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Revista chilena de anatomía

Print version ISSN 0716-9868

Rev. chil. anat. vol.18 n.1 Temuco  2000

http://dx.doi.org/10.4067/S0716-98682000000100014 

MORPHOLOGY AND INCIDENCE OF VALVES IN THE FACIAL VEIN OF HUMANS

MORFOLOGIA E INCIDENCIA DE VALVAS EN LA VENA FACIAL DEL HOMBRE

* Sonia Lucy Molinari
** João Adolfo Caldas Navarro
* Marcílio Hubner de Miranda-Neto
*** Renato Paulo Chopard
**** Liberato João Alfonso DiDio

* Department of Morphophysiological Science, Universidade Estadual de Maringá, Paraná, Brazil.
** Department of Anatomy, Faculdade de Odontologia de Bauru, São Paulo, Brazil.
*** Department of Anatomy, Universidade de São Paulo, São Paulo, Brazil.
**** Medical College of Ohio and Faculdade de Medicina de Santo Amaro, São Paulo, Brazil.

SUMMARY: This study was carried out to determine the number of venous valves of the facial vein. Left and right veins from 50 adult male corpses previously maintained in formaldehyde were dissected and analyzed microscopically as well as under a stereomicroscope. Valves were found in 41 cases (82%). They were well developed and were classified as ostial and parietal. The ostial valves were unicuspid or bicuspid. The parietal valves were bicuspid. The facial vein segment with the largest number of venous valves was located at the submandibular gland level. A valval sinus was found on the venous walls with valves. The relations among anatomical variations, nature of the venous wall and presence of valves are discussed.

KEY WORDS: 1. Morphology; 2. Veins; 3. Facial vein; 4. Venous valve.

INTRODUCTION

Venous valves are present in veins in which blood runs against gravity (TESTUT & LATARJET, 1954). The veins of the head and neck do not need valves to oppose blood reflux since blood flow to the heart is mantained due to the lower pressure and the action of gravity (HOLLINSHEAD, 1980). Consequently, facial veins have been reported to lack valves (BARNHILL & MELLINGER, 1940; TESTUT & LATARJET; WARWICK & WILLIAMS, 1973; SICHER & DuBRUL, 1977; SALASHE et al., 1988). Nevertheless, in studies carried out on Japanese specimens, OGO (1933) and NISHIHARA et al. (1995) reported the presence of valves in the facial vein. In view of these data, we carried out the present study in order to determine the incidence and the morphology of valves in the facial vein of humans.

MATERIAL AND METHOD

In fifty, adult male corpses, previously fixed in 10% formol solution, the right and the left facial veins were dissected from the region of the orbital part of the orbicular muscle of the eye to its discharge.

After dissection, we made a longitudinal incision throughout the extent of the facial vein in order to observe the location and types of valves.

Dissections and photographic documentation were carried out with the help of an OMPI-1 Zeiss stereomicroscope and a Nikon Camera N2020, with a Medical Nikkor 110 mm lens.

For the histological study we used the segments of the facial veins of five corpses previously fixed in 10% formalin and routinely processed for paraffin embedding. In each segment we cut serial transverse and longitudinal 10 µm-thick sections, which were alternately and sequentially stained by the method of Masson trichrome modified by van de Grift, Verhoeff, van Gieson and Calleja. Serial sections were analyzed under a WILD M-7 stereomicroscope with transillumination, and with a BAUSCH & LOMB light microscope. Selected material for photographic documentation was photographed with a WILD M-20 photomicroscope using WILD MPS-51 photographic equipment.

RESULTS

The valves detected in the facial vein are delicate and translucid. When stretched, they completely occluded the vascular lumen, characteristic of developed valves. Each valve presents an arch-shaped base, convex superiorly and concave inferiorly, which is attached to the vessel wall.

At the insertion of the valve, collagen, elastic and muscle fibers coming from the facial vein bend and reach the base of the insertion and travel obliquely towards the free part of the valve leaflet. Due to the inclination, the bundles of muscle fibers cross the base of the insertion reaching its convex side, where they are interruped, while the elastic fibers contribute to the formation of a network of elastic fibers, which is most defined on the convex side of the valve.

In turn, the bundles of collagen fibers deepen on the free part of the valve, being its main constituent.

