Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : AC06 - AC12 Full Version

Variations in Superficial Veins of Neck among Population of Eastern India in the Light of Embryological Explanation: A Cadaveric Cross-sectional Study


Published: March 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/57471.17583
Susmita Ghosh, Anup Shyamal, Mithu Paul, Oyndrila Sengupta, Sibani Mazumdar

1. Assistant Professor, Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India. 2. Associate Professor, Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India. 3. Demonstrator, Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India. 4. Assistant Professor, Department of Anatomy, Murshidabad Medical College, Berhampore, Murshidabad, West Bengal, India. 5. Professor, Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Oyndrila Sengupta,
58/1B, Raja Ram Mohan Sarani, Kolkata-700009, West Bengal, India.
E-mail: sanskritabrata@gmail.com

Abstract

Introduction: Development of veins of head and neck is complex. Variations in the venous architecture of head and neck includes persistence or complete obliteration of communication between Internal Jugular Vein (IJV) and External Jugular Vein (EJV) and also partial obliteration in EJV. Knowledge of variations in venous architecture is beneficial to avoid injuries to these veins during interventions like EJV cannulation for diagnostic and therapeutic purposes.

Aim: To study the variations in the venous architecture of the neck in the cadavers.

Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India during December 2017 to December 2019. Total 26 specimens of both male and female cadavers were dissected, and variations in the venous architecture was noted, also each variation was explained in the light of embryology.

Results: Retromandibular Vein (RMV) was found to be undivided in all 10 of the variations found in the eight male and two female cadavers. EJV was found to be absent in one specimen among 26 dissected. Communication between IJV and EJV was found in one specimen. In another specimen, EJV was found to be draining into IJV which can be embryologically seen as a communication between IJV and EJV while the caudal part of EJV had degenerated.

Conclusion: Undivided RMV, particularly absent posterior division is not very uncommon in male and female in this ethnicity. Absence of common facial vein was more common in male as compared to female. Persistent communication between EJV and IJV were also more in male. Moreover occurrence of facial vein drainage into EJV was also remarkably high.

Keywords

Ethnicity, External jugular vein, Facial vein, Retromandibular vein, Vein communication

During performing dissection of cadavers for undergraduate students it is found that the Facial Vein (FV) joins with the anterior division of RMV to form the Common Facial Vein (CFV) which drains into the IJV. When RMV remains undivided and joins facial vein, then also the vein formed is called the CFV. It is also seen that in cases of undivided RMV, it most often continues as EJV. But, EJV may be absent, when undivided RMV joins with FV to form the common trunk of CFV to drain into IJV (1).

Undivided RMV were found in 0.01% of specimen in a study by Pai M et al., (2). Bertha A and Suganthy R comments that in cases of RMV without any divisions, RMV mostly continues as EJV (3). Absence of RMV was reported by Patil J et al., in a specimen instead, the maxillary vein was divided into anterior and posterior divisions (4). Sometimes communications may persist between CFV and EJV or EJV and IJV. EJV may even be completely absent (5).

Exploring the formation of RMV by dissection is an area not much cultivated. Variations in the termination of Anterior Jugular Vein (AJV) are also area to be explored. Keeping all these variations in mind and also the importance of all these variations in head and neck surgery it is evident that there is huge scope of many more to be explored by dissection. Hence, present study was conducted to study the variations in the venous architecture of the neck in the cadavers.

Material and Methods

This descriptive cross-sectional study was conducted in the Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India, from December 2017 to December 2019. As the study was carried out on cadavers, from voluntarily donated bodies in the Department of Anatomy, examination of any organ or, structure for academic purpose is permitted, according to the prevailing laws of the land. Hence, no further consent was necessary.

Inclusion criteria: Both male and female adult cadavers, aged above 60 years were included in the study. The dissection was done on both sides of the neck of voluntarily donated preserved cadavers.

Exclusion criteria: Cadavers having any neck injury, diseases of neck were excluded from the study.

Sample size: A total of 26 specimens were dissected among which, there were 9 male (left-side), 9 male (right-side), 4 female (left-side), 4 female (right-side).

Data Collection

During routine dissection of voluntarily donated human cadavers for conducting undergraduate class the neck veins were dissected. Neck was extended with support and fixed in position for proper exposure. Wooden block, rope, dissecting toothed and non toothed forceps, scissors, scalpel were used for this purpose. In case of any variation regarding the neck vein formation, tributaries or termination were documented by taking pictures.

Operational Definitions

1. External Jugular Vein (EJV): Formed by posterior division of RMV and the posterior auricular vein, and drains into the subclavian vein of same side. Receives cervical, suprascapular and AJV (6),(7),(8).

2. Common Facial Vein (CFV): Formed by facial vein and the anterior division of RMV and drains into the IJV (7),(8).

3. Retromandibular Vein (RMV): Formed by union of superficial temporal and maxillary veins and terminates by dividing into anterior and posterior divisions in the anterior triangle of neck (7),(8).

