Bilateral High Trifurcation of the Common Carotid Artery and Variable Emergence of the Lower Branches of the External Carotid Artery: A Cadaveric Case Report

Abstract

Trifurcation of the common carotid artery in the neck region is a rare anatomical variation. In the present study, we reported a rare case having the combination of anomalies of the bilateral high common carotid arteries trifurcation and variable origin of lower branches of the external carotid artery during routine dissection of the head and neck region of a 60-year-old male cadaver in the Department of Anatomy. Both on the left and right sides of the neck region, the common carotid artery gave off three terminal branches: internal carotid artery, external carotid artery, and ascending pharyngeal arteries. Further, we also observed the presence of bilateral linguofacial trunks (common arterial trunks) that emerged from the external carotid arteries and also the left superior thyroid artery that originated directly from the left common carotid artery. Even though the embryogenesis of the variable origin of such arterial trunks is not apparent, it is very indispensable to have sound knowledge and better comprehension of the accurate anatomical architecture of such a rare combination of carotid arterial system anomalies for correct interpretation of the vascular imaging that pave the pathway for successful execution of surgical interventions in the neck region because of its utmost clinical implication.

Tri-ramification of left external carotid artery associated with anatomical variation of its branches and aneurysm formation

“…Shreevastava et al [ 2 ] described bilateral higher trifurcation of CCA as the ECA, the ICA, and the APA originating between the two arteries. There was a bilateral LFT originating from the ECA.…”

“…There was a bilateral LFT originating from the ECA. The hypoglossal nerve is quite close to the termination in cases of high CCA termination, making it susceptible to damage from a variety of surgical procedures, including carotid endarterectomy, carotid stenting, and radical neck dissection [ 2 ].…”

“…In the present exemplar, we reported a higher division of CCA and arteries of ECA emerging from common trunks may be due to the inordinate cranial extension of truncus arteriosus resulting in an upward shift of the aortic arches, causing higher origin of the CCA eventually leading to a higher CCA termination. Due to this, the ECA branches get small space in the region of the neck [ 2 ].…”

Clinical implications of variations of common carotid artery trifurcation

“…Changes in the bifurcation of the common carotid artery have also been detected during surgical procedures. It was observed that the third branch, branching-off from the bifurcation of the common carotid artery (in addition to the internal carotid artery and external carotid artery), may be the facial artery [25], occipital artery [26,27], vertebral artery [28], or ascending pharyngeal artery [29]. The thyroglossal trunk [30], thyro-glosso-facial trunk [31,32], and thyroglosso-facial-occipital trunk [33,34] have also been described as the third branch of the common carotid artery.…”