Superior Thyroid Artery Research Articles

Variations of Bifurcation of the Common Carotid Artery, and Origin of Superior Thyroid Artery, in Sudanese: A Cadaveric Study

Background: Knowledge of the bifurcation level of the common carotid artery (CCA) is important during surgery, mummification, and radiological studies. This study aim to evaluate the anatomical variations in the bifurcation level of CCA, and the origin of the superior thyroid artery (STA), in Sudanese populations. Their knowledge reduces risk during surgery and helps in arterial ligation. Materials and Methods: 30 neck cadaveric specimens were evaluated on sides, using natural anatomical tools and methods for the anatomical studies. Results: The bifurcation of CCA was found at 36.7% at the level of the upper border of thyroid cartilage (TC), 61.7% above, and 1.6% below. No big differences were found in carotid bifurcation on both sides. The right side showed 30% were normal, 66.7 % high, and 3.3% were low-level bifurcation, left showed 43.3% were normal, 56.7% high, and no low level of bifurcation was observed. Origin of STA either from external 50% or bifurcation 46.7% was nearly about the same, with a few incidences 3.3% from the common carotid. Significance differences were observed in origin STA between both sides, on the right the artery commonly originates from external, and on the left commonly from the bifurcation. Conclusion: CCA bifurcates at a higher level in Sudanese, with no big difference in carotid bifurcation on both sides. Statistically, a significant difference was found in the origin of STA on both sides. Recommendation: higher bifurcation of CCA, and side variations in origin of STA, should be put into consideration during surgery and radiology.

Arterial blood supply of the internal neck organs: anatomy, topography, clinical significance in endocrine surgery

BACKGROUND. Current trends of «fast track surgery» give rise to development of new safe techniques of the thyroid and parathyroid surgery, the purpose of which is to minimize the level of postoperative complications, such as vocal cord palsy, hypoparathyroidism, bleeding. In this regard, it is important for the endocrine surgeon to save «dry operating field», which contributes to the clear visualization of such «thin» structures as the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands. Therefore, the key issue of this surgery is to understand the anatomical and topographic features of the blood supply to the internal neck organs (a complex of neck organs consisting of the thyroid and parathyroid glands, larynx, trachea, esophagus).AIM. To determine the main sources of arterial blood supply of the internal neck organs and their anatomical, topographic features.MATERIALS AND METHODS. The computed tomography protocols of cervical branches of brachiocephalic arteries were analysed in the study. The thickness of the reconstructed sections in the axial, frontal and sagittal planes was 0.35±0.05 mm. The fact of blood supply was confirmed by the anatomical close of the arterial structure to the internal organ and the presence of intramural arterial branches.RESULTS. The course of all cervical branches of the subclavian and common carotid artery was traced among 42 patients. It is noted, that only the inferior, superior thyroid arteries and thyroid ima artery supply internal neck organs with the blood. At the same time, the superior thyroid artery was visualized in all angiograms. However, the inferior thyroid artery was absent in 2.4% of cases. The thyroid ima artery was rarely detected (in 4.8% of patients). In 73.2% of cases, the inferior thyroid artery was detected high at the upper third level of the thyroid lobe and then had a descending course. In 23.2% of cases, the artery was formed at the middle third level of the thyroid lobe and was directed horizontally to the gland. Only in 3.6% of cases, the ascending course was determined in the vessel. The inferior thyroid artery was located on the posterior surface of the thyroid lobe, where it formed glandular branches. On the contrary, the branches of the superior thyroid artery were located mainly along the anterolateral surface of the thyroid gland. The average thickness of the inferior thyroid artery was 2.1±0.5 mm, and the superior thyroid artery was 1.6± 0.7 mm.CONCLUSION. According to the study, arterial blood supply to the internal neck organs is provided mainly by the inferior and superior thyroid arteries. At the same time, the trunk of the inferior thyroid artery is larger than the superior thyroid artery (p=0.032). The inferior thyroid artery forms branches along the posterior surface of the thyroid lobe and from a topographic point of view it is the main source of blood supply to the parathyroid glands. In most cases, the inferior thyroid artery has a descending course, is directed along the posterior surface of the thyroid gland and forms an X-shaped intersection with the recurrent laryngeal nerve.

