duplication on the same side.     

经锁骨下路锁骨下静脉穿刺的应用解剖

本文解剖观察了32例成人男性锁下静脉的锁骨下段。锁骨下静脉与锁骨的交叉点位于肩峰或肩锁关节至胸锁关节连线的内,中1/3稍外侧。在交叉点与环状软骨和胸骨颈静脉切迹连线的中点之间作一连线,此连线在锁骨下方的延长线即是锁骨下段的体表投影。     

Clinical presentation of a persistent jugulocephalic vein

The clinical history is presented of a 46-year-old woman with a permanently distended left external jugular vein which passed anterior to the clavicle instead of entering the subclavian vein just superior to the clavicle in the usual manner. For cosmetic reasons the vein was excised. Embryologically, the vein passing anterior to the clavicle was a persistent jugulocephalic vein. This is a normal venous channel which usually disappears after an anastomosis develops between the cephalic vein and the subclavian vein, inferior to the clavicle.     

颈前外侧入路的应用解剖学研究

目的　为颈前外侧入路手术提供应用解剖学基础。 方法　对10具标本模拟右侧颈前外侧入路进行解剖观测。 结果　颈总动脉的分叉在C4水平为70%。面静脉70%在C3/4椎间盘水平注入颈内静脉。颈交感干位于椎前筋膜下方,行于颈动脉鞘的正后方,并在头长肌和颈长肌表面纵向延伸。C6水平颈交感干和颈长肌内侧缘之间的距离（14.5±4.8）mm, C6水平颈交感干的直径为（2.6±1.2）mm。上神经节位于C2水平,长度和宽度分别是（11.9±2.5） mm和（7.4±4.2）mm。中神经节位于C5水平4例,C6水平6例。长度和宽度分别是（8.9±5.9）mm和（5.1±3.2）mm,椎动脉无一例外都穿过C6横突孔上行。C5的钩突的高度和宽度是最小的,但是从钩突的内侧缘到横突的前结节却拥有最长的距离（P<0.05）。 结论　采用该入路对于颈椎前外侧的病理性损害具有直达病变部位、损伤小、减压彻底,最大程度上保留病变节段的运动性和脊柱的稳定性等优点。     

颈静脉孔的应用解剖学

目的：为与颈静脉孔相关的影像诊断和临床治疗提供解剖学资料。方法：从颅底内、外面,对80具成年颅骨的颈静脉孔进行观测;并对20具成人尸头进行解剖,观察该区域神经血管解剖关系。结果：①62.3%右侧颈静脉孔较左侧大,15.9%左侧较大,21.8%两侧大小一致;②14.38%的颈静脉孔有骨桥,85.62%无骨桥;③颈静脉孔内、外侧缘距正中矢状面两侧的平均距离颅外均较颅内大：颅外分别为26.11mm和33.41mm,颅内分别为22.29mm和27.52mm。④XI脑神经多沿颈静脉孔前上缘,X、XI脑神经沿内侧缘出颅,两者被纤维索（占87.5%）或骨桥（占12.5%)隔开。⑤IX脑神经多经颈静脉孔外口前上缘向前下越过颈内动脉表面;IX脑神经经颈内静脉深面（占57.5%）或其浅面（42.5%)行向后下。结论：右侧颈静脉孔通常较左侧大,左右不对称;影像学观测该区域血管、神经应选择恰当的层面。     

改良先天性肌性斜颈手术方法的解剖学研究

【摘要】目的：根据颈筋膜解剖特点,改进传统的先天性肌性斜颈的手术方法。方法：选取经福尔马林固定,颈部无肉眼病变的成人尸体标本12具。沿锁骨切开皮肤、颈阔肌,向上在颈筋膜浅层浅面（封套筋膜）进行仔细分离,观察封套筋膜和颈阔肌的相互关系,粘连程度。以锁骨上方1.5 cm水平为中心,在胸锁乳突肌内缘内侧0.5 cm纵行剪开封套筋膜约3 cm,在胸锁乳突肌后鞘深面进行分离达胸锁乳突肌外侧,感觉分离的难易程度,观察封套筋膜和颈动脉鞘的完整性。结果：封套筋膜在颈前完整、致密,将胸锁乳突肌完整套封,颈阔肌与封套筋膜可以轻易地完整分离;在颈中下部胸锁乳突肌后鞘与颈动脉鞘也无粘连,各自独立,很容易完整分离。结论：依据胸锁乳突肌前后筋膜鞘的结构特点,可以将先天性肌性斜颈传统手术加以改进,提高疗效。     