Most of the bundles of muscle fibers, and part those of collagen and elastic fibers are interrupted when they reach the valve insertion, thus forming the valval sinus (Figs. 1 A and B ). In this segment the muscle fibers are scarce and restricted to the neighborhood of the tunica intima. The elastic ones are abundant, but collagen fiber bundles predominate.


Fig. 1. Wall of the facial vein, 10 µm longitudinal section, showing parietal valve and the formation of a valval sinus (S), stained by (1a) van Gieson; and (1b) Calleja. Blue filter. 44X.

 

Among the 50 corpses analyzed, the facial vein had valves in 41 cases (82%) and lacked them in 9 (18%). In 16/41 cases (39%) we verified the presence of valves in only one facial vein, in 7/16 cases (43.8%) on the right and 9/16 (56.2%) on the left. In 25/41 cases (61%) valves were observed bilaterally. Thus, the right facial vein had valves in 32 cases (64%) and the left facial vein in 34 (66%).

We observed that a single vein can show more than one valve along its course. As a whole, 102 valves were found in this study. The facial vein exhibited ostial and parietal valves. Ostial valves were unicuspid (Fig. 2A) in four cases (3.93%) and bicuspid (Fig. 2B) in 10 (9.8%), while in 88 cases the parietal valves were all bicuspid (86.27%). Up to four valves could be seen in a single facial vein. The valves can be located in different segments of the facial vein. The segment which possesses the largest number of valves is related to the submandibular gland. At this site 38.77% of the valves of the right facial vein and 33.96% of the valves of the left facial vein are found (Table I).

Fig. 2. Evidence of valves in the facial vein.
2a) Unicuspid ostial valve, 10X.
2b)Bicuspid parietal valve, 5X.

Table I. Incidence of valves on the different segments of the right and left facial veins. Obtained from a study of 50 corpses.

SEGMENTS
RIGHT
   
LEFT
 
  I % S   I % S
Orbicular muscle of the eye -- - -   -1 --1.89 ±1.87
Adipose body of the cheek -3 --6.12 ±3.42   -1 --1.89 ±1.87
Masseter muscle -7 -14.29 ±4.99   -3 --5.67 ±3.27
Mandible body -7 -14.29 ±4.99   15 -28.30 ±6.18
Submandibular gland 19 -38.77 ±6.96   18 -33.96 ±6.50
Post-glandular segment -7 -14.29 ±4.99   -8 -15.09 ±4.91
Discharge -6 -12.24 ±4.68   -7 -13.20 ±4.64
TOTAL
49 100.00     53 100.00  

Legend:I = absolute incidence. % = incidence relative to the sum of the number of valves. S = stantard error of percentage.

DISCUSSION

The most prominent element in the free part of the leaflet of the valves of the facial vein were the bundles of collagen fibers, in agreement with the composition of venous valves described by BARGMANN (1968) and BAILEY et al. (1973). This differs from the description of PATURET (1951), who reported that the valves are composed of elastic connective tissue surrounded by endothelium.

At the site of valve insertion most of the bundles of muscle fibers and part of those of elastic and collagen fibers are interrupted, causing the formation of the valval sinus. The presence of this structure has also been reported by POIRIER et al. (1908) and BAILEY et al. (1973). This segment has scarce muscle and elastic fibers, being composed predominately of bundles of collagen fibers.

Human Anatomy and surgery textbooks refer to the facial veins as vessels which lack valves (BARNHILL & MELLINGER; TESTUT & LATARJET; WARWICK & WILLIAMS; SICHER & DuBRUL; SALASCHE et al., nevertheless, we observed that the facial veins do possess valves in 64% of cases on the right and in 66% of cases on the left, with cases with multiple valves also occurring.

In 37 cases the valves were located in its course over the submandibular gland, resembling the findings of OGO (1933) and NISHIHARA et al., who reported the presence of valves at the level of the inferior margin of the mandible. KAMPMEIER & BIRCH (1927) highlight the occurrence of valves at the site of discharge of the facial vein into the internal jugular vein.

We observed bicuspid valves in 96.01% of cases, while NISHIHARA et al. observed them in 93.7%. Unicuspid valves were present in four cases, similar to the findings of OGO (1933) who reported the presence of three unicuspid valves in his material.

