Características de las venas pericondíleas de la articulación temporomandibular en la celda parotídea / Characteristics of the pericondylar veins of the temporomandibular joint in the parotid cell

Introducción: La presencia de la vena pericondílea en la zona de la articulación temporomandibular es escasamente reportado en la literatura, sin embargo se encuentra presente en los preparados anatómicos disecados, y durante los procedimientos quirúrgicos. Objetivo: Determinar las características de la vena pericondílea ubicada en la zona de la articulación temporomandibular, relacionadas con la región parotídea. Material y Métodos: Se diseñó un estudio transversal, prospectivo que incluyó 30 cadáveres humanos que fueron diseccionados a nivel de la articulación temporomandibular. Se analizó las variables de distribución de la vena pericondílea, forma, dimensiones y relaciones con las estructuras adyacentes. Resultados: Los 30 casos presentaron la vena pericondílea que rodeó la cara externa del cuello del cóndilo mandibular. El 73,3 por ciento de venas desembocó a nivel de la vena retromandibular. El 38,3 por ciento de venas presentaron trayecto oblicuo. La longitud promedio fue de 2,37 cm y su diámetro promedio de 1,82 mm. Entre las relaciones, se encontró la presencia de la arteria pericondílea en dos casos. Conclusiones: La vena pericondílea estuvo presente en todos los casos en su mayoría única y localizada rodeando por fuera el cuello del cóndilo mandibular; desemboca con mayor frecuencia en la vena retromandibular y hasta su desembocadura presenta frecuentemente trayecto oblicuo, de arriba hacia abajo y hacia atrás(AU)

Introduction: The presence of the pericondylar vein in the area of the temporomandibular joint is scarcely reported in the literature; however, it is present in anatomical dissected preparations and during surgical procedures. Objective: To determine the characteristics of the pericondylar vein located in the area of the temporomandibular joint, related to the parotid region. Material and Methods: A cross-sectional, prospective study that included 30 human cadavers that were dissected at the temporomandibular joint level was conducted. The variables analyzed were the distribution of the pericondylar vein, its shape, dimensions and the relationships existing between bony structures. Results: The 30 cases presented the pericondylar vein that surrounded the external face of the neck of the mandibular condyle; 73,3 percent of the veins ended at the level of the retromandibular vein; 38,3 percent of them presented an oblique path. The average length of the vein was 2,37 cm and its average diameter was 1.82 mm. The presence of the pericondyleal artery was found in two cases, among other relationships. Conclusions: The pericondyleal vein was present in all cases, mostly unique and located around the outside of the neck of the mandibular condyle. It most frequently runs into the retromandibular vein. Up to its mouth, it often has an oblique path, from top to bottom and backwards(AU)

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Termination Of The Common Facial Vein Into The Anterior Jugular Vein: A Rare Case Report

The facial vein drains the facial region of our body. It unites with the anterior division of the retromandibularvein to form the common facial vein. In this case report, the retromandibular vein was seen dividing normallyinto the anterior and posterior divisions. The posterior division was seen uniting with the posterior auricularvein to form the external jugular vein. Formation and course of the external jugular vein was normal. The anteriordivision of the retromandibular vein was uniting with the facial vein to form the common facial vein, which wasdraining into the anterior jugular vein instead of the internal jugular vein.

Retromandibular Approach for Subcondylar Fractures: A Prospective Study

Background: Condylar fractures accounts for 25-50% of all mandibular fractures. It can be extracapsular or intracapsular, nondisplaced, displaced, deviated, or dislocated from the disc. Objective: To evaluate the retromandibular transparotid approach for open reduction & internal fixation of subcondylar fractures for post-operative occlusal status, stability of fixation & postoperative complications. Material and Methods: The prospective study was performed on 24 patients (18 male and 8 females) sustaining 26 subcondylar fractures who were treated surgically utilizing retromandibular transparotid incision. Results: The most common etiology of injury was road traffic accidents in 62.5% patients. Satisfactory anatomic reduction and occlusion was achieved in all patients. The incidence of transient facial nerve injury was 16.67%. The facial nerve returned to normal function in 3 months in all the 4 affected patients. Conclusion: The incision provides easy visualization of the subcondylar region from the posterior edge of the ramus to the sigmoid notch, allows the perpendicular placement of screws to the fracture site, with minimal post operative complications and satisfactory esthetic results.