Anatomical variations in the origin of the superior thyroid artery

Superior thyroid artery (STA) is first and lowest branch of external carotid artery (ECA) and it supplies thyroid, parathyroid, upper larynx and neck region. The STA origins either from ECA, common carotid artery (CCA) or its bifurcation level. Various researchers have reported differences in its origin. The STA commencing from the ECA is comparatively more in Indian and Ethiopian but its derivation from CCA bifurcation point is more in Turkey and Korean. Origin of STA in relative to upper border of thyroid cartilage is used as a landmark. The CCA bifurcates into external and internal carotid arteries at same level and occasionally bifurcates at a higher or lower level than its usual site. Origin of STA from CCA is associated with high bifurcation and its origin from the ECA is related with the low CCA division. Comparatively STA origin from CCA or its bifurcation level is more on right side. The CCA developed from third aortic arch and any alteration in development of aortic arches might also contribute to these variations. The STA is an artery of abundant clinical significance and it is recommended to do detailed study of its origin, course, branches, size, and positional relation with the external laryngeal nerve, hyoid bone and thyroid cartilage. Understanding of these variations is immense importance in academic and clinical arena for planning and performing surgical procedures in neck region.

A cadaveric study on variation in branching pattern of common carotid artery

Carotid arterial system are vessels of head and neck region. Comprehensive understanding on its branching configuration is of considerable importance to avoid accidental injury during surgical interventions. Common carotid artery (CCA) usually bifurcates into external carotid artery (ECA) and internal carotid artery (ICA) at level of upper border of thyroid cartilage. Normally ECA lies anteromedial to ICA at its commencement and provides branches, but ICA does not provide any branches in neck. In this case, right CCA bifurcated above cricoid cartilage and divided into two branches of equal diameter in a middle-aged female cadaver. Medial one does not provide any branch and it appeared pale. It continued upward, entered carotid canal and it was confirmed as ICA. The ECA was found lateral to right ICA both in its origin and course. ECA provided lingual, facial and occipital branches. Superior thyroid artery was not identified, and it might be accidently damaged during dissection. It was noticed ECA was a content of carotid sheath. Vagus nerve first found between IJV and CCA and subsequently located between IJV and ECA. Third aortic arch contributed to development of CCA, leading part of ICA and entire part of ECA. Remaining part of ICA was developed from cranial portion of dorsal aorta. Therefore, any embryological deficiency in third aortic arch, dorsal aorta or changes inside of origin of ECA may lead to alteration in position of these vessels. Understanding vascular anatomy of neck is vital in precise interpretation of radiological images and neck surgeries.

Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction

The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149–336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314–142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects.

Doppler Study of the Left Common Carotid Artery With Preocclusive Stenosis

Preocclusive stenosis of the common carotid artery is a rare and potentially life-threatening entity, and the early recognition of associated internal and external carotid artery patency is important for the management plan. The patient in this case report was sent for a thyroid ultrasound for complaints of neck pain, voice change, and dysphagia, and a preocclusive stenosis of the left common carotid artery was found. Multiple collateral pathways had developed to supply blood flow to the left internal carotid artery, and there was retrograde flow in the external carotid artery and antegrade flow in the internal carotid artery. Collaterals from the left thyrocervical trunk were supplying the superior thyroid artery which supplied the external carotid artery and finally the internal carotid artery through the carotid bulb. Doppler ultrasound is valuable in the identification of preocclusive common carotid artery stenosis and mapping of collateral pathways.

Results of contralateral anastomosis of microvascular free flaps in head and neck reconstruction.

Despite various solutions to the issue of ipsilateral vessel-depleted neck in microvascular head and neck reconstruction, concrete data on its safety and implementation are scarce. This paper focuses on the feasibility and success rates of contralateral anastomosis in free flap reconstruction in the head and neck region. This single-center retrospective study at a tertiary referral center includes all patients who underwent free flap reconstruction of the head and neck with contralateral anastomosis between January 1st, 2007 and February 28th, 2021. Primary objectives were frequency, success, and flap-associated complication rates. Secondary objectives were recipient vessels and flap type. Of 318 patients who underwent microvascular reconstruction, anastomosis was performed on the contralateral side of the neck in 32 patients (10.0%). Recipient vessels involved mainly the superior thyroid artery (74.2%; n = 23) and the facial vein (51.1%; n = 23). Thirty patients (93.8%) received a radial forearm free flap. Flap-associated complications occurred in 12.5% of included cases (n = 4): one partial flap necrosis (3.1%), one anastomotic insufficiency (3.1%), one venous thrombosis of the microvascular pedicle (3.1%), and one wound dehiscence (3.1%). All of these complications were resolved without complete flap loss. This study demonstrates that contralateral anastomosis is a successful and safe option in microvascular head and neck reconstruction, especially using a radial forearm free flap. Thus, anastomosing to the contralateral side of the neck can be advocated as a valuable option in the ipsilateral vessel-depleted neck.

Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience

BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.

Hypothyroidism After Using Superior Thyroid Artery as A Recipient Artery.

Superior thyroid artery (SThA) is a common recipient artery in free tissue transfer even after total pharyngolaryngoesophagectomy (TPLE) with hemithyroidectomy. The aim of this study was to evaluate whether the use of SThA as a recipient vessel affect thyroid function in patients undergoing TPLE with hemithyroidectomy. From 2011 to 2020, 91 patients who underwent free jejunum transfer after TPLE with hemithyroidectomy were divided into two groups. In Group1 (n=47), the contralateral SThA was used for the anastomosis. In Group2 (n=44), other vessels were used. Retrospective chart review was performed comparing postoperative thyroid function between two groups. In group1, 17 patients presented hypothyroidism, 21 presented latent hypothyroidism and 9 presented no thyroid dysfunction comparing 15, 19, and 10 respectively in group 2. There were no significant differences between the two groups. Even after hemithyroidectomy, with inferior thyroid arteries are preserved, the SThA can be used as a recipient vessel. 3 Laryngoscope, 133:557-561, 2023.

Study of Branching Pattern of External Carotid Artery

Background: Anatomical information of vasculature is of need for the surgeons and radiologists. Carotid artery and its branches supply most of head, neck, and brain. Injuries to the external carotid artery and its branches is often complex and results in high mortality. Knowledge of types and frequencies of vascular variations of external carotid artery is of help for invasive diagnostic and interventional procedures. Materials and methods: 50 external carotid arteries were dissected to study the branching pattern of external carotid artery. Results: Conventional branching pattern was seen in 58% specimens. Superior thyroid artery originated from common carotid artery in 12% specimens. Linguofacial trunk was observed in 16%. Occipital artery and ascending pharyngeal artery rose from a single trunk in 12%. Origin of facial artery from maxillary artery was observed in one specimen. Conclusion: Study of variations in the branching pattern of the external carotid artery adds to the existing anatomical knowledge. Variations in the branching pattern is of definite help for interventional radiologists, vascular, craniofacial and neck surgeons. KEY WORDS: External carotid artery, Facial artery, Linguofacial trunk.

Variations in the Origin of the Superior Laryngeal Artery and their Clinical Significance: A Case Report with a Proposal for a New Classification

The superior laryngeal artery is the primary vessel providing the blood supply to the larynx. Commonly, it is derived from the superior thyroid artery. Different variations in the origin have been described in the current literature; knowledge of such variations is crucial for various surgical interventions of the larynx and surgical procedures in the lateral region of the neck regarding the carotid triangle. It should be noted that radiological studies, such as selective angiography of the thyroid gland, can also be misleading in cases of variations. Herein, we describe a case of bilateral superior laryngeal artery originating directly from the external carotid artery of the neck. The arteries at first have a transverse course and then pierce through the thyrohyoid membrane alongside internal laryngeal nerves. Moreover, we also review the known variations in the origin of the superior laryngeal artery and propose a new classification of all known variations.

Clinical and embryological relevance of a unique thyroidea ima artery variation providing collateral circulation to the mediastinum

The thyroidea ima artery (TIA) is a highly variable arterial deviation of the blood supply to the thyroid gland with critical implications for surgical neck procedures such as tracheostomy. Though relatively common in the population at large (~3‐10%), most TIA variations are related to the initiation of the artery and whether it emerges from the common sites of the brachiocephalic trunk, aortic arch, right common carotid artery, or another more unique vessel as opposed to its dispersion pattern. Generally, TIA variants supply the thyroid gland, often co‐occurring with absent inferior or superior thyroid arteries. Here, we report on a unique case of a four‐pronged variation of the TIA discovered during an anatomy lab of first year medical students. This variant initiates from the brachiocephalic trunk (diameter 5.3mm, recorded averages 3‐5mm) and has three branches terminating in the thyroid and a fourth branch traveling into the thorax and providing accessory circulation in the mediastinum. Specifically, small arterial branches off of the inferior TIA branch supply the pericardium and surrounding fat deep to the sternum, with anastomoses to the left pericardiophrenic artery. Following the large size of the TIA itself, the thyroid gland of this individual is also markedly increased in size (A‐P diameter 21mm, lateral width 58mm, S‐I diameter 45mm) Potential embryological underpinnings of this variation include overactive HIF‐1α vascular remodeling. The size and spread of this TIA variation provide further support for imaging as a requirement before surgical neck procedures to prevent catastrophic bleeding in the event of a TIA variant.