TESTUT & LATARJET attributed the presence of valves to those veins in which blood runs against gravity, while HOLLINSHEAD reported that the veins of the head and neck do not need valves to oppose the blood reflux since blood flow to the heart is mantained due to the lower pressure and the action of gravity. The statements of these authors, at first sight, seem to apply also to the present study, because, when we take into account the human being in an orthostatic position, the facial vein is in a favorable position relative to gravity. We believe that the presence and relatively high incidence of valves in the facial vein can be explained by the fact that in some of his activities, man will have his head on a lower level than the heart, so that blood will have to drain against gravity; another factor is that the facial vein, directly or indirectly, drains into the jugular veins and these, in episodes of increased central venous pressure, are among the first vessels to be overloaded. These situations could pose difficulties for the venous drainage of the face and could even facilitate the occurrence of refluxes. In these cases, the valves possibly would guide the flow and protect the venous wall from abrupt increases in pressure, as pointed out by MARTINET & TUBIANA (1950).

RESUMEN: Se realizó este estudio para constatar la periodicidad y cantidad en que se encuentran las valvas en la vena facial. Las venas faciales, derecha e izquierda de 50 cadáveres, adultos, de sexo masculino, previamente sumergidos en formol al 10%, fueron disecadas y abiertas longitudinalmente, desde su origen hasta su desembocadura, con el fin de constatar la presencia y ubicación de las valvas. Se observaron valvas en 41 casos (82%). Éstas eran bien desarrolladas y fueron clasificadas en valvas ostiales y parietales. Entre las valvas ostiales habían unicúspides y bicúspides, mientras que las parietales eran solamente bicúspides. El trecho de la vena facial que presentó el mayor número de valvas fue el que se encuentra a nivel de la glándula submaxilar. Las paredes venosas que tenían valvas, presentaban seno valvular. Las relaciones entre variaciones anatómicas, constitución de la pared venosa y la presencia de valvas, son discutidas a lo largo del presente trabajo.

PALABRAS CLAVE: 1. Morfología; 2. Venas; 3. Vena facial; 4. Valva venosa.

REFERENCES

BAILEY, F. R.; COPENHAVER, W. M.; BUNGE, P. P. & BUNGE, M.B. Histologia. São Paulo, Edgar Blücher, 1973. pp. 268-9.         [ Links ]

BARGMANN, W. Histología y anatomía microscópica humanas. Barcelona, Labor, 1968. pp. 303-7.         [ Links ]

BARNHILL, J. F. & MELLINGER, W. J. Surgical anatomy of the head and neck. Baltimore, Williams & Wilkins, 1940. p. 415.         [ Links ]

HOLLINSHEAD, W. H. Livro texto de anatomia humana. São Paulo: Harper & Row do Brasil, 1980. pp. 79, 816-7.         [ Links ]

KAMPMEIER, O. F. & BIRCH, C. F. The origin and development of the venous valves, with particular reference to the saphenous district. Am. J. Anat, 38:451-99, 1927.         [ Links ]

MARTINET, J. D. & TUBIANA, R. Pathologie des veines. Paris, Doin, 1950. pp. 4-5.         [ Links ]

NISHIHARA, J.; TAKEUCHI, Y.; MIKI, T.; ITOH, M. & NAGAHATA, S. Anatomical study on valves of human facial veins. Journal of Cranio Maxillo-Facial Surgery, 23: 182-186, 1995.         [ Links ]

OGO, M. On the venous valves of the Japanese. Nippon Geka Hokan, 10:491-541, 1933.         [ Links ]

SALASCHE, S. J.; BERNSTEIN, G. & SENKARIK, M. Surgical anatomy of the skin. California: Appleton & Lange, 1988. pp. 134-5.         [ Links ]

SICHER, H.; DuBRUL, E. L. Anatomia bucal. Rio de Janeiro: Guanabara Koogan, 1977. pp. 334-41.         [ Links ]

TESTUT, L.; LATARJET, A. Tratado de anatomia humana. Barcelona: Salvat, 1954. V. 2. pp. 417-22, 475.         [ Links ]

WARWICK, R. & WILLIAMS, P. L. (eds.). Gray's anatomy. London, Longman, 1973. p. 650.         [ Links ]

Correspondence to:
Prof. Dra.
Sonia L. Molinari
Universidade Estadual de Maringá
Avenida Colombo, 5790, Bloco H-79 - DCM
87020-900
Maringá
Paraná-BRASIL

Recibido : 18-05-2000
Aceptado: 19-06-2000

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