Download Where is the external carotid artery located?

Where is the external carotid artery located?
Poster No.:
C-2364
Congress:
ECR 2014
Type:
Educational Exhibit
Authors:
M. Carrillo García , S. Sánchez Jiménez , A. Andreo Sola , M.
1
2
2
2
2
2
Franulic Guggiana , M. Moreno Cascales , J. M. Garcia Santos ;
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2
Cartagena/ES, Murcia/ES
Keywords:
Blood, Computer Applications-3D, CT-Angiography, Arteries /
Aorta, Anatomy
DOI:
10.1594/ecr2014/C-2364
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Learning objectives
Fig. 1
References: Servicio de Radiología. HGU Morales Meseguer
1. To review the neck anatomy of external carotid artery (ECA) and its branches.
2. To identify their relationship with anatomic structures in cross-sectional imaging
epecially in the usual axial images
3. To show how neck surgery affects these vessels in cross-sectional imaging.
Images for this section:
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Fig. 1
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Background
These two following images help us to easily identify the external carotid branches.
Fig. 2
References: Servicio de Radiología. HGU Morales Meseguer
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Fig. 3: Digital Substraction Angiography. Selective injection of the external carotid
angiography. Lateral view
References: Servicio de Radiología. HGU Morales Meseguer
1. External Carotid Artery.
It originates by the division of common carotid artery, in the upper edge of thyroid
cartilage; at C4-level in the thyroidal space (carotid triangle)
It first ascends in medial position, and then goes deep to posterior side of the digastrics
muscle. Medially it describes a convex curve that approaches to the palatine tonsil
through the diaphragm of styloid muscles and enters the parotid cell. Then it turns
laterally, going deeper in the gland in an upright position from medial to lateral.
The trunks of most of its branches are within the carotid triangle.
It ends in the carotid region, behind and close to the neck of mandibular condyle, by
bifurcation in: the maxillary artery and the superficial temporal artery.
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Fig. 4
References: Servicio de Radiología. HGU Morales Meseguer
2. Branches of the External Carotid Artery
a. Superior thyroid artery:
It is the lowest of the three branches of the ECA.
First is directed medially, below the greater horn of the hyoid bone. And then goes down
towards the upper pole of the thyroid gland, where it ends.
Medially contacting the thyrohyoid membrane.
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Fig. 5
References: Servicio de Radiología. HGU Morales Meseguer
b. Lingual Artery:
It is a flexuous artery adapted to the mobility of the tongue. It originates at the level of
greater horn of the hyoid bone.
It's directed upwards and medially before leaning forward.
Located on the deep surface of the hyoglossus muscle and it ends near the tip of the
tongue, where it is called deep lingual artery.
After a short segment in the carotid triangle, the artery is related to the submandibular,
sublingual regions and then with his tongue.
In the submandibular triangle is hidden laterally by the hyoglossus, medially supported
on the middle constrictor muscle of the pharynx.
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Fig. 6
References: Servicio de Radiología. HGU Morales Meseguer
c. Facial Artery:
It arises from the anterior aspect of the ECA from a common trunk which also emerges
or lingual artery immediately above it.
It lies deep to digastric and stylohyoid muscles, penetrates the submandibular region,
where it goes up and sideways. Then crosses the lateral aspect of the body of the jaw
and becomes shallow and sinuous.
Browse the face back and forth, from the bottom up and from lateral to medial side
anastomosing the dorsal nasal artery (branch of the ophthalmic artery) in the medial
canthus.
Relations:
- In his short segment in the carotid triangle the artery is located medially and against
the pharyngeal wall.
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- it digs a canal in the posterior pole of the submandibular triangle and in the upper face of
the submandibular gland, crosses under the deep surface of the medial pterygoid muscle
and the inferior border of the mandible, in which marks a groove, after that is located
superficially to masseter muscle.
- In the posterior face is accompanied by facial vein. Take a path between the deep
muscular plane (buccinator, elevators and the infraorbital nerve) and superficial muscular
plane (platysma, giggly, and zygomatic branches of the facial nerve).
Fig. 7
References: Servicio de Radiología. HGU Morales Meseguer
d. Ascending pharyngeal artery
It is a small artery that ascends vertically, generally medial to the internal carotid artery,
lying against the lateral wall of the pharynx, which irrigates.
e. Occipital artery
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Originates at the rear face of the external carotid artery, at the height of the jaw angle
and deep to it. It keeps the lower edge of the posterior belly of the digastric, up and back
oblique muscle passes against the base of the skull, medial to the mastoid process, which
prints its passage (groove of the occipital artery), lateral the lateral mass of the atlas. Get
through the muscles of the neck to finish in the superficial layers of the region.
