Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
권호 표지
DOI QR코드

DOI QR Code

A cadaveric study on variations in branching pattern of external carotid artery

  • Devadas, Deepa (Department of Anatomy, Andaman and Nicobar Islands Institute of Medical Sciences) ;
  • Pillay, Minnie (Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham) ;
  • Sukumaran, Tintu Thottiyil (Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham)
  • Received : 2018.02.28
  • Accepted : 2018.06.18
  • Published : 2018.12.30
⟨ Previous Next ⟩

Abstract

Variations in the vascular anatomy of the carotid triangle have been reported in current scientific literature. The carotid arteries, being the major feeding arteries of the head and neck deserve special importance and protection from iatrogenic injury during radiological evaluations and surgical interventions. The present study was carried out over a period of 4 years from 2012-2016 to assess the variant anatomy of external carotid artery. The external carotid artery and its branches were dissected bilaterally in 40 formalin embalmed cadavers. The external carotid artery was traced from its origin to termination and variations in the branching pattern as well as the level of the carotid bifurcation were observed and analysed. A higher carotid bifurcation was observed in 25% cases. The linguofacial trunk was the commonest variation noted in the branching pattern seen in 20% cases. A single case of unilateral thyrolinguofacial trunk was also observed. The external carotid artery gave rise to accessory branches in 7.5% cases namely the superior laryngeal, accessory ascending pharyngeal and masseteric branches. A slender branch to the internal jugular vein was also observed in one case. These findings may provide further insight into the understanding of the vascular anatomy of the carotid triangle to the curious student, the discerning radiologist and the vigilant surgeon to avert complications and help improve overall treatment outcome.