Supraclavicular artery in Japanese: an anatomical basis for the flap using a pedicle containing a cervical, non-perforating cutaneous branch of the superficial cervical artery

We investigated the morphology of the non-perforating cervical cutaneous branch in the lateral cervical triangle using 65 (130 sides) donated cadavers. We found the branch in 104 of the entire 130 sides (80.0%). In the majority (72.1%), the cutaneous branch did not cross the clavicle or acromion but supplied the dorsolateral cervical area. The branch was originated from the superficial cervical artery close to the posterior belly of the omohyoideus muscle and immediately lateral to the external jugular vein. The comitant vein, if present, drained into the external jugular vein. Our observations and measurements (length and diameter) suggested that the non-perforating cutaneous branch is useful for a pedicle of the dorsolateral cervical flap in Japanese people. However, detailed morphologies differ from the previous studies published in western countries.     

Duplicate testicular veins accompanied by anomalies of the testicular arteries.

Duplicate testicular veins associated with other anomalies of the testicular arteries were observed during dissection of the posterior abdominal wall in a 90-year-old Japanese male cadaver. The right testicular vein was composed of the medial and lateral testicular veins. The medial testicular vein drained into the inferior vena cava, whereas the lateral testicular vein drained into the confluence of the inferior vena cava and right renal vein. Several anastomosing branches were seen between the medial and lateral testicular veins. The left testicular vein was formed after the medial and lateral venous trunks joined and drained into the ipsilateral renal vein. The right testicular artery originated from the anterior surface of the abdominal aorta at the level of the left renal artery, passed posterior to the inferior vena cava, and accompanied the right lateral testicular vein running downwards. The left testicular artery arose from the abdominal aorta at a level of 5 cm below the origin of the right testicular artery, and then ran downwards accompanied by the medial trunk of the left testicular vein.     

Comparative study of the ramification patterns of the subclavian branches as the subclavian artery passes in front or behind the scalenus anterior muscle

We investigated the ramification patterns of four subclavian branches (i.e., vertebral artery, internal thoracic artery, thyrocervical trunk, and costocervical trunk) as the subclavian artery passes in front or behind the scalenus anterior muscle. The investigation was carried out on 56 cadavers (112 cases) during student dissection practice sessions at Osaka Dental University. In 110 of the 112 cases, the subclavian artery passed behind the scalenus anterior muscle. The pattern of ramification of the subclavian branches in these cases was classified into six types (types A–F). In the remaining two cases (two cadavers), the subclavian artery passed in front of the scalenus anterior muscle. In both of these latter cases, the pattern of ramification of the subclavian branches differed from the six pattern types observed as the subclavian artery passed behind the scalenus anterior muscle: the first branch was the vertebral artery; the second, the costocervical trunk; the third, the thyrocervical trunk; the fourth, the internal thoracic artery. This same pattern of ramification was observed in three previously reported cases (two cadavers) in which the subclavian artery passed in front of the scalenus anterior muscle. Taken together, these observations indicate that the ramification pattern reported here and in a previous investigation for the subclavian artery passing in front of the scalenus anterior muscle is characteristic of this anatomical condition.     