Fig. 8
References: Servicio de Radiología. HGU Morales Meseguer
f. Internal maxillary artery
Bifurcation branch of external carotid artery originated near to parotid gland, it goes to
the front side locating between mandibular condyle and sphenomandibular ligament and
deep in the infratemporal fossa. Generally follows the lateral ptrigoideo muscle, in the
depth or superficially. It ends in the bottom of pterygopalatine fossa, giving a branch
(sphenopalatine artery).
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Fig. 9
References: Servicio de Radiología. HGU Morales Meseguer
g. Superficial temporal artery.
It originates within parotid gland, behind the mandibular neck. Is directed obliquely up
and laterally, situating between the temporal articular tubercle and de external auditive
conduct. Cross the lateral side of articular tubercle, going under the skin of the temporal
region and ends bifurcating in two branches: frontal and parietal arteries.
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Fig. 10
References: Servicio de Radiología. HGU Morales Meseguer
Images for this section:
Page 12 of 42
Fig. 2
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Fig. 3: Digital Substraction Angiography. Selective injection of the external carotid
angiography. Lateral view
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Fig. 4
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Fig. 5
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Fig. 6
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Fig. 7
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Fig. 8
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Fig. 9
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Fig. 10
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Findings and procedure details
1. AXIAL ANATOMY
a. Superior thyroid artery:
Main references : membrane thyrohyoid and hyoid bone.
Fig. 11: A)axial gross-section image B)axial contrast-enhanced CT image White
arrow : Superior thyroid artery, 1:Common carotid artery, 2:Hyoid bone, 3:Thyrohyoid
membrane
References: Servicio de Radiología. HGU Morales Meseguer
b. Lingual Artery:
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Main references: greater horn of the hyoid bone and hyoglossus muscle.
Fig. 12: A) Coronal gross-section image B) Axial contrast-enhanced CT image White
arrow:Lingual artery, 1: Hyoid bone, 2: Hyoglossus muscle, 3:Mylohyoid muscle,
4:Tongue
References: Servicio de Radiología. HGU Morales Meseguer
c. Facial Artery:
Main references: Submandibular gland and angle of the mandible.
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Fig. 13: A)Coronal gross-section image B)Axial contrast-enhanced CT image. White
arrow: Facial artery,1: Angle of the mandible, 2:Submandibular gland, 3:Mandible
References: Servicio de Radiología. HGU Morales Meseguer
d. Distal external carotid and occipital arteries
Main references:
- Distal external carotid artery: the styloid pyramid.
- Occipital artery: the posterior belly of the digastric muscle and the base of the skull,
medial to the mastoid process.
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Fig. 14: A) Axial gross-section image B) Axial contrast-enhanced CT image White
arrow: External carotid artery, 1: Stylopharyngeus muscle, 2:Styloglossus muscle,
3:Stylohioid muscle,4: Digastricus muscle , 5:Occipital artery,6: Parotid gland, 7:
Mandible
References: Servicio de Radiología. HGU Morales Meseguer
e. Internal maxillary artery
Main references: mandibular condyle and lateral ptrigoideo muscle.
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Fig. 15: A) Axial gross-section image B) Axial contrast-enhanced CT image White
arrow: Maxillary artery, 1: Temporal muscle, 2:Lateral pterygoid muscle, 3:Medial
pterigoid muscle, 4:Masseter muscle, 5: Mandible.
References: Servicio de Radiología. HGU Morales Meseguer
f. Superficial temporal artery.
Main references: mandibular neck .
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Fig. 16: A) Axial gross-section image B) Axial contrast-enhanced CT image. White
arrow: Superficial temporal artery, 1:Masseter muscle, 2: Mandibular condyle, 3:Lateral
pterygoid muscle, 4:Medial pterygoid muscle.
References: Servicio de Radiología. HGU Morales Meseguer
2. THE EXTERNAL CAROTID ARTERY AFTER LYMPH NODE DISSECTIONS
Usually the main ECA branches are respected whatever the cervical lymphadenectomy
technique was. However, in specific cases, in which the branches or even the main trunk
of the external carotid artery are affected, resection could be mandatory.
- Selective lymphadenectomy
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Fig. 17: Before selective lymphadenectomy A) Coronal reformatted CT B) Axial
contrast-enhanced CT image. White arrow: External carotid artery, 1: Tumor, 2:
Necrotic lymphadenopathy, 3: Common carotid artery, 4: Internal carotid artery, 5:
Internal yugular vein.
References: Servicio de Radiología. HGU Morales Meseguer
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Fig. 18: After Lymphadenectomy A) Coronal reformatted CT B) Axial contrastenhanced CT image. White arrow: External carotid artery,Triangle: Supposed location
of internal yugular vein 3: Common carotid artery, 4:Internal carotid artery 5: Internal
yugular vein
References: Servicio de Radiología. HGU Morales Meseguer
- Radical lymphadenectomy
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