The Clinical Significance of Detecting Blood Supply to the Inferior Parathyroid Gland Based on the "Layer of Thymus-Blood Vessel-Inferior Parathyroid Gland" Concept.

Objective How to preserve the inferior parathyroid gland (IPTG) in situ during central neck dissection (CND) is the major concern of thyroid surgeons. The “layer of thymus-blood vessel-IPTG” (TBP layer) concept showed to be effective in preserving IPTG. The objective of this study was to identify the origin and course of blood supply to IPTG (IPBS) within the TBP layer and to take key points of operation during CND. Design This is a retrospective control study. Participants. Patients who underwent thyroidectomy plus CND using the TBP layer concept and conventional technique between 2017 and 2019 were enrolled. Measurements. The origin and course of IPBS in relation to recurrent laryngeal nerve (RLN) and thymus and prevalence of hypoparathyroidism were detected. Results A total of 71.3% of IPTGs (251 of 352) were supplied by ITA branches, defined as type A. Type A was further divided into Types A1 (branches of ITA, coursing laterally to the RLN (53.1%, 187 of 352)) and A2 (branches of ITA, traversing medially to the RLN (18.2%, 64 of 352)). Type A2 was more common on the right side than on the left side (P < 0.001). Fifty-five (15.6%) IPTG feeding vessels originated from the thymus or mediastinum. Nineteen (5.4%) IPTGs were supplied by branches of the superior thyroid artery. The incidence of transient hypoparathyroidism decreased from 45.7% to 3.6% (P < 0.001), in the TBP layer group compared with the conventional technique group. Conclusion The origin and course of IPBS follow a definite pattern. This mapping and precautions help surgeons optimize intraoperative manipulations for better preservation of IPBS during CND.

Mandibular AV Malformation: Life-Threatening Bleeding from the Mouth managed by Endovascular Intervention Complicated by Acute Ischemic Stroke on table. Case Report

Arteriovenous malformations (AVM) of mandibula are rare abnormal congenital vascular condition that can result in serious complications. Although, various treatment options have been advocated in the literature, there seems to be no complete consensus on a suitable treatment option in these cases. Here, we describe a case of mandibular AVM, who has presented with massive oral bleeding, treated successfully by embolization of the bilateral external carotid arteries and the left superior thyroid artery. During the procedure, the patient developed symptoms of acute ischemic stroke that was diagnosed and managed during the same session by endovascular techniques.

Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks.

Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient. During a retrospective study of computed tomography angiograms of 52 adult patients, 2 cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented. The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: 1) direct occipital-vertebral arterial anastomosis; 2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; 3) bilateral atresia of posterior communicating arteries; 4) linguofacial and labiomental trunks; 5) terminal trifurcation of the external carotid artery. The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

The Thyroid Gland: A Revision Study on Its Vascularization and Surgical Implications.

Background: The “classic” thyroid gland arterial vascularization takes into account two superior thyroid arteries (STA), two inferior thyroid arteries (ITA) and, occasionally, a thyroid ima artery (TIMA). The present review focuses on exploring the available data concerning thyroid gland arterial vascularization and its variations. Methods: Here, we analysed 49 articles from the last century, ranging from case reports to reviews concerning cadaver dissection classes, surgical intervention, and non-invasive techniques as well. Results: The harvested data clearly highlighted that: (i) the STA originates predominantly from the external carotid artery; (ii) the ITA is a branch of the thyrocervical trunk; and (iii) the TIMA is a very uncommon variant predominantly occurring to compensate for ITA absence. Conclusion: A systematic review of a highly vascularized organ is of great relevance during surgical intervention and, thus, the knowledge of normal anatomy and its modification is essential both for fact-finding and in surgery.

Six-years experience in major scalp defect reconstruction with free flap: analysis of the results.