Variaciones anatómicas en el drenaje venoso del cuello / Anatomical variations in the venous drainage of the neck

Resumen Las venas superficiales, especialmente la vena yugular externa, son cada vez más utilizadas para canalización o procedimientos diagnósticos, terapias intravenosas, nutrición parenteral en pacientes debilitados. Las variaciones en el drenaje venoso de la cabeza y cuello son importantes no solamente para los anatomistas y radiólogos, sino también para los cirujanos. Durante una disección de rutina en el Laboratorio de Morfología de la Universidad de Pamplona en un cadáver masculino de 75 años de edad, se encontraron variaciones anatómicas e inusuales patrones de drenaje en la región de cara y cuello, las cuales fueron cuidadosamente disecadas y los detalles morfológicos fueron fotografiados; esas variaciones consistían en: ausencia unilateral de vena yugular externa. La vena lingual, la vena infrahioidea y la vena tiroidea superior tenían conexiones venosas transversas que drenaban en un arco venoso localizado entre la arteria carótida común y la arteria tiroidea superior. Este arco venoso drenaba hacia arriba en la vena facial común y hacia abajo en la vena yugular interna. El conocimiento de las variaciones anatómicas y morfológicas en las venas de cabeza y cuello es esencial para llevar a cabo procedimientos quirúrgicos exitosos en estas regiones.

Abstract The superficial veins, especially the external jugular vein are increasingly used for cannulation or diagnostic procedures, intravenous therapy, parenteral nutrition in debilitated patients. Variations in the venous drainage of the head and neck are important not only for anatomists and radiologists but also for surgeons. During routine dissection in the Laboratory of Morphology, University of Pamplona in a 75 year-old male cadaver in the region face and neck anatomical variations and unusual drainage patterns were found, which were dissected carefully and morphological details were photographed; these variations consisted of unilateral absence of external jugular vein. The lingual vein, the infrahyoid vein and the superior thyroid vein had transverse venous connections that drained into a venous arch located between the common carotid artery and the superior thyroid artery. This draining venous arch upward in the common facial vein and down into the internal jugular vein. Knowledge of the anatomical and morphological variations in the veins of the head and neck is essential to carry out successful surgical procedures in these regions.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region / 대한해부학회지

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

Absence of retromandibular vein associated with atypical formation of external jugular vein in the parotid region / 대한해부학회지

Veins of the head and neck exhibiting anatomical variations or malformations are clinically significant. Anatomical variation in the external jugular vein is very common. However, anatomical variation in the retromandibular vein is rare. In this paper, we report a rare case of complete absence of the retromandibular vein. In the absence of the retromandibular vein, the maxillary vein divided into anterior and posterior divisions. The posterior division joined the superficial temporal vein to form an atypical external jugular vein, and the anterior division joined the facial vein to form an anonymous vein. In clinical practice, radiologists and surgeons use the retromandibular vein as a guide to expose the branches of the facial nerve during superficial parotidectomy. Therefore, absence of the retromandibular vein is a hurdle during this procedure and may affect the venous drainage pattern from the head and neck.

An Unusual Termination of Facial Vein and Anterior Division of Retromandibular Vein into External Jugular Vein: A Case Report

Facial vein, being the largest vein of the face forms the common facial vein after joining with the anterior division of retromandibular vein below the angle of the mandible. Usually, it drains into the internal jugular vein. During routine dissection of head and neck region of a male cadaver, aged approximately 50 years, an unusual pattern in the termination of veins on the left side of the neck was observed. The formation, course and termination of external jugular vein were normal. The anterior division of retromandibular vein joined with external jugular vein about 5 cm above the clavicle and the facial vein opened into the external jugular vein about 2.5 cm above the clavicle. In addition, there was a thin venous communication between anterior division of retromandibular vein and external jugular vein. The superficial veins of the neck are often used for cannulation; either for intravenous infusion or for central venous pressure monitoring. Furthermore, these venous segments are used as a patch for carotid endarterectomies. Hence, a thorough knowledge of the normal anatomy and their variations may be useful for performing these procedures.

