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Aberrant common carotid artery – a surprise for the unwary
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British Journal of Oral and Maxillofacial Surgery 51 (2013) 363–364
Short communication
Aberrant common carotid artery – a surprise for the unwary Satish Madhavarajan, Carmelo Barbaccia, Lawrence Newman, Darryl M. Coombes ∗ Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, United Kingdom Accepted 26 July 2012 Available online 30 November 2012
Abstract An aberrant common carotid artery is a rare anatomical anomaly. We report a case of an aberrant carotid artery running across the trachea in a patient undergoing total thyroidectomy. This rare anomaly may make a tracheostomy, a particularly hazardous procedure. © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Aberrant; Common carotid artery; Tracheostomy
Introduction An aberrant common carotid artery is a rare anatomical anomaly. We report a case of an aberrant carotid artery running across the trachea in a patient undergoing total thyroidectomy. This rare anomaly may make a tracheostomy, a particularly hazardous procedure.
Case report A 74-year-old fit and well lady underwent a total thyroidectomy for a multinodular goitre with obstructive symptoms (dysphagia). At the time of mobilization of the lower pole of the right thyroid, a large vascular structure was found to overlie the trachea across the 3rd and 4th tracheal rings. On further dissection of this structure, it was found to be the common carotid artery running across the trachea (Fig. 1). There were no branches arising from it and higher up in the neck, it branched into the external and internal carotid artery. A CT angiogram (Fig. 2) was performed post operatively, with the patient’s consent, to further investigate this anomaly. The CT angiogram showed an abnormally high innominate artery which divided into the right subclavian ∗ Corresponding author at: Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom. Tel.: +44 7525820483. E-mail address: [email protected] (D.M. Coombes).
and right common carotid arteries. The CT angiogram also confirmed that the common carotid artery crossed the midline of the neck from left to right across the trachea.
Discussion According to Gray’s textbook of anatomy,1 the common carotid arteries differ in length and in their mode of origin. The right common carotid artery begins at the bifurcation of the innominate artery behind the sternoclavicular joint and is confined to the neck. The vessel then passes obliquely upward, from behind the sternoclavicular articulation, to the level of the upper border of the thyroid cartilage, where it divides into the external and internal carotid arteries. The anamolies of the right common carotid artery may relate to its origin from the Innominate artery or to its division. In 12% of cases, the right common carotid artery may arise above the sternoclavicular joint. If the Innominate artery is absent, the two common carotid arteries may arise usually as a single trunk. Only two references following a literature search describe the right common carotid artery crossing the midline of the neck, anterior to the trachea. Prior et al.2 reported an aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture in the neck. On the side of the surgical approach the right common carotid artery was found to cross the midline
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.07.019
364
S. Madhavarajan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 363–364
Fig. 1. Right common carotid artery (white arrow) crossing trachea (red arrow) following thyroidectomy.
to the other side of the neck, and created difficulties both with the procedure and future management. A cadaveric report by Conoyer et al.3 found the right common carotid artery was the first branch of the aorta and ascended on the left side, anterolateral to the trachea. It crossed the midline anterior to the trachea between the sternal notch and the isthmus of the thyroid gland. Once on the right side, the artery resumed a normal course. An anomaly such as this, although rare, should be borne in mind while performing a tracheostomy, as it could prove disastrous for the unwary. Another situation where such an aberration may prove particularly challenging would be while performing a tracheostomy with a minimal access, in a patient with a neck dissection, where the tracheostomy needs to remain separate from the neck wound. As in Prior’s report, difficulties may be encountered while mobilizing tissues in the neck for anastomosis in the neck.
Conflict of interest The authors declare no conflict of interest.
References 1. Gray’s Anatomy, The anatomical basis of clinical practice. 40th ed., 2009 Churchill Livingstone. 2. Prior MJ, Johnson IJ, Jones K, et al. Aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture. J Laryngol Otol 1997;111(8):772–4. 3. Conoyer BM, Varvares MA, Cooper MH. Right common carotid artery crossing the midline neck anterior to the trachea: a cadaver case report. Head Neck 2008;30(9):1253–6. Fig. 2. CT angiogram (sagittal view) showing position of right common carotid (red arrow) in relation to the trachea.