4. Facial Vein (FV): Formed by continuity of the angular vein at the medial canthus of the eye and drains into the IJV after forming CFV (7),(8).

Statistical Analysis

The variations were documented in Microsoft excel sheet and their proportions was calculated in the both male and female subgroups in terms of number and percentage.

Results

A total of 26 specimens were dissected among which variations in venous architecture was found in 10 specimens among which eight were males (4 left, 4 right) and two were female specimen (1 left, 1 right). All had undivided RMV along with other associated variations. One male specimen had bilaterally absent CFV (Table/Fig 1)a,b,(Table/Fig 2)a,b. Presence of communication between EJV and IJV was also found bilaterally in another male specimen (Table/Fig 3)a,b,(Table/Fig 4)a,b. Rest all variations were unilateral. Among all the specimens, in eight male specimens undivided RMV was found to be continuing as EJV, and the CFV was found to be absent in six of them (Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8),(Table/Fig 9),(Table/Fig 10),(Table/Fig 11).

The EJV was absent in one female specimen (Table/Fig 5),(Table/Fig 10)a,(Table/Fig 12). In this study 10 (38.5%) undivided RMV was found with equal incidence on either side (5 on left and 5 on right) (Table/Fig 13), where FV was not united with anterior division of RMV no CFV was formed. Absence of CFV was found in 6 (23.1%) of this study population (3 left and 3 right) (Table/Fig 14). EJV was found to be absent in 3.85% of the sample. Communication between EJV and IJV was found in 2 (7.7%) cases (1 left and 1 right) (Table/Fig 4)a,(Table/Fig 5),(Table/Fig 10)a.

The FV joined with undivided RMV to form CFV and continued as EJV in one male specimen (Table/Fig 4)a,(Table/Fig 12). In 2 (22.2%) of male left-sided specimen FV found to drain into EJV without joining with RMV. In female the same occurred in 1 (25%) but after joining with RMV (Table/Fig 15). In two male specimens communication between EJV and IJV were found (Table/Fig 3)a,(Table/Fig 4)a,(Table/Fig 5),(Table/Fig 12). In one male specimen EJV was found to drain into IJV (Table/Fig 3)a. Embryologically the anterior connection (ac) between EJV and IJV persist while the part of EJV distal to the communication obliterates. Hence, EJV has drained into IJV through its communication.

Discussion

Knowledge of variations and persisting communications help in avoidance of injuries to the veins during interventions like EJV cannulaion for diagnostic and therapeutic purposes including monitoring of Central Venous Pressure (CVP) (9). Transjugular liver biopsy and postsystemic shunts have also been tried through this route. CFV is used as a patch material for carotid angioplasty and in ventriculo-jugular shunts as a treatment of hydrocephalus (10). Knowledge of superficial veins of neck prevents injuries of interventional procedures or during neck surgeries (11).

Ultrasound-guided venepuncture can avoid trauma related to variations in venous architecture. Grafting of these veins is also utilised in microvascular anastomosis in oral reconstruction surgeries (8). Venous segments are used as patches in carotid endarterectomies. The superficial course of EJV makes it easier than the IJV to be accessed with a venous manometer (9). EJV is also used in catheterisation for performing haemodialysis (10). RMV can be used as a guide to identify the facial nerve branches during parotid surgeries and open reductions of mandibular condylar fractures (11). The RMV is an important anatomical guide in radiology where it is used to localise 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 (11).

Embryological explanation: Development of the veins of head and neck undergo a complex pattern and are only apparent after the development of skull (3). The ventral pharyngeal vein, which opens into the precardinal vein (the future IJV) develops early. Then, it receives a tributary called linguo-facial vein (finally becoming the facial vein), draining face and tongue. RMV, which is considerably large vein, develops draining blood from the temporal region into the linguo-facial vein. The common trunk called CFV drains into the precardinal vein. The preaxial vein of the upper limb which in future will form the cephalic vein, receives EJV, draining tissues of the neck. The finally formed EJV drains into the SCV (7).

The EJV communicates in front (ac in (Table/Fig 16)) with terminal part of the developing CFV or into the precardinal vein and posteriorly (new communication (nc) in (Table/Fig 16)) with the RMV. PAV opens in the posterior communication which in future appears to be the posterior division of the RMV, thus in future forming the EJV. The initially formed RMV becomes the anterior division of future RMV, which joins with the FV, to form CFV. Sometimes, if in early developmental stages, cephalic part of EJV may disappears (3), an extra communication arises between CFV and caudal part of EJV. Then there may be no posterior communication with RMV, and PAV has to open in the undivided RMV. The pathway of venous drainage then is as follows: undivided RMV? joins with FV ?CFV? opens into caudal part of EJV (segment of CFV draining into precardinal or IJV disappears) via the extra communication (nc) ?SV. All the variations cited in this article are cited in the light of this embryological explanation.

