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Article ID: WMC003533 ISSN 2046-1690

Bilateral Facio- Lingual Arterial Trunk From External Carotid : A Case Report

Corresponding Author: Dr. Sandeep Shah, Doctor, Department of Anatomy, BP Koirala Institute of Health Sciences - Nepal

Submitting Author: Dr. Sarun Koirala, Assistant Professor, Department of Human Anatomy, BP Koirala Institute of Health Sciences, 56700 - Nepal

Article ID: WMC003533 Article Type: Case Report Submitted on:06-Jul-2012, 03:29:41 AM GMT Published on: 06-Jul-2012, 09:42:32 PM GMT Article URL: http://www.webmedcentral.com/article_view/3533 Subject Categories:ANATOMY Keywords:, , Head and Neck Surgery How to cite the article:Shah S, Koirala S. Bilateral Facio- Lingual Arterial Trunk From External Carotid Artery: A Case Report. WebmedCentral ANATOMY 2012;3(7):WMC003533 Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: None

Competing Interests: None

Additional Files: BILATERAL FACIO - LINGUAL ARTERIAL TRUNK FROM EXTE BILATERAL FACIO - LINGUAL ARTERIAL TRUNK FROM EXTE

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Bilateral Facio- Lingual Arterial Trunk From External Carotid Artery: A Case Report

Author(s): Shah S, Koirala S

Abstract to ensure accurate arterial ligation during Oral and Maxillo-Facial Surgery and Radical Neck Dissection.This knowledge can also help radiologists to understand and interpret Carotid System The common carotid provide the major source Imagings[8]. of to the head and neck. The right common In this case report, a rare variation of the origin of carotid artery originates from the brachiocephalic trunk lingual and facial artery, as the common trunk from in the neck while the left arises in the thorax from the both external carotid artery, is being reported. aortic arch. Normally, it gives two terminal branches, external and internal carotid arteries at the level of Materials and methods superior border of thyroid cartilage in . The anatomic understanding of the facial and is thus necessary since most of the cosmetic This study involved the head and neck dissection of a surgeries take place in the Head and Neck region. The middle-aged male cadaver of Nepalese origin in the present case, thus would provide useful information for Department of Human Anatomy, B.P KOIRALA clinical applications in different fields related with Head INSTITUTE OF HEALTH and Neck surgery. SCIENCES(BPKIHS),DHARAN,NEPAL. Introduction The dissection of head and neck was carried out according to the instructions by Cunningham’s Manual of Practical Anatomy(vol-3 15th edition; 130-35).The dissections took place during the year 2011–2012. The common carotid arteries provide the major source The body was preserved by the injection of a formalin based preservative (10% formalin) and stored at -4? of blood to the head and neck. The right common centigrade in cold chamber. carotid artery originates from the brachiocephalic trunk in the neck while the left arises in the thorax from the Results aortic arch. Normally, it gives two terminal branches, external and internal carotid arteries at the level of superior border of thyroid cartilage in carotid triangle During routine dissection in Laboratory Exercise [1]. (LABEX) session for 2nd year medical undergraduate The facial artery normally arises from the external students in Anatomy department in BPKIHS, variation carotid artery, just above the lingual artery, at the level in the origin of facial and lingual artery from external of greater cornu of in the carotid triangle. It carotid artery on both sides was observed in a male then passes upwards and forwards medial to the cadaver. The lingual artery and facial artery were ramus of the [ 2].The reported variations of originating on both sides as the common facio-lingual the facial artery include: its intra parotid origin [3], trunk from the anterior side of external carotid artery, origin as a common trunk with the lingual artery as 17 mm from Carotid Bifurcation and 11 mm above the linguo-facial trunk [ 4,5]. origin of . The Facio-lingual The lingual artery is typically the second branch taking arterial trunk was running medially and upwards which origin anteriorly from the external carotid artery and was crossed by . The facial and may arise either below or under cover of posterior lingual arteries were separeted from the common trunk belly of digastric [6]. The lingual artery arises from a at a distance of 12.5 mm and 7 mm from the origin of common trunk with the facial artery(linguofacial trunk) the common trunk on right and left sides respectively in 10–20% of cases; however, a rare combination .The venous drainage system of the neck was normal branch of the external carotid is thyrolingual trunk [7]. on both sides. It is important for surgeons and radiologists to be Discussion aware of the normal anatomy of branches of since variations among these arteries are quite common; surgeons should be able to differentiate between the facial and the lingual artery Variations in branching pattern of carotid system are

