Preoperative detection of anomalies of carotid arteries in the neck surgery

Abstract

The aim of this study was to examine the course of the carotid artery (CA) and define CA anomalies important for neck surgery using conventional and three-dimensional computer tomography (3D CT). This was designed as an observational study with retrospective CT and 3D CT angiography analysis. 4,000 CAs depicted on 2,000 CT angiographies were analyzed to determine the relationship of common, internal, and external portions of the CA to the neck organs, with special emphasis on the thyroid gland area and organs involved in the neck dissection surgery. A total of 47 out of 4,000 imaged CAs had congenital anomalies (1.18%). These anomalies were found in 45 patients, unilaterally in 33 and bilaterally in two. The level of the common CA bifurcation to internal and external CAs was rarely abnormal. It was at the level of C5 and C6 in two cases only (0.05%). The common CA, either aberrant or tortuous, ran abnormally close to the thyroid gland in 22 cases (0.55%). In planning neck dissection surgery, laryngectomy, or thyroidectomy, the surgeon should bear in mind that CA anomalies are present in approximately 1.2% of cases. Preoperative conventional CT angiography or 3D CT allows precise identification of anomalous CAs, thereby reducing the possible risk of intraoperative injury.

Aberrant innominate artery: A possible hazard during total laryngectomy

“…Normally the innominate artery has a straight course. Nevertheless, it has been reported to have congenital anomalies such as left brachiocephalic or retroesophageal location, or the innominate artery can have an aberrant course such as high brachiocephalic bifurcation or tortuosity, as seen in our case …”

“…This can guide head and neck surgeons to the optimal surgical approach and prevent unnecessary, unplanned intervention of the procedure (see Figs. and , and the Supporting Video 1 fragments) …”

“…However, all patients with an unusual pulsatile neck mass during preoperative clinical examination need to undergo Computed Tomography Angiography (CTA) evaluation . Some authors suggested preoperative color‐coded duplex sonography evaluation of the vessels in addition to CT imaging . In addition to that, 3‐Dimensional Computed Tomography (3D‐CT) imaging was preferred if no abnormalities were detected on 2‐Dimensional Computed Tomography (2D‐CT) imaging.…”

Intrathyroidal carotid artery and nonrecurring right recurrent laryngeal nerve: A case report

“…Preoperative 3D CT can define the location of anomalous carotid arteries and can reduce of the risk of intraoperative injury by clearly delineating the relationship of the vasculature to the surrounding anatomy; however, this is not routinely performed. Typically, a preoperative ultrasound of the thyroid is obtained.…”

“…We describe a rare variant, in which the right common carotid artery is medially displaced from the carotid sheath structures and found coursing centrally through the right thyroid lobe parenchyma. Although cases of carotid arteries running abnormally close to the thyroid have been described, 1 intrathyroidal carotid arteries have not previously been described in the medical literature. In addition to this rare anatomic variant, it was noted that this patient had a nonrecurrent recurrent laryngeal nerve (NRLN) ipsilateral to the carotid vascular variant, with the nerve identified entering the larynx from superolaterally.…”