From above explanation by the term undivided RMV, authors thus assume, developmentally in due course of time, either anterior or posterior division got obliterated. The presence of anterior or posterior division as mentioned in the specimens of variation, are embryological explanations where undivided RMVs are detected. Authors assume that where RMV has joined with FV, it may be considered to persist its anterior division (as anterior division meets FV to form CFV), irrespective of its drainage into either EJV or IJV. But undivided RMVs which have no connection with FV, may be considered to persist with posterior divisions with anterior divisions obliterated (as posterior division of RMV joins with PAV), which drain into EJV mostly but may drain into IJV through persisting communication between IJV and EJV (12),(13).

All 10 specimen had undivided RMV along with other associated variations (Table/Fig 1)b(Table/Fig 4)b,(Table/Fig 6)b,(Table/Fig 7)b,(Table/Fig 8)b,(Table/Fig 9)b,(Table/Fig 10)b,[Table/Fig-11b]. The possible embryological explanation of the 10 cases that were found with variations are:

Specimen 1-SMV drains into FV which does not communicate with anterior division of RMV. The anterior division of RMV thus degenerates. Posterior division of RMV continues with the EJV. PAV is absent and FV drains into IJV. Communications between FV or IJV and EJV do not persist (Table/Fig 6)b.

Specimen 2-RMV has only posterior division which joins with EJV. PAV is absent. Anterior division of RMV degenerates, so communication between RMV and FV, CFV is not formed. FV drains directly into IJV. Anterior and posterior communications between IJV/CFV (which is not formed at all) and EJV degenerate (Table/Fig 7)b.

Specimen 6-Posterior division of RMV drains into EJV. Anterior division of RMV does not communicate with FV and degenerates. FV drains into IJV and no anterior or new communication persists (Table/Fig 11)b.

Specimen 7 and 8-Anterior division of RMV obliterates and posterior division joins EJV. FV drains into IJV and has no communication with anterior division of RMV. This anterior division degenerates (Table/Fig 2)b.

So in present study anterior division of RMV was absent in 44.4% and 33.3% of male specimen on right and left-sides, respectively. On the other hand posterior division of RMV were absent in 22.2% of left-side in male and 25% on either sides of female specimen. Bertha A and Suganthy R comments that in cases of RMV without any divisions, RMV mostly continues as EJV (3). Rao YL et al., had cited undivided RMV associated with absence of EJV and common trunk of RMV and FV draining into IJV (1). CFV was absent in 23.1% of either side of male specimen. On left-side CFV drain into EJV in 7.7% of female and 15.4% of male (Table/Fig 14). Arquez HF and Torres SIG in their study during 2013 to 2017 found that right common facial vein (3%) was draining into the contralateral pericardiophrenic vein and internal thoracic vein on one side. They also found remarkable communications with the EJV, the IJV, the anterior jugular vein, and left brachiocephalic vein (13).

Specimen 3-PAV does not drain as posterior division of RMV. Thus, cephalic part of EJV degenerates and anterior division of RMV joins with FV to form CFV which communicates with EJV through extra communication. SMV however independently drains into IJV without draining into FV (Table/Fig 8)b.

Specimen 4-The anterior division of RMV persists to join FV, to which SMV has already communicated. CFV, which is formed of joining to FV and anterior division of RMV, through extra communication (nc) drains into EJV instead of IJV. CFV loses its contact with IJV. The cephalic part of EJV disappears, having no posterior division of RMV to drain into it (Table/Fig 9)b.

Specimen 10-Posterior division of RMV and cephalic part of EJV obliterate. FV joins with anterior division of RMV to form CFV which through new communication drains into EJV, but loses connection with IJV. However, in the caudal part, EJV is connected with IJV by the communication which persists as a transverse communication between IJV and EJV in adult life (Table/Fig 4)b.

Unusual drainage of the CFV into the EJV on left-side in two specimen and right-side in one specimen were observed by Bertha A and Suganthy R (3). Among male specimen 44.4% on right-side and 22.2% on left-side FV did not join with RMV, drained into IJV. A 22.2% on left-side of male and 25% on left-side of female specimen the FV drained into EJV (Table/Fig 15).

Specimen 5-Anterior division of RMV unites with FV to form CFV which drains into IJV. There is no posterior division of RMV and in this case the whole of EJV obliterates as no vein drains into it (Table/Fig 10)b.

Among all the specimen from female EJV was absent in 25% on right-side. Balachandra N et al., in their case report, described absent EJV on right-side of a male cadaver aged about 50 years. The RMV was not dividing into anterior and posterior divisions (14). Rao YL et al., also found absent EJV (1).

