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Complications of carotid endarterectomy
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Laura T. Boitano, Mark F. Conrad
The patient is positioned on the table with the neck turned toward the contralateral side, and a rolled towel or thyroid bag is placed under the shoulders in order to hyperextend the neck, thus facilitating access to the carotid bifurcation. It is important to ensure that the head does not float above the table and the head is held in position with 1-inch cloth tape. The incision is made along the anterior border of the sternocleidomastoid muscle (Figure 13.1). A pitfall at this point in the operation would be making the incision too medial so the larynx becomes an obstacle or too lateral, which can injure the spinal accessory or greater auricular nerves. The incision is carried towards the ear and should stop 1–2 cm below the mandible to reduce injury to the marginal mandibular branch of the facial nerve. The platysma is divided and the deep cervical fascia is incised anterior to the sternocleidomastoid muscle, which is retracted laterally. The carotid sheath is incised to then expose the internal jugular vein, which is exposed along its medial border. The common facial vein is divided to further allow lateral mobilization of the internal jugular vein. It is important to skeletonize the facial vein to avoid inadvertent ligation of the hypoglossal nerve, which can lie posterior to the vein in patients with a high bifurcation. The jugular vein is retracted laterally, and the common carotid artery is exposed. Heparin should be given at this time as a bolus, usually 100 units/kg.
The Neck
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Having made the sternocleidomastoid muscle incision, platysma is divided, and the sternomastoid is retracted laterally to expose the fascial sheath covering the internal jugular vein. The vein cannot be mobilized until the common facial vein is divided. Omohyoid muscle is the only strap muscle that crosses the carotid sheath obliquely, and acts as a landmark for the common carotid artery. Lateral retraction of the jugular vein and underlying carotid artery allows access to the trachea, oesophagus, and thyroid, and medial retraction of the carotid sheath and its contents will allow the dissection to proceed posteriorly to the prevertebral fascia and vertebral arteries. Posterior to the carotid sheath, the sympathetic chain lies on longus colli, which separates it from the transverse processes of the cervical vertebrae (Figure 7.4).
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Recipient veins in the head and neck: Internal jugular vein (IJV) – end-to-side or end-to-end to a tributary close to the main trunk.External jugular vein (EJV), which is formed by the posterior auricular vein joining the posterior division of the retromandibular vein (from the superficial temporal vein and the maxillary vein) and drains into the subclavian vein. It crosses the sternomastoid (SM) muscle, and there is some concern that it may be prone to compression.Facial vein. The common facial vein is formed by the junction of the anterior facial vein with the anterior division of the retromandibular vein. It divides into two – one drains into the IJV whilst the other receives the anterior jugular vein before draining into the EJV.
Single versus dual venous anastomosis in radial forearm free flaps in head and neck reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
We also analyzed the relationship between venous compromise and recipient venous systems. The external jugular vein (EJV) system of the head and neck includes the anterior jugular vein and the EJV, while the internal jugular vein (IJV) system includes the tongue vein, the superior thyroid vein, the IJV, the anterior facial vein, the common facial vein and the concomitant venae of facial artery. When applying one vein anastomosis, the IJV system (N = 53) was more commonly used than the EJV system (N = 27). When two veins were used during the operation, attaching both the EJV and IJV systems was the most favored option (N = 161), followed by two IJV system veins (N = 10) and two EJV system veins (N = 2) (Figure 1). Venous compromise occurred the most when using one IJV system vein (N = 4, 7.5%), followed by one EJV system (N = 1, 3.7%), and both the EJV and IJV systems (N = 1, 0.6%). No venous compromise was observed when two IJV or EJV system veins were used. There was not a significant difference in the incidence of venous compromise between recipient venous systems (p=0.051).
Anatomic Alert: Spinal accessory nerve traversing a fenestrated internal jugular vein
Published in British Journal of Neurosurgery, 2019
Jay I. Kumar, Shunchang Ma, Pankaj Agarwalla, Nir Shimony, Shih S. Liu
Awareness of this anatomical variant of a fenestrated IJV may be important in several neurosurgical procedures. During upper cervical exposures for vascular, skull base, and even high cervical spine surgeries, the IJV at the level of the posterior belly of the digastric provides an anatomic landmark for access to multiple critical structures including the occipital artery, the great auricular nerve, the hypoglossal nerve, and the SAN.9 The IJV is often mobilized by ligating the common facial vein to open this space.
Intravenous sinus meningioma with intraluminal extension to the internal jugular vein: case report and review of the literature
Published in British Journal of Neurosurgery, 2023
Kei Yamashiro, Mitsuhiro Hasegawa, Saeko Higashiguchi, Hisayuki Kato, Yuichi Hirose
The tumour had also invaded the peripheral veins, such as the common facial vein and the retromandibular vein (Figure 6(E)). These veins were ligated and cut after confirming the end of the tumour. The cranial side of cervical intraluminal tumour was excised with the wall of the internal jugular vein at the level of the atlas. The excision cavity was connected to the cranial side. The resected internal jugular vein was not reconstructed as it had already nearly occluded prior to the surgery.