Computed Tomography-based Classification of External Jugular Vein Confluence Patterns: Suitability as a Recipient...

Area of Science:

• Anatomy
• Vascular Surgery
• Head and Neck Reconstruction

Background:

• The external jugular vein (EJV) is a common recipient vessel in head and neck free flap reconstruction.
• Significant variations in EJV branching patterns impact its surgical utility.
• Classifying EJV confluence is vital for successful microvascular anastomosis.

Purpose of the Study:

• To classify external jugular vein (EJV) confluence patterns using preoperative imaging.
• To assess the suitability of the EJV as a recipient vein in head and neck reconstruction.
• To correlate EJV confluence patterns with potential surgical limitations.

Main Methods:

• Retrospective observational study of 100 contrast-enhanced computed tomography scans.
• Analysis of patients undergoing head and neck reconstruction (April 2022 - November 2022).
• Categorization of EJV confluence into four types: subclavian vein (SCV), venous angle, internal jugular vein (IJV), and absence of EJV.

Main Results:

• EJV drained into the SCV in 47% of cases.
• The venous angle was the confluence point in 37% of cases.
• 11% drained into the IJV and 5% had no EJV, with up to 16% deemed unsuitable for anastomosis due to IJV involvement or absence.

Conclusions:

• Preoperative imaging is essential for confirming EJV confluence patterns before head and neck reconstruction.
• Identification of EJV confluence is critical, especially when IJV resection is planned.
• Alternative recipient veins should be prepared for cases with unsuitable EJV or IJV patterns to prevent intraoperative complications.