Anat Cell Biol.  2020 Dec;53(4):444-450. 10.5115/acb.20.236.

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

• Sugahara K
• Matsunaga S
• Yamamoto M
• Noguchi T
• Morita S
• Koyachi M
• Koyama Y
• Koyama T
• Kasahara N
• Abe S
• Katakura A

• KMID: 2509690
• DOI: http://doi.org/10.5115/acb.20.236

Abstract

Major bleeding associated with sagittal split ramus osteotomy (SSRO) involves vessels such as the inferior alveolar, facial, and maxillary arteries and veins, and the retromandibular vein (RMV). The present study aimed to clarify and classify the three-dimensional variations in RMV position and course direction in relation to the mandible. Specimens comprised a total of 15 scientific cadavers, and the relationship between RMV and the mandible lateral and posterior views was observed. We identified 3 patterns on the lateral view, the mean distance between the RMV and the posterior border of the ramus was 3.9 mm at the height of the lingula. A total of five course patterns were identified on the posterior view. In no course pattern, the RMV inferior to the lingula was lateral to its position superior to the lingual. The present findings suggest that it may be possible to predict correlations with intraoperative bleeding risk. Further study is planned using contrast computed tomography in patients with jaw deformity for skeletal classification.

Keyword

Retromandibular vein; Blood vessels; Neck dissection; Sagittal split ramus osteotomy; Sagittal split ramus osteotomy

Figure

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  Fig. 1 (A) Measurement distance between the posterior border of the mandibular ramus and RMV at the height of the mandibular lingula. Dotted white line: RMV; dotted black line: height of the mandibular lingula; arrow: measurement distance. (B) Classifications of the positional relationship between RMV and the posterior border of the mandibular ramus from a lateral view. (Type A) RMV positioned posterior to the posterior border of the ramus, (Type B) RMV adjoining the posterior border of the ramus, (Type C) RMV positioned anterior to the posterior border of the ramus. (C) RMV course patterns on the posterior view of the mandibular ramus. Images were divided into three buccolingual sections in relation to the ramus. These were then each divided horizontally at the height of the mandibular lingula. The upper part is divided into three parts (A, B, C), and the lower part is divided into three parts (1, 2, 3). The driving was classified running pattern by combining one each in the upper and lower parts. RMV, retromandibular vein.

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  Fig. 2 Topographical anatomy of the retromandibular region. (Panel A) The RMV (green star) and the STV (red star) run posteriorly to the mandibular ramus (86.7%). (Panel B) The superior (inferior) part of the RMV (green star) is continuous with the STV (the internal jugular vein) (13.3%). CCA, common carotid artery; Di, digastric muscle; EJV, external jugular vein; M, mandibular bone; Ma, masseter; RMV, retromandibular vein; STV, superficial temporal vein.

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  Fig. 3 Positioning of the posterior border of the mandible and posterior veins of the mandible. Panel A–C inverts the vein of Panel A’–C’ (original image) and the other than the mandible (or cusp). (Type A) The posterior border of the mandible is separated from the posterior vein of the mandible (Panel A and A’). (Type B) The anterior border of the mandibular posterior vein is in contact with the posterior border of the mandibular branch (Panel B and B’). (Type C) The posterior vein of the mandible is located in front of the posterior border of the mandible and inside the posterior border of the mandible (Panel C and C’). Asterisk, retromandibular vein; M, mandibular bone; Ma, masseter; STV, superficial temporal vein.

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  Fig. 4 Course pattern on the posterior view of RMV and the posterior border of the mandibular ramus. RMV, retromandibular vein.

Reference

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