Morphological study of the ansa cervicalis and the phrenic nerve

Morphological features of ansa cervicalis and phrenic nerve were studied in 106 cadavers. Ansa cervicalis was located medial to the internal jugular vein in 63% (medial type) and lateral to the vein in 33.7% (lateral type). Ansa cervicalis was derived from a combination of C1-C4 spinal segments, with C1-C3 being the most frequent pattern (87.5%). In >60% the ansa was bilaterally symmetrical. The distribution of medial and lateral types was equal on left and right sides of the body. The segmental composition of the inferior root was higher in the medial type and also on the left side of the body. In the lateral type the branches that formed the inferior root frequently (75%) formed a common trunk before joining the superior root, but in 74.8% of the medial type they joined the superior root independently. The phrenic nerve was derived from C4 and C5 in 52%. The C4 segment was present in the phrenic nerve in all cases except one. Additional phrenic components that pass anterior to the subclavian vein were defined as accessory phrenic nerves and found in 28.7%, while those passing posterior to the same vein were defined as secondary phrenic nerves (19.8%). Most of the accessory phrenic nerves contained a C5 segment and the nerve to subclavius was the commonest source. Various relationships between the ansa cervicalis and the phrenic nerve are investigated and, based on these findings, two separate classifications for the two nerves are suggested.     

Venous distribution of superficial cervical region in rhesus (Macaca mulatta) monkey

The superficial veins of the cervical region in over 50 Macaca mulatta monkeys were studied. We found, in addition to the external jugular vein, another major vein, which we have termed jugular accessory. It is comparable in size and runs ventral to the external jugular vein. It commenced at the angle of the mouth, ran in a groove on the dorsal aspect of the submandibular gland, and descended on the surface of the sternocleidomastoid muscle where it was connected to the external jugular vein by a short transverse twig. It then descended toward the clavicle, crossed it ventrally, and immediately joined the cephalic vein. The resultant common vein pierced the thoracic wall between the clavicle and first rib and joined the external jugular and axillary veins, producing the subclavian vein. It was the jugular accessory and the external jugular, being connected as described, that formed an "H"-shaped system.     

The relationship between the internal jugular vein and common carotid artery in the carotid sheath: the effects of age, gender and side

The internal jugular vein is often used for central venous catheter placement. The variations in the location of this vein along the major neck vessels (in the carotid sheath) may account for unsuccessful cannulations or iatrogenic arterial injuries. The aim of this study was to delineate the relation of the internal jugular vein and common carotid artery in the lower neck, and to assess the effects of age, gender and side on these anatomical structures. Two-dimensional ultrasonographic examinations of the right and left supraclavicular triangle were performed in 219 adult individuals who had no history of neck surgery or known pathology. The location of the internal jugular vein in relation to the common carotid artery was recorded. An anterolateral location of the internal jugular vein was the most common configuration observed on both sides (84% right side and 91.8% left side) followed by the lateral (14.2% right and 6.4% left) and anterior (1.4% right and 1.8% left) locations. A single case of a medial internal jugular vein was observed on the right side (0.23% of both sides). Subjects with a laterally located internal jugular vein were older than those with an anterolateral configuration (P<0.01). No gender differences were found with regard to these two configurations (P=0.867). The laterally located internal jugular vein was more frequent on right sides (P=0.007). Such information may be potentially useful for clinicians who are managing critically ill patients or patients undergoing hemodialysis.     

Anomalous origin and cervical course of the vertebral artery in the presence of a retroesophageal right subclavian artery

The vertebral artery is usually described as the first branch of the subclavian artery, originating medial to the scalenus anterior muscle. During its cervical course, the vertebral artery presents a prevertebral segment and then enters the foramen transversarium of the sixth cervical vertebra. We describe a case of an unusual origin and course of the right vertebral artery in a cadaver specimen wherein the right vertebral artery originates from the right common carotid artery at the inferior border of the thyroid gland. In its cervical course the vertebral artery ascends outside and anteriorly to the foramen transversarium of vertebrae C VI to C III, and enters the foramen transversarium of the axis. In the same specimen, a retroesophageal right subclavian artery is also present. These vascular abnormalities are presented for physicians to keep in mind such variations during diagnostic investigation and surgical procedures of the neck.