Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
The left common carotid varies more than the right, arising either from the brachiocephalic or from a common stem with the right common carotid. In those cases where the right subclavian is a separate branch of the aorta, the two carotids most frequently arise by a common trunk.
The right common carotid, when arising from the aorta, on occasion, runs behind the trachea or the esophagus to the right side of the neck. The origin of the right common carotid artery may be above or below the usual point, depending on whether the brachiocephalic bifurcates higher or lower than usual. A low bifurcation of the brachiocephalic is somewhat more common. The common carotid artery sometimes follows a very tortuous course, forming one or more distinct loops in the neck.
The common carotids may bifurcate higher or lower than usual; a high bifurcation is more common. The bifurcation can occur as high as the hyoid bone (Quain, 5/295; Poynter, 3/400) or even the styloid process, or as low as the cricoid cartilage (Quain, 10/295; Poynter, 18/400) or within 3.7 cm of its origin. The artery may not bifurcate but provide branches usually derived from the external carotid as it ascends in the neck. A common carotid artery may be absent, the external and internal carotids arising directly from the arch of the aorta or from the termination of innominate artery.
As a very rare occurence, the carotid my ascend in the neck without dividing into the two usual branches; either the external or internal carotid being absent.
The common carotid may provide one or more of the branches usually derived from the external carotid. Examples are: superior thyroid, thyroidea ima, and cases have been reported in which a vertebral, inferior thyroid, or ascending laryngeal is a branch of the common carotid.
The vagus nerve may run in front of the common carotid artery instead of behind it.
Collateral circulation after ligature of a common carotid is maintained by the following anastomoses; blood is conveyed to the cerebral and ophthalmic branches of the internal carotid from the vertebral arteries and the internal carotid from the opposite side, by means of the free communication existing between these vessels and the circle of Willis. The branches of the external carotid receive blood from the subclavian artery through the anastomoses of the superior and inferior thyroid arteries, and of the occipital with the ascending cervical, vertebral, and deep cervical arteries, and from the external carotid of the opposite side through the anastomoses of the two superior thyroid, lingual, facial, superficial temporal, and occipital arteries; and the ophthalmic with the angular. The anastomosis between the deep cervical branch of the costocervical trunk (superior intercostal) and the descending branch of the occipital is important; it is located deep at the back of the neck between semispinalis capitis and cervicis muscles.
Common carotid arteries may give rise to an esophageal artery.
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Image 422, Image 436
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