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

Aim: During the neck surgery, vascular complications could be encountered in the cases with vascular anomalies. To reduce the complication rates and minimize operative morbidity and mortality, it is important to know the normal vascular anatomy of the neck and its related anomalies.

Presentation of Case: In this report, a 60-year-old male patient diagnosed with laryngeal carcinoma was presented. Total laryngectomy and bilateral functional neck dissection was performed to the patient with the diagnosis of squamous cell carcinoma of the larynx. During the neck dissection, bifurcation of right common carotid artery was detected lower than the usual localization, hypoplastic as well as tortuous internal carotid artery was seen on the same side. Multiple fusiform dilatation with narrowing of the right internal jugular vein (IJV) was also detected.

Discussion: Previously, there are several reported anomalies in the literature. The bifurcation of the common carotid arteries may be lower or higher than the normal levels. Also tortuous arteries can be seen during surgery and it may be asymptomatic if it is mild otherwise may lead to ischaemia of the organs if it is severe. The cause could be genetic, or may be thickening of the arteries.

Conclusion: We wanted to emphasize the importance of the knowledge of normal anatomy and also anomalies of vessels of the head and neck region and implications of these anomalies were discussed under the light of literature.