Sialocele como Complicação de Acesso Retromandibular: Relato de Caso / Sialocele as a complication of the retromandibular approach: a case report

A sialocele é o acúmulo de extravasamento salivar numa cavidade subcutânea, ocorrendo, principalmente, após, um episódio traumático ou infeccioso no parênquima da glândula parótida, lesão do ducto parotídeo ou estenose ductal com subsequente dilatação. A realização do correto diagnóstico e o tratamento imediato das lesões traumáticas da glândula parótida tornam-se importantes para evitar complicações. Várias modalidades de tratamento são mencionadas na literatura, e a escolha dependerá do tempo de evolução desde a lesão à região acometida. O presente caso envolve um paciente do gênero masculino vítima de acidente motociclístico que evoluiu com uma sialocele pós-operatória devido à abordagem retromandibular para redução cruenta de fratura condilar. O tratamento realizado foi a instalação de um cateter provisório, criando um novo trajeto para secreção da glândula parótida.

The condition known as sialocele is an accumulation of salivary extravasation in a subcutaneous cavity occurring mainly after a traumatic or infectious episode in the parenchyma of the parotid gland, a parotid duct injury or stenosis with subsequent ductal dilatation. The correct diagnosis and treatment of traumatic lesions of the parotid gland are important in order to avoid complications. Several treatment options are mentioned in the literature and the choice will depend on the time elapsed since injury and the affected region. The patient in the case reported is a male victim of a motorcycle accident who developed a postoperative sialocele due to the use of the retromandibular approach for open reduction of a condylar fracture. The treatment performed was the insertion of a temporary catheter creating a new pathway for secretion of the parotid gland.

Two rare anatomical variations of external jugular vein: an embryological overview / Dos raras variaciones anatómicas de la vena yugular externa: una visión embriológica

Human anatomy is an ocean of unending variations and its mysteries are being unravelled since ages. Knowledge of variations in the superficial veins of head and neck is essential to carry out successful surgical procedures. During routine dissection of head and neck of two middle aged male cadavers, in the Department of Anatomy, Calcutta National Medical College, Kolkata, India, we came out with some interesting venous architecture. The retromandibular vein on the left side of both the cadavers was found to be undivided and joined with the facial vein in the neck at an acute angle to form a common venous trunk at variable distances from the angle of the mandible. That trunk ultimately drained into the left subclavian vein. This might be the result of disappearance of the cephalic part of the external jugular vein and formation of an additional communication between common facial vein and the external jugular vein in foetal life. In one case, we also came across an extra transverse communication between that common trunk and the internal jugular vein. A detail of those cases with embryological explanation is attempted...

La anatomía humana tiene un sin fin de variaciones y sus misterios se han develado desde el inicio de los tiempos. El conocimiento de las variaciones anatómicas de las venas superficiales de la cabeza y del cuello es fundamental para llevar a cabo con éxito los procedimientos quirúrgicos. Durante una disección de rutina de cabeza y cuello encontramos una arquitectura venosa interesante en dos cadáveres de hombres de mediana edad en el Departamento de Anatomía de la Facultad de Medicina Nacional Calcuta, Calcuta, India. En el lado izquierdo del cuello de ambos cadáveres, la vena retromandibular no se encontraba dividida, y se unía a la vena facial en un ángulo agudo, para formar un tronco venoso común a una distancia variable desde el ángulo de la mandíbula. Ese tronco finalmente drenaba en la vena subclavia izquierda. Esto podría ser el resultado de la desaparición de la parte cefálica de la vena yugular externa y la formación de una comunicación adicional entre la vena facial común y la vena yugular externa en la vida fetal. En un caso, también se encontró con una comunicación adicional transversal entre ese tronco común y la vena yugular interna. Se realiza una descripción en detalle de los casos junto a una explicación embriológica...

Analysis of two different surgical approaches for fractures of the mandibular condyle.

Background: Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. Aim: The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. Materials and Methods: A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. Statistical Analysis: t- test was used for statistical analysis of the data obtained in the study. Results: Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Retromandibular Approach versus an Endoscope-assisted Transoral Approach to Treat Subcondylar Fractures of the Mandible

Undivided Retromandibular Vein Continuing As External Jugular Vein With Facial Vein Draining Into It : An Anatomical Variation.

Despite the fact that the blueprint of the whole body is unravelled, faultlessly during the growth and development of an animal; but amazingly variations do occur. During routine dissection of head and neck in a middle aged cadaver in the Post Graduate Department of Anatomy of this medical college, we found variation in the formation of external jugular vein on both sides, which was formed by the continuation of undivided trunk of retromandibular vein. The facial vein and posterior auricular vein were the tributaries of external jugular vein. The sound anatomical knowledge of variations of the veins of head and neck is essential to the success of surgical procedures. The embryological evaluation of the above anomaly was done and compared with the available literature which showed that the observed variation was rare.