British Journal of Oral and Maxillofacial Surgery 51 (2013) 363–364
Short communication
Aberrant common carotid artery – a surprise for the unwary Satish Madhavarajan, Carmelo Barbaccia, Lawrence Newman, Darryl M. Coombes ∗ Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital, United Kingdom Accepted 26 July 2012 Available online 30 November 2012
Abstract An aberrant common carotid artery is a rare anatomical anomaly. We report a case of an aberrant carotid artery running across the trachea in a patient undergoing total thyroidectomy. This rare anomaly may make a tracheostomy, a particularly hazardous procedure. © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Aberrant; Common carotid artery; Tracheostomy
Introduction An aberrant common carotid artery is a rare anatomical anomaly. We report a case of an aberrant carotid artery running across the trachea in a patient undergoing total thyroidectomy. This rare anomaly may make a tracheostomy, a particularly hazardous procedure.
Case report A 74-year-old fit and well lady underwent a total thyroidectomy for a multinodular goitre with obstructive symptoms (dysphagia). At the time of mobilization of the lower pole of the right thyroid, a large vascular structure was found to overlie the trachea across the 3rd and 4th tracheal rings. On further dissection of this structure, it was found to be the common carotid artery running across the trachea (Fig. 1). There were no branches arising from it and higher up in the neck, it branched into the external and internal carotid artery. A CT angiogram (Fig. 2) was performed post operatively, with the patient’s consent, to further investigate this anomaly. The CT angiogram showed an abnormally high innominate artery which divided into the right subclavian ∗ Corresponding author at: Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, United Kingdom. Tel.: +44 7525820483. E-mail address: [email protected] (D.M. Coombes).
and right common carotid arteries. The CT angiogram also confirmed that the common carotid artery crossed the midline of the neck from left to right across the trachea.
Discussion According to Gray’s textbook of anatomy,1 the common carotid arteries differ in length and in their mode of origin. The right common carotid artery begins at the bifurcation of the innominate artery behind the sternoclavicular joint and is confined to the neck. The vessel then passes obliquely upward, from behind the sternoclavicular articulation, to the level of the upper border of the thyroid cartilage, where it divides into the external and internal carotid arteries. The anamolies of the right common carotid artery may relate to its origin from the Innominate artery or to its division. In 12% of cases, the right common carotid artery may arise above the sternoclavicular joint. If the Innominate artery is absent, the two common carotid arteries may arise usually as a single trunk. Only two references following a literature search describe the right common carotid artery crossing the midline of the neck, anterior to the trachea. Prior et al.2 reported an aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture in the neck. On the side of the surgical approach the right common carotid artery was found to cross the midline
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.07.019
364
S. Madhavarajan et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 363–364
Fig. 1. Right common carotid artery (white arrow) crossing trachea (red arrow) following thyroidectomy.
to the other side of the neck, and created difficulties both with the procedure and future management. A cadaveric report by Conoyer et al.3 found the right common carotid artery was the first branch of the aorta and ascended on the left side, anterolateral to the trachea. It crossed the midline anterior to the trachea between the sternal notch and the isthmus of the thyroid gland. Once on the right side, the artery resumed a normal course. An anomaly such as this, although rare, should be borne in mind while performing a tracheostomy, as it could prove disastrous for the unwary. Another situation where such an aberration may prove particularly challenging would be while performing a tracheostomy with a minimal access, in a patient with a neck dissection, where the tracheostomy needs to remain separate from the neck wound. As in Prior’s report, difficulties may be encountered while mobilizing tissues in the neck for anastomosis in the neck.
Conflict of interest The authors declare no conflict of interest.
References 1. Gray’s Anatomy, The anatomical basis of clinical practice. 40th ed., 2009 Churchill Livingstone. 2. Prior MJ, Johnson IJ, Jones K, et al. Aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture. J Laryngol Otol 1997;111(8):772–4. 3. Conoyer BM, Varvares MA, Cooper MH. Right common carotid artery crossing the midline neck anterior to the trachea: a cadaver case report. Head Neck 2008;30(9):1253–6. Fig. 2. CT angiogram (sagittal view) showing position of right common carotid (red arrow) in relation to the trachea.