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well known; common variations being superior thyroid, lingual and facial arteries arising from the common carotid artery and posterior auricular, maxillary and 1. Standring S. ed. Gray’s Anatomy. 40th Ed., New superficial temporal arteries originating from the York, Churchill Livingstone. 2008; 444–45. common carotid artery by a common trunk. The 2. Hollinshead W. H. Anatomy for surgeons: head and occipital and ascending pharyngeal arteries can also neck, vol. 1, 3rd edition, Harper and Row Publishers, arises from the . In some cases, Philadelphia, 1954, 302. no specific external carotid artery was observed [9]. 3. Nayak S. Abnormal intra-parotid origin of the facial Unusual case of origin of the superior thyroid, lingual artery, Saudi Med J, 2006, 27(10):1602. was also described by Arthur Thomson in his notes on 4. Gray H., Anatomy, descriptive and surgical, 2nd unusual variations [10]. Babu , Budhiraj and edition, Blanchard & Lea, Philadelphia, 1862, 374–76. Rastogi reported variable origin of thyrolingual trunk 5. Midy D., Mauruc B., Vergnes P., Caliot P. A from right and left Common Carotid Artery respectively contribution to the study of the facial artery, its [11,12]. Mahendrakar reported unilateral agenesis branches and anastomoses; application to the lingual artery [13]. Zümre et al in their study on human anatomic vascular bases of facial flaps, Surg Radiol foetuses found linguofacial trunk in 20%, a Anat, 1986, 8(2):99–107. thyro-lingual trunk in 2.5% and a thyro-linguofacial 6. Hollinshead WH. Anatomy for Surgeons. Vol. 1. 3rd trunk in 2.5% of the human foetuses studied [14]. Ed., Phelidelphia, Harper and Row. 1982; 374–375. Recently, for reconstruction purposes, the Facial 7. Bergman RA, Afifi AK, Miyauchi R. Illustrated Artery Musculo-Mucosal (FAMM) flap was introduced Encyclopedia of Human Anatomic Variation: Opus II: by Pribaz J et al. (1992), which has been widely used Cardiovascular System: Arteries: Head, Neck, and for reconstruction of oronasal fistulas and closure of Thorax. Common Carotid Arteries. soft tissue defects in the mandibular vestibule . http://www.anatomyatlases.org/AnatomicVariants/Card Although the FAMM flap has many advantages with its iovascular/Text/Arteries/CarotidCommon.shtml long rotational arc, its use is limited by variations in the (accessed June 15th, 2010). course of the facial artery. Therefore, application of 8. Thwin S S, Soe M M, Myint M, Than M, Lwin knowledge of the precise course and branching S.Variations of the origin and branches of the external pattern of the facial artery is required for construction carotid artery in a human cadaver.Singapore Med of FAMM flap and its successful utilization [15-17]. Case Report J 2010; 51(2) : e40 9. Kaneko K, Akita M, Murata E, Imai M, Sowa K. Conclusion Unilateral anomalous left common carotid artery; a case report. Ann Anat. 1996; 178: 477–480. 10. Thomson A. Notes on some unusual variations in Thus,variations in the origin and branches of the human anatomy. Anat Physiol. 1885; 19: 328–332. External Carotid Artery on both sides are rare findings 11. Babu BP. Anomalous origin of thyrolingual trunk providing knowledge useful for surgeons operating on from right common carotid artery – a case report. J the face and neck regions, as well as for radiologists in Anat Soc India. 2001; 50: 47–48. the interpretation of imagings. The anatomic 12. Budhiraja V, Rastogi R. Variant origin of understanding of the facial and lingual artery is thus thyrolingual trunk from left common carotid artery. necessary since most of the cosmetic surgeries take International Journal of Anatomical Variations. 2010; 3: place in the Head and Neck region. The present case, 44–45. thus would provide useful information for clinical 13. Mahendrakar MA. Variation in the branching applications in different fields related with Head and pattern of external carotid artery: a case report. J Anat Neck surgery Soc India. 2007; 56: 47–51. 14. Zümre O, Salbacak A, Ciçekciba?i AE, Tuncer I, Acknowledgments Seker M. Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann We would like to thank the entire staff members of Anat 2005; 187:361-69. Anatomy Department especially Mr Binod and Mr 15. Pribaz J., Stephens W., Crespo L., Gifford G., A Satya for their assistance during the dissection. new intraoral flap: facial artery musculomucosal (FAMM) flap, Plast Reconstr Surg, 1992, 90(3):421–29. References 16. Dupoirieux L., Plane L., Gard C., Penneau M., Anatomical basis and results of the facial artery

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musculomucosal flap for oral reconstruction, Br J Oral Maxillofac Surg, 1999, 37(1):25–28. 17. Hatoko M., Kuwahara M., Tanaka A., Yurugi S., Use of facial artery musculomucosal flap for closure of soft tissue defects of the mandibular vestibule, Int J Oral Maxillofac Surg, 2002, 31(2):210–11

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