Keywords

References

  1. Reid DB, Irshad K, Miller S, Reid AW, Reid W, Diethrich EB. Endovascular significance of the external carotid artery in the treatment of cerebrovascular insufficiency. J Endovasc Ther 2004;11:727-33. https://doi.org/10.1583/04-1321.1
  2. Heltzel S, Jelinek L, Jaynes D. Variation in the caudal branches of the external carotid artery: comparison of sex and side. Med Res Arch 2015;(1):1-10.
  3. Mangla S, Sclafani SJ. External carotid arterial injury. Injury 2008;39:1249-56. https://doi.org/10.1016/j.injury.2008.06.012
  4. Nicoucar K, Popova N, Becker M, Dulguerov P. Pseudoaneurysm of the external carotid artery after a blunt facial trauma. J Trauma 2008;65:E24-7. https://doi.org/10.1097/01.ta.0000209400.14212.a7
  5. Ii N, Fuwa N, Toyomasu Y, Takada A, Nomura M, Kawamura T, Sakuma H, Nomoto Y. A novel external carotid arterial sheath system for intra-arterial infusion chemotherapy of head and neck cancer. Cardiovasc Intervent Radiol 2017;40:1099-104. https://doi.org/10.1007/s00270-017-1635-z
  6. Tsurumaru D, Kuroiwa T, Yabuuchi H, Hirata H, Higaki Y, Tomita K. Efficacy of intra-arterial infusion chemotherapy for head and neck cancers using coaxial catheter technique: initial experience. Cardiovasc Intervent Radiol 2007;30:207-11. https://doi.org/10.1007/s00270-005-0272-0
  7. Xu DS, Abruzzo TA, Albuquerque FC, Dabus G, Eskandari MK, Guterman LR, Hage ZA, Hurley MC, Hanel RA, Levy EI, Nichols CW, Ringer AJ, Batjer HH, Bendok BR. External carotid artery stenting to treat patients with symptomatic ipsilateral internal carotid artery occlusion: a multicenter case series. Neurosurgery 2010;67:314-21. https://doi.org/10.1227/01.NEU.0000371728.49216.3B
  8. Al-Basheer M, Ferrar D, Nelson D, Vasudevan T. Outcome of the external carotid artery following carotid endarterectomy with added external carotid artery eversion endarterectomy. Ann Vasc Dis 2011;4:225-8. https://doi.org/10.3400/avd.oa.11.00020
  9. Won SY. Anatomical considerations of the superior thyroid artery: its origins, variations, and position relative to the hyoid bone and thyroid cartilage. Anat Cell Biol 2016;49:138-42. https://doi.org/10.5115/acb.2016.49.2.138
  10. Banks ND, Hui-Chou HG, Tripathi S, Collins BJ, Stanwix MG, Nam AJ, Rodriguez ED. An anatomical study of external carotid artery vascular territories in face and midface flaps for transplantation. Plast Reconstr Surg 2009;123:1677-87. https://doi.org/10.1097/PRS.0b013e3181a3f3ae
  11. Shang JB, Li YH, Chen Y, He XG, Zeng QL, Wang JY. Clinical application of transarterial embolization for massive hemorrhage in the nasopharyngeal and maxillofacial regions. Di Yi Jun Yi Da Xue Xue Bao 2004;24:210-2.
  12. Michalinos A, Chatzimarkos M, Arkadopoulos N, Safioleas M, Troupis T. Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int 2016;2016:6907472.
  13. Hayashi N, Hori E, Ohtani Y, Ohtani O, Kuwayama N, Endo S. Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir (Tokyo) 2005;45:25-9. https://doi.org/10.2176/nmc.45.25
  14. Lucev N, Bobinac D, Maric I, Drescik I. Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg 2000;122:590-1.
  15. Ito H, Mataga I, Kageyama I, Kobayashi K. Clinical anatomy in the neck region: the position of external and internal carotid arteries may be reversed. Okajimas Folia Anat Jpn 2006;82:157-67. https://doi.org/10.2535/ofaj.82.157
  16. Sanjeev IK, Anita H, Ashwini M, Mahesh U, Rairam GB. Branching pattern of external carotid artery in human cadavers. J Clin Diagn Res 2010;4:3128-33.
  17. Al-Rafiah A, AA EL-H, Aal IH, Zaki AI. Anatomical study of the carotid bifurcation and origin variations of the ascending pharyngeal and superior thyroid arteries. Folia Morphol (Warsz) 2011;70:47-55.
  18. Mompeo B, Bajo E. Carotid bifurcation: clinical relevance. Eur J Anat 2015;19:37-42.
  19. Gomez CK, Arnuk OJ. Intrathoracic bifurcation of the right common carotid artery. BMJ Case Rep 2013;2013:bcr2012007554.
  20. Gailloud P, Murphy KJ, Rigamonti D. Bilateral thoracic bifurcation of the common carotid artery associated with Klippel-Feil anomaly. AJNR Am J Neuroradiol 2000;21:941-4.
  21. Gulsen S, Caner H, Altinors N. An anatomical variant: low-lying bifurcation of the common carotid artery, and its surgical implications in anterior cervical discectomy. J Korean Neurosurg Soc 2009;45:32-4. https://doi.org/10.3340/jkns.2009.45.1.32
  22. Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S. Anatomical variations of the common carotid artery bifurcation. ANZ J Surg 2006;76:970-2. https://doi.org/10.1111/j.1445-2197.2006.03913.x
  23. Kurkcuoglu A, Aytekin C, Oktem H, Pelin C. Morphological variation of carotid artery bifurcation level in digital angiography. Folia Morphol (Warsz) 2015;74:206-11. https://doi.org/10.5603/FM.2015.0032
  24. Zumre O, Salbacak A, Cicekcibasi AE, Tuncer I, Seker M. Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann Anat 2005;187:361-9. https://doi.org/10.1016/j.aanat.2005.03.007
  25. Ozgur Z, Govsa F, Ozgur T. Assessment of origin characteristics of the front branches of the external carotid artery. J Craniofac Surg 2008;19:1159-66. https://doi.org/10.1097/SCS.0b013e3180690252
  26. Mata JR, Mata FR, Souza MC, Nishijo H, Ferreira TA. Arrangement and prevalence of branches in the external carotid artery in humans. Ital J Anat Embryol 2012;117:65-74.
  27. Acar M, Salbacak A, Sakarya ME, Zararsiz I, Ulusoy M. The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique. Int J Morphol 2013;31:1407-14. https://doi.org/10.4067/S0717-95022013000400042
  28. Vazquez T, Cobiella R, Maranillo E, Valderrama FJ, McHanwell S, Parkin I, Sanudo JR. Anatomical variations of the superior thyroid and superior laryngeal arteries. Head Neck 2009;31:1078-85. https://doi.org/10.1002/hed.21077
  29. Iwai T, Izumi T, Inoue T, Fuwa N, Shibasaki M, Oguri S, Mitsudo K, Tohnai I. Thyrolinguofacial trunk arising from the carotid bifurcation determined by three-dimensional computed tomography angiography. Surg Radiol Anat 2013;35:75-8. https://doi.org/10.1007/s00276-012-1004-1
  30. Baik FM, Chang AA, Green DA, Pakbaz RS, Bergeron CM. Posttonsillectomy lingual artery pseudoaneurysm. Laryngoscope 2011;121:S61. https://doi.org/10.1002/lary.21931
  31. Manzato L, Trivelato FP, Alvarenga AY, Rezende MT, Ulhoa AC. Endovascular treatment of a linguofacial trunk pseudoaneurysm after tonsillectomy. Braz J Otorhinolaryngol 2013;79:524. https://doi.org/10.5935/1808-8694.20130094
  32. Bergman RA, Afifi AK, Miyauchi R. Illustrated encyclopedia of human anatomic variation. Ascending pharyngeal artery [Internet]. Anatomy Atlases; c1995-2018 [cited 2017 Apr 26]. Available from: https://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/PharyngealAscending.shtml.
  33. Devadas D, Pillay M, Sukumaran TT. Variations in the origin of superior laryngeal artery. Anat Cell Biol 2016;49:254-8. https://doi.org/10.5115/acb.2016.49.4.254
  34. Nayak SR, Krishnamurthy A, Prabhu LV, Potu BK, Bagoji IB, Jiji PJ, Chettiar GK. Variable origin of the superior laryngeal artery and its clinical significance. Al Ameen J Med Sci 2011;4:69-74.
  35. Marinho LH, Shanahan DA, Langdon JD, Sinnatamby CS. The inferiorly based masseter muscle flap: anatomical basis for its use in head and neck reconstructive surgery. Int J Oral Maxillofac Surg 1991;20:100-5. https://doi.org/10.1016/S0901-5027(05)80718-0
  36. Ariji Y, Kimura Y, Gotoh M, Sakuma S, Zhao YP, Ariji E. Blood flow in and around the masseter muscle: normal and pathologic features demonstrated by color Doppler sonography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:472-82. https://doi.org/10.1067/moe.2001.111760
  37. Eroschenko VP. DiFiore's atlas of histology with functional correlations.12th ed. New Delhi: Wolters Kluwer/Lippincott Williams & Wilkins Publishers; 2014. p.216-9.
  38. Ross MH, Pawlina W. Histology: a text and atlas with correlated cell and molecular biology. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2011. p.408-14.
  39. Delic J, Bajtarevic A, Isakovic E. Positional variations of the external and the internal carotid artery. Acta Med Salin 2010;39:86-9.

Cited by

  1. A novel technique of arterial blood flow modification in intra-arterial chemoradiotherapy of maxillary sinus squamous cell carcinoma vol.109, pp.None, 2020, https://doi.org/10.1016/j.oraloncology.2020.104873