Introduction:The purposes of this study were to report 10-years experiences in microsurgical reconstruction of major scalp defects, comparing outcomes, evaluating complications.Materials and methods:From November to July 2015, 10 consecutive patients underwent microsurgical procedures for severe scalp defects.Results:The average age was 55,1 years ranging from 6 to 87 years. The mean follow-up was 16.7 months ranging from 12 to 24 months. The size of the lesions ranged from 9x10 to 16x20cm. The average hospital stay was 20 days ranging from 8 to 43 days. Mean operative times was 5.3 h ranging from 5 to 6.45 h. Free flaps included 8 Latissimus Dorsi flaps (LD) and 2 anterolateral thigh flaps (ALT). The superficial temporal vessels were used as recipient vessels in 9 cases while the superior Thyroid artery was used in remaining case.Discussion:For large or complex lesions, the use of free flaps is mandatory. Nowadays LD and ALT flaps are among the most common reconstructive choices for scalp defects reconstructions. Older age does not contraindicate the operation procedure nevertheless in younger patients the size of vessels is proportionately larger and pristine.Conclusion:Microvascular free tissue transfer is the mainstay of scalp defects coverage. In our series early complications are less common and concerning than late complications and in fact reoperations are mainly required to manage these latter. Advanced age should be not consider a contraindication for free flap surgery and the procedure can be considered safe and reliable in both old and young population. (www.actabiomedica.it)

Topographic and anatomical features of muscular and vascular structures in lateral cervical region during prenatal period of human ontogenesis

Background. One of topical areas of morphological research is features of topographic a relationships of the vascular, nervous, muscular, fascial and cartilaginous structures of the neck in prenatal period of human ontogenesis, as data on their formation at different stages of development will improve diagnostic methods of visualization and surgical correction of congenital and acquired pathologies of head and neck. Objective. To find out the peculiarities of synthopia of vascular and muscular structures of the lateral cervical region in human prefetuses. Methods. 9 human prenatal specimens aged 9-12 weeks of prenatal development have been studied by using a set of morphological methods, according to existing bioethical norms. Results. During 9th week of development, bony and musclar boundaries of the lateral triangle of the neck, the carotid vagina, and the components of the vascular-nervous bundle of the neck have been determined. Within the carotid triangle, the external carotid artery is located superficially; it is crossed frontally by the cervical branch of facial nerve and the sublingual nerve. The superior thyroid artery departs from the external carotid artery at the level of the cartilaginous model of the large horns of hyoid bone and passes to the rudiment of thyroid gland. Retropharyngeal space is found at 9th week of development, moderately filled with adipose tissue. The anterior vertebral plate of the cervical fascia forms the bottom for posterior triangle of neck. Conclusion. The lateral cervical region in human prefetuses is represented by a multilayered topographic zone with formed boundaries and contents. Cervical fascia forms carotid vagina within the carotid triangle, and pharyngeal space. The course of blood vessels and nerves within the lateral cervical region is variable. Three-dimensional reconstructions of prefetuses serve as evidence of the early formation of definitive topographic connections within early bony and cartilaginous models in relation to the muscles of the anterior and lateral cervical regions.

Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique

BackgroundPrevious studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle.MethodsIt is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage.ResultsOut of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle.ConclusionBased on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.

Quantitative Prediction of the Location of Carotid Bifurcation and Neurovascular Structures in the Carotid Region: A Cross-Sectional Cadaveric Study.

Introduction The carotid region is encountered in vascular and neurological surgery and carries a potential for vascular and cranial nerve trauma. The carotid bifurcation is an especially important landmark and difficult to predict based on currently established landmarks. This study is a detailed analysis of the carotid region and proposes a novel methodology to predict the height of the bifurcation. Materials and Methods Superficial and deep dissections were performed on the anterior triangle of the neck to expose the carotid region in twenty-one formalin-fixed donor cadavers. Musculoskeletal and neurovascular structures were assessed in relation to the carotid bifurcation and the medial border of the clavicle (MBC). Results The carotid bifurcation occurred, on average, 11.4 mm higher on the left (p < 0.001; 95% CI: 9.28, 13.54). The superior thyroid artery (p < 0.001), facial vein (p < 0.001), and cranial nerve XII (p < 0.001) were all more distal on the left side when measured from the MBC while the angle of the mandible and stylohyoid muscle remained symmetric. Left- and right-sided vascular structures were symmetric when measured from the carotid bifurcation. Conclusions Neurovascular structures within the carotid region are likely to be anatomically superior on the left side while vessels are likely to remain symmetric in relation to the carotid bifurcation. When measured from the MBC, the bifurcation height can be predicted by multiplying the distance between the MBC and mastoid process by 0.65 (right side) or 0.74 (left side). This novel methodological estimation may be easily learned and directly implemented in clinical practice.