Details of rare and novel anatomical variations in a case with bilateral long styloid processes

Vol. 66 No. 2, 2025

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Mugurel Constantin Rusu, Razvan Costin Tudose, Alexandra Diana Vrapciu, Mihai Butucescu

Anatomical vascular variants are frequently reported; however, their broader anatomical context and potential associations with additional variations are often overlooked. This case report presents a unique combination of multiple rare and novel cervical vascular anatomical variants identified in a single patient, thereby highlighting the importance of comprehensive anatomical assessment. A 64-year-old female patient underwent a computed tomography angiography, during which several unexpected anatomical variants were identified: bilaterally elongated styloid processes, with differing ossified segments; bilateral internal jugular vein (IJV) compression at the atlas transverse processes, consistent with jugular nutcracker syndrome; and bilateral Launay s external carotid veins, which drained into the IJVs and communicated via the prevertebral venous plexus. Additionally, a bilateral overlap of the mastoid and transverse processes of the atlas was observed. The right lingual artery exhibited an unusual sinuous course, perforating the hyoglossus muscle. The left IJV displayed a 2.78 cm longitudinal fenestration, with distinct anterior and posterior arms. Complex venous communications were also noted, including a left anterior jugular vein (AJV)-superior thyroid vein connection, a bilateral AJV prelaryngeal anastomosis, and evidence of a drainage pathway from the left IJV to the right AJV. Furthermore, a left posterior external jugular vein (EJV) was observed, continuing the left occipital vein and draining into the left EJV. This case illustrates that the presence of a specific anatomical variant should prompt careful evaluation for additional, potentially unexpected variations. A thorough anatomical assessment can reveal complex interrelationships among vascular structures, which may have significant clinical and surgical implications.

Corresponding author: Mugurel Constantin Rusu, Professor, Dr.Med., Dr.Biol., Dr.Habil.; e-mail: mugurel.rusu@umfcd.ro

DOI: 10.47162/RJME.66.2.14 Download PDF
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