Management Of The External Jugular Vein

The external jugular vein begins in the substance of the parotid gland. It is most often formed by the union of the retromandibular (posterior facial) and the posterior auricular veins. It runs vertically downward across the superficial surface of the sternocleidomastoid muscle to pierce the fascia of the posterior triangle of the neck just above the clavicle. The external jugular vein terminates in the subclavian or in the internal jugular vein after receiving several tributaries throughout its cervical course (Fig. 2-12).

During functional neck dissection, the external jugular vein is found at different stages of the operation and should be ligated and divided at different levels. In a complete functional neck

Figure 5-5 Identification and preservation of the great auricular nerve on the right side. (A) The great auricular nerve crosses the external face of the sternocleidomastoid muscle from Erb's point toward the ear lobule. (B) The fascia over the sternocleidomastoid muscle is incised anterior to the great auricular nerve in order to preserve innervation of the ear lobule. ga, great auricular nerve; tc, transverse cervical branch of the cervical plexus; SC, sternocleidomastoid muscle; P, platysma muscle; F, fascia dissected from the sternocleidomastoid muscle; Erb's point.

Figure 5-5 Identification and preservation of the great auricular nerve on the right side. (A) The great auricular nerve crosses the external face of the sternocleidomastoid muscle from Erb's point toward the ear lobule. (B) The fascia over the sternocleidomastoid muscle is incised anterior to the great auricular nerve in order to preserve innervation of the ear lobule. ga, great auricular nerve; tc, transverse cervical branch of the cervical plexus; SC, sternocleidomastoid muscle; P, platysma muscle; F, fascia dissected from the sternocleidomastoid muscle; Erb's point.

Repair External Jugular Vein
Figure 5-6 The external jugular vein must be ligated and divided at different levels during the operation. 1, tail of the parotid gland; 2, posterior border of the sternocleidomastoid muscle; 3, supraclavicular fossa.

dissection, there are three places where the external jugular vein must be ligated and divided (Fig. 5-6). From topdown the vein must be transected at the tail of the parotid gland during the dissection of the upper part of the surgical field at the level of the posterior border of the sternocleidomastoid muscle during the dissection of the muscle and within the fibrofatty tissue of the supraclavicular fossa while dissecting the posterior triangle of the neck.

During the ligature of the external jugular vein and other large veins in the neck special attention should be directed to distal venous stumps. Open distal venous stumps may be responsible for air embolism. Thus, careful closure of all distal stumps must be ensured before closure of the wound.

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