CASE REPORT Bifurcation of external jugular vein: an anatomical variation during neck dissection Santhosh Rao 1 & Sameer Pandey 1 & Yogesh Kumar 1 & Sruthi Rao 1,2 Received: 11 July 2018 /Accepted: 24 August 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Background The pattern of venous drainage of head and neck involves single external jugular vein bilaterally. Methods and results We report a case of bifurcation of the external jugular vein observed during a neck dissection procedure. Conclusions Anatomical variations in drainage pattern of superficial veins of the head and neck are important for head and neck surgeries including for anastomosis during free tissue transfer for head and neck reconstruction. Keywords External jugular vein Introduction Posterior retromandibular and posterior auricular vein join to form external jugular vein (EJV) which descends in superfi- cial fascia deep to the platysma to enter posterior triangle, where it pierces investing layer of deep fascia and ends in to subclavian vein. The complex embryologic development of vascular system often results in clinically relevant anomalies. The relevance and importance of varied drainage pattern are important for their use in surgeries involving microvascular anastomosis. Case report A 48-year-old male patient diagnosed with squamous cell car- cinoma of right buccal mucosa underwent modified radical neck dissection; while the subplatysmal flap was raised, two parallel veins were identified in superficial fascia of the neck (Fig. 1). Both originated from within the deep lobe of parotid gland and followed a course lateral to sternocleidomastoid and joined as a single vein of large calibre before penetrating deep fascia inferiorly. Based upon anatomical similarities with usu- al description of the EJV, the vessels were confirmed as bifur- cated external jugular vein. The calibre of both veins was greater than normal and found equal in comparison with in- ternal jugular vein (IJV). Coincidentally, all other vessels and muscles like the omohyoid had a larger calibre and size as compare to the normal. Discussion Numerous anatomical variations of external jugular vein have been reported in literature. Hollinshead reported that in one third of cases the external jugular vein drains into the internal jugular vein [1]. Lalwani et al. reported an unusual venous communica- tion of the external jugular vein of one side, into the internal jugular vein of the opposite side [2]. Keith R. Reinhardt reported an anomalous EJV coursing anterior to the clavicle [3]. Shima et al. have described two types of external jugular vein, in which type 2 begins as two veins in cranial part of the neck and join along posterior border of the sternocleidomastoid to form single vein [4]. Although there appears several reported cases of anom- alies in EJV, we found only one reported case of EJV duplication in the literature. Ela Comert reported a case of duplication of EJV which started as a single vein but divided in its course to again join into a single vein before piercing the deep facia [5]. The literature search did not find any reported case of ex- cessive calibre of the EJV which was equivalent to IJV in our case. Abnormal calibre of the veins could be critical factor for intraoperative blood loss; Keith R. Reinhardt cautioned about * Santhosh Rao raomaxfax@gmail.com 1 Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Raipur, India 2 Oral & Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, India Oral and Maxillofacial Surgery https://doi.org/10.1007/s10006-018-0717-7