Association of high carotid bifurcation and thyrolinguofacial trunk: a rare variation

Long linguofacial trunk with infrahyoid origin

The linguofacial trunk (LFT) is the conjoined origin of the lingual (LA) and facial (FA) arteries. We present an uncommon case of LFT due to its origin, length, and diameter. The computed tomography angiogram of an adult male case was evaluated. On the right side, the external carotid artery (ECA) gave off a large LFT before reaching the greater hyoid horn, with an outer diameter of 3.7 mm. The outer diameter of the ECA of 3.4 mm. The ECA and the LFT were on the outer side of the greater hyoid horn. After an ascending course of 20.9 mm anteriorly to the ECA, the LFT branched into the LA and FA. Bilateral elongated styloid processes reaching laterally to the oropharyngeal isthmus were also assessed. In conclusion, care should be taken not to confuse a large LFT with the ECA on the outer side of the greater hyoid horn.

Thyrolinguofacial trunk arising from the common carotid artery and diagnosed by computed tomography angiography

PURPOSE

Various variations in the head and neck vasculature have been reported. The purpose of this report is to describe an extremely rare case of thyrolinguofacial trunk (TLFT) arising from the common carotid artery (CCA).

METHODS

A 66-year-old woman with vertigo, dizziness, and heaviness in the head underwent computed tomography (CT) angiography of the neck and head region for evaluation of cerebrovascular diseases.

RESULTS

The TLFT originated from the anterior wall of the right CCA and was divided into the superior thyroid artery and linguofacial trunk (LFT). The LFT was divided into lingual and facial arteries. In addition, we observed fusiform dilatation of the intracranial right vertebral artery, which might have caused these symptoms.

CONCLUSION

The presence of a common trunk of the external carotid artery (ECA) branches increases the risk of complications such as bleeding and ischemia during treatment of the head and neck region, including chemoradiotherapy for oral bleeding and tongue cancer. Therefore, this is an area of significant interest across various medical specialties, including surgery, otolaryngology, and radiology. Understanding the diverse variations in the neck vasculature is expected to lead to a reduction in complications associated with various procedures.

Origin variations of the superior thyroid, lingual, and facial arteries: a computed tomography angiography study

PURPOSE

To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches.

METHODS

Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined.

RESULTS

A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3-C4 (55.9% of cases).

CONCLUSIONS

STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures.