Int J Anat Res 2014, 2(3): 511-14. ISSN 2321-4287 511
Original Article
BIFURCATION LEVELS OF THE COM M ON CAROTID ARTERIES: A
CADAVERIC STUDY IN SOUTH INDIAN POPULATION
K.Radha
ABSTRACT
Add ress fo r Cor resp o nd e nce :
S-8.St af f Qu ar t er s, Kar p aga V in ayaga m edi cal col l ege,
Chinnakolambakkam, Palayanoor Post , M adhurant hagam, Kanchipuram 603308, Tamilnadu,India.
: ajjuradha@gmail.com
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Assist ant Professor, Depart ment of Anat omy, Karpaga Vinayaga Inst it ute of M edical sciences,
Kanchipuram, Tamilnadu, India.
Background and aim: The present st udy aim s at finding t he bifurcat ion level of com m on carot id art ery and cor relat e it w it h t he level of upper border of t hyroid cart ilage.
M aterials and M ethods: Fort y cadavers w ere dissect ed t o st udy t he bifurcat ion level of com m on carot id art ery. The sym m et ry bet w een t he sides w ere not ed.
Results: The level of bifurcat ion of t he com m on carot id art ery w as at t he level of upper border of t hyroid car t ilage in sixt y-seven cases .Only nine cases show ed t he higher level w it h t he range of 3.2 m m t o 19.3 m m above t he level of upper border of t hyroid car t ilage.4 cases show ed t he low er level of bifurcat ion in t he range of 2 m m t o 10 m m below t he level of upper border of t hyroid cart ilage. In t he present st udy, t he bif urcat ion levels w ere sym m et rical on bot h sides.
Conclusion: The bifurcat ion level of com m on carot id art ery coincides w it h t he upper border of t hyroid cart i lage in t he present st udy. The aw areness in t he variat ion of bifurcat ion level is necessary t o avoid undue com plicat ions dur ing t he surgeries and procedures done in head and neck region.
KEYW ORDS:Bif urcat ion, Com m on Carot id, Thyroid Car t ilage.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(3):511-14. ISSN 2321- 4287
Received: 24 July 2014
Peer Review : 24 July 2014 Published (O): 31 Aug 2014
Accepted: 14 Aug 2014 Published (P): 30 Sep 2014
Internat ional Journal of Anat omy and Research
ISSN 2321-4287
w w w.ijmhr.org/ ijar.ht m
The t wo common carot id arteries differ in length,
f or t he r igh t u su al l y ar i ses f r o m t h e
b rach io ceph al ic
ar t er y
b ehi n d
t h e
sternoclavicular joint , w hile t he left arises from
t he arch of the aorta and has t herefore a thoracic
as w ell as a cervical course [1]. The bifurcat ion
of com m on carot id art eries norm ally occurs
b el ow t h e su p er io r b or d er o f t he t hyr oi d
cart ilage [2].
Convent ional angiography is considered t he
most reliable met hod for diagnosis of carot id
bi f ur cat i on diseases, such as st en osis [ 3] .
Accurate interpretat ion of t he level of t he
bifurcat ion of common carot id artery w it h non
invasive techniques remains an important goal
and ext er nal anat om ical landm ar ks can be
clinically useful in predict ing the bifurcation level
of t he carot id artery [4].
The know ledge of point
of bif ur cat io n of CCA is ver y im po r t ant in
surgeries of head and neck region t o prevent
vascular accident s, during cat het erizat ion of
carot id arteries and int ra-arterial administ rat ion
of chemot herapeut ic agent s [5].
Int J Anat Res 2014, 2(3): 511-14. ISSN 2321-4287 512 Tab 1: Levels of bif urcat ion of com m on carot id art eries.
K.Radha. BIFURCATION LEVELS OF THE COM M ON CAROTID ARTERIES: A CADAVERIC STUDY IN SOUTH INDIAN POPULATION.
M ATERIALS AND M ETHODS
The presen t st u dy w as u n der t aken i n 40 ad ul t form alin fixed cadavers procured from t he division o f An at o m y, Raj a M u t h i ah M ed i cal Co l l e ge , Ch i d am b aram an d Kar p aga V i n ayaga M ed i cal College, M ad hurant hagam . The dissect ions w ere carried out according t o t he inst ruct ions given in Cunningham ’s m anual of pract ical anat omy [6]
.