A Rare Termination of Left Common Facial Vein into Left Subclavian Vein: A Case Report / Terminación Rara de la Vena Facial Común Izquierda en la Vena Subclavia Izquierda: Reporte de Caso

During routine dissection of head and neck, an unusual drainage in pattern of the veins on the left side of the face was observed in an adult male cadaver. In the present case, he superficial temporal vein united with maxillary vein to form retromandibular vein within the substance of the left parotid gland. The anterior division of retromandibular vein joined with facial vein to form common facial vein that drained into left subclavian vein directly. Knowledge of such variations is important for surgeons performing head and neck surgeries. Facial veins are often grafted into carotid endarterectomy.

Durante una disección de rutina de cabeza y cuello, fue observado en un cadáver aduto masculino un inusual drenaje de los patrones venosos del lado izquierda de la cara. La vena temporal superficial se unía con la vena maxilar formando la vena retromandibular dentro del parénquima de la glándula parótida izquierda. La división anterior de la vena retromandibular se unió a la vena facial formando la vena facial común la cual drenó directamente en la vena subclavia izquierda. El conocimiento de estas variaciones es importante para los cirujanos de cabeza y cuello. A menudo, las venas faciales se injertan en la endarterectomía carotídea.

Retromandibular approach for open reduction & internal fixation of mandibular condylar neck fracture

Fractures of the mandibular condyle are account for between 26 percent and 57 percent of all mandibular fractures. Clinicians should decide how to treat the fractured condyle with many factors considered. Many surgical methods have been developed to reduction of fractured condyle and it's internal fixation. In open reduction of fractured condylar neck and subcondyle, retromandibular approach offers a safe and effective approach for direct fixation due to easy access and low surgical morbidity.

Post operative evaluation for retromandibular approach of subcondylar fractures

PURPOSE: The classic technique for open reduction of subcondylar fractures is the submandibular approach. The aim of this study was to evaluate clinical result of retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS: During a period of 24months we perfomed a prospective study with a retromandibular approach in 23 paients with displaced subcondylar fractures. In this article we describe clinical result in 23 patients with follow ups for 3 months after surgery. Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULT: The retromandibularl approach for ORIF was good in all case. Mouth opening(M/O) was 49mm. Occlusion was good too. Permanent facial nerve palsy was not detected. CONCLUSION: Our findings indicate that the retromandibular approach is a safe technique for subcondylar fractures.

Outcome of Open Reduction Via Retromandibular Approach for Mandibular Subcondyle Fracture

Subcondylar fractures have generally been treated by intermaxillary fixation except in cases where there is an absolute indication for open reduction. The reason behind a less aggressive surgical approach lies on the inherent difficulties in manipulating fragments in such a small area at the risk of damaging facial nerves or vessels such as the internal maxillary artery. However, long-term follow-up studies showed that conservative treatment of subcondylar fractures results in disturbances of occlusal function, deviation of the mandible, internal derangement of the temporomandibular joint, and ankylosis of the joint. We carried out open reduction of dislocated subcondylar fractures in 14 patients from 2000 to 2004 by a retromandibular approach. After the reduction of fractured bone, two H-shaped miniplates with 6 holes were fixed with screws at the anterior and posterior surfaces of the subcondyle. The retromandibular approach allowed good access and easy manipulation of the subcondyle. Immediate relief from malocclusion and correction of mandibular midline shifting were observed in all patients. Late temporomandibular dysfunction and ankylosis were not observed. Open reduction with plate osteosynthesis made it possible to avoid IMF in 7 of the 14 patients. The present study shows that open reduction through this retromandibular approach can produce good outcome in adult patients with subcondylar fracture.

Retromandibular approach for open reduction of the mandibular condyle fracture

Most popular incisions for open reduction of mandibular condylar fractures are submandibular approach, preauricular approach, Risdon approach, and retromandibular approach etc. These methods are selected according to the location of condylar fracutre, condylar segments displacement, and preference of the surgeon. We performed the open reduction and rigid fixation by means of retromandibular approach for the treatement of mandibular condyle fracture in the 9 patients (8 cases were performed by direct reduction and rigid fixation, and 1 case was performed by Dr. Nam's method). The retromandibular approach has many advantages. This is more easier approach to the fracture site, better visibility and accessibility, less wound exposure, less muscle retraction, and more comfortable to patient because lesser sensory and motor nerve injury.