Bilateral Lower Cervical Bifurcation of the Common Carotid Artery

Abstract

Lower cervical bifurcation of cervical common carotid artery (CCA) is a very rarely encountered anatomic variation. Knowing the normal vascular anatomy and also its anomalies is important in preventing the vascular complications. Ill-defined vascular anomalies may lead to massive hemorrhage and eventually death during head and neck surgery. Imaging of the neck by magnetic resonance Imaging (MRI), CT, or angiography is helpful for diagnosis. We present a 62-year-old male patient diagnosed with laryngeal carcinoma who had been treated. His MRI revealed bilateral low-level bifurcation of the cervical common carotid arteries as well as tumor localization and its boundaries. Total laryngectomy and right selective neck dissection was performed to the patient with the diagnosis of squamous cell carcinoma of the larynx. During the neck dissection, carotid bifurcation was detected in common border of Level 3 and Level 4 of the neck.

Multiple Variations in Carotid Arteries: Lower Common Carotid Bifurcation, Hypoplastic and Tortuous Internal Carotid Artery

“…during traction of the tissues to expose the disc spaces and insertion of the cages into the cervical interspaces) in a cervical dissection in a patient with low-lying CCA bifurcation. Uzun et al [7] reported a 62year-old male patient with bilateral lower cervical bifurcation of CCA.…”

“…Surgeons must be well-versed in anatomy of the great vessels of the neck and its anomalies before undertaking such an operation. Previously, in the literature, several carotid artery anomalies and anatomic variations which are agenesis, aplasia, hypoplasia, trifurcation, curved, kinked, anomalous origin, non-bifurcated cervical carotid artery, independent origins, aberrant artery, lower carotid bifurcation, and tortuosity were reported [1][2][3][4][5][6][7]. In some cases, bifurcation of common carotid artery (CCA) is seen lower than the usual localization, like lower cervical or thoracic bifurcation and tortuosity of carotid artery may be seen but in our knowledge, there has been no report in which tortuous internal carotid artery and lower cervical CCA bifurcation are co-existent.…”

Treatment of a symptomatic intrathoracic internal carotid artery

“…The standard surgical carotid endarterectomy for atherosclerotic ICA disease is a complex procedure that requires a full understanding of all normal and potentially anomalous neck anatomy. 1 , 2 , 3 , 4 , 5 Variability of the right CCA bifurcation occurring below the cervical vertebra is an infrequent occurrence. Clinical reports suggest that the level at which the CCA bifurcates is most common at vertebral levels C3 to C5.…”

“…Variability of the CCA bifurcation can be found as high as C1 and as low as the thoracic inlet, with anatomic data demonstrating frequencies of high, normal, and low bifurcation locations as 31.2%, 57.5%, and 11.3%, respectively. 5 , 6…”

“… 4 Normal anatomic position of the CCA bifurcation takes place at the level of C3 to C5, nearest the body of the hyoid bone and the superior border of thyroid cartilage. 4 , 5 , 6 Consequently, bifurcations of the CCA as low as the T3-T4 level are an extremely rare anatomic occurrence, providing extensive interest in the clinical, diagnostic, radiologic, and treatment options. 1 , 4 This case report offers an unconventional surgical treatment option that may serve to reduce intraoperative embolic sources while re-establishing normal distal ICA flow.…”