The level of bifurcat ion of com m on carot id art ery was not ed and co rrel at ed w it h t he upper bo rder of t hyroid cartilage. If t he level of bifurcat ion was above or below t he upper border of t hyroid cart ilage, t he d ist an ce bet w een t h e u pp er b order o f t hyroi d cart ilage and bif urcat ion w ere m easured. All t he specim ens w ere phot ographed and result s w ere tabulat ed.RESULTS
The level of bifurcat ion of t he common carot id
artery was at the level of upper border of t hyroid
cart ilage in sixt y-seven cases .Only nine cases
show ed t he higher level w it h t he range of 3.2
mm t o 19.3 mm above t he level of upper border
of t hyroid cart ilage.4 cases show ed t he low er
level of bifurcat ion in t he range of 2 mm t o 10
mm below t he level of upper border of t hyroid
cart ilage. In t he present st udy, t he bifurcat ion
levels w ere symmet rical on bot h sides (Tab. 1).
Level of Bifurcation Number of
specimens Percentage
At the level of upper border of
thyroid cartilage 67 83.75 Above the level of upper border
of thyroid cartilage 9 11.25 Below the level of upper border
of thyroid cartilage 4 5
Tab 2:Com parat ive incidence of bifurcat ion level of com m on carot id ar t eries.
Bifurcation level Amboli M anoj et
al
Al Rafiah et al
Present study At the level of upper border of
thyroid cartilage 57 48.3 83.75
Above the level of upper
border of thyroid cartilage 42 46.3 11.25
Below the level of upper
border of thyroid cartilage 1 5 5
Fig. 1: Norm al bifurcat ion of Com m on carot id at t he level of t hyroid cart ilage.
CCA ECA
ICA
CCA-Com m on carot id art ery, ECA-Ext ernal carotid artery, ICA-Int ernal carot id art ery.
Fig. 2: Low bif urcat ion of Com m on carot id below t he level of t hyroid cart ilage
CCA-Com m on carot id art ery, ECA-Ext ernal carotid artery, ICA-Int ernal carot id art ery.
Fig 3: High bifurcat ion of com m on carot id art ery.
Int J Anat Res 2014, 2(3): 511-14. ISSN 2321-4287 513 K.Radha. BIFURCATION LEVELS OF THE COM M ON CAROTID ARTERIES: A CADAVERIC STUDY IN SOUTH INDIAN POPULATION.
DISCUSSION
Th er e w ere var i ou s repo r t s r egar di ng t he
bifurcat ion level of common carotid artery in t he
literature. The findings of t he present st udy w ere
correlated w it h t hat of Ambali M anoj et al [7]
and Al Rafiah A et al [8]. (Tab. 2) The level of
bifurcat ion of common carot id artery was found
t o be at t he upper border of t hyroid cart ilage in
89% of 59 cases st udied by Lo A [9]
and 50% by
Lucev et al [10]. The present st udy show s t he
higher incidence w it h t he frequency of 83.75%
Bifurcat ion as high as t he hyoid bone or t he
st yloid process and as low as the cricoid cart ilage,
or w it hin 3.7 cm of it s origin have previously
been reported [8]. The higher level of bifurcat ion
of common carotid artery was found t o be 37.5%
by Lucev et al [10]. The incidence of higher
bifurcat ion is low in t he present st udy(11.25%).
Low er cervical bifurcat ion of t he carot id arteries
was first reported by Orr in 1906 [11]. The low er
division of Common carot id has been recorded
t o as frequent as 30% [12].
It was reported t o be
12.5% by Lucev et al [10]. Gulsen et al reported
a case of bilateral low-lying bifurcat ion of t he
common carot id artery [13]. The incidence of
low bifurcation was very low in t he present st udy
(5%).
In case of high bifurcat ion, t he embolic material
could extend int o t he com mon carot id artery
inst ead of t he ext er nal carot id ar t er y w it h
subsequent st roke [14]. A high common carot id
is at a higher risk of im pingem ent by int
ra-art icular screw s during procedures on cervical
vertebrae [15].
Hypoglossal nerve lies closer in relat ion t o t he
CCA bifurcat ion especially w hen it bifurcates at
higher level [16].
Thoracic bifurcat ion of CCA may be associated
w it h t he Klippel-Feil anomaly [17]. Gulsen et al
h ad enco u nt er ed di f f icu l t i es i n a cer v i cal
discect omy operat ion in a pat ient w it h low-lying
bif u rcat io n of CCA [ 13] . Sm it h and Larsen
reported t hat t he left carot id bifurcat ion t o be
higher t han t he right in 50% of t he cases and
t he right bifurcat ion higher t han left in 22% of
t he cases [18].
In t he present st udy, t he bifurcat ion level was
symmet rical on bot h sides.
CONCLUSION
Conflicts of Interests:
None
REFERENCES
The p resent st u d y f i n ds t he i nci d en ce o f
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constant at t he level of upper border of t hyroid
car t i lage in So ut h In d ian p op ul at i on . Th e
incidence of higher level of bifurcat ion is more
t han low er level of bifurcat ion.
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