Specimen 9-The caudal part of EJV obliterates. So, via the communication, EJV drains into IJV. EJV, in its cephalic part receives posterior division of RMV, which in turn receives PAV. Anterior division of RMV obliterates. So, FV drains into IJV without forming CFV. Communication nc obliterates (Table/Fig 3)b.

A 38.5% of all specimens under study had shown undivided RMV unlike the finding of Pai M et al., study where it was 0.01%. 11.1% of male specimen show persistence of communication between external and IJV, unlike the female specimen where no such thing could be found (Table/Fig 17) (2). In 25% of female specimen the RMV was found to drain into IJV in present study (Table/Fig 12). But absence of RMV was not found which was reported by Patil J et al., found a specimen with no RMV formed, instead, the maxillary vein divided into anterior and posterior divisions (4).

Limitation(s)

Limitations of present study was less sample size as prosection was not allowed at Calcutta National Medical College, and cadavers required for classes are only allowed to get dissected. Moreover, there was less scope of exploration of parotid region as the existing cadavers were being used for undergraduate classes.

Conclusion

In present study, the prevalence of variations in venous architecture was found to be 38.5%. Undivided RMV was encountered in all the specimens. Absence of EJV is a rarity, which was found in one specimen in present study. Communication between IJV and EJV was found in two specimens, which can be explained by the persistence of the embryological communications between these two veins of the neck. In future studies, exploration of parotid region with meticulous dissection of infratemporal fossa must be carried out to study the variations of RMV and communications among superficial and deep venous systems of neck region. RMV is used as a guide to expose the branches of facial nerve during superficial parotidectomy. So, variation of the division of RMV or its absence may affect such procedures, prior knowledge will definitely help practicing alternative skill during such surgeries.

Acknowledgement

Authors express gratitude to those who donated their bodies for academic purpose.

References

1.
Rao YL, Ballal V, Murlimanju VB, Pai MM, Tonse M, Krishnamurthy A. Undivided retromandibular vein leading to the absence of external jugular vein. J Morphol Sci. 2018;35:225-28. [crossref]
2.
Pai M, Vadgaonkar R, Prabhu L, Shetty P. The different termination patterns of the facial vein: A cadaveric study. First Tip Dergisi. 2008;13:32-34.
3.
Bertha A, Suganthy R. Anatomical variations in termination of common facial vein. J Clin Diag Res. 2011;5(1):24-27.
4.
Patil J, Kumar N, Swamy RS, D’Souza MR, Guru A, Nayak SB. Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region. Anat Cell Biol. 2014;47(2):135-37. [crossref] [PubMed]
5.
Cvetko E. A case of left-sided absence and right-sided fenestration of the external jugular vein and a review of literature. Surg Radiol Anat. 2015;37(7):883-86. [crossref] [PubMed]
6.
Dalip D, Iwanga J, Loukas M, Oskouian RJ, Tubbs RS. Review of the variations of the superficial veins of the neck. Cureus. 2018;10(6):2826. [crossref] [PubMed]
7.
Standring SM. Grays Anatomy. 42 nd ed. London. Elsevier Churchill Livingstone, 2021. Pp. 590-93.
8.
Richard S. Snell. Clinical Anatomy by Regions, 8 th Ed. India, Wolter Kluwer India, 2007. Pp. 752.
9.
Siegel EA, Caresio J, Eckard DA. Use of the external jugular vein approach for transvenous liver biopsy. JVIR.1992;3:371-74. [crossref] [PubMed]
10.
Gogolev MP. The treatment of hydrocephalusby ventriculojugular shunting. Zh Vopr Neirokhir Im N N Burdenko.1993;(3):24-26.
11.
Nagase T, Kobayashi S, Sekiya S, Ohmori K. Anatomic evaluation of the facial artery and vein using colour doppler ultrasonography. Ann Plast Surg. 1997;39:64-67. [crossref] [PubMed]
12.
Ghosh S, Mandal L, Roy S, Bandyopadhyay M. Two rare anatomical variations of external jugular vein-An embryological overview. IJM. 2012;30:821-24. [crossref]
13.
Arquez HF, Torres SIG. Unusual venous drainage of the common facial vein. A morphological study. Arch Int Med. 2018;11:1-12. [crossref]
14.
Balachandra N, Kadirappa P, Prakash BS, Bindinganavile RR. Variation of the veins of the head and neck-external jugular vein and facial vein. IJAV. 2012;5:99-101.

DOI and Others

DOI: 10.7860/JCDR/2023/57471.17583

Date of Submission: May 01, 2022
Date of Peer Review: Jun 15, 2022
Date of Acceptance: Oct 20, 2022
Date of Publishing: Mar 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 11, 2022
• Manual Googling: Aug 26, 2022
• iThenticate Software: Oct 18, 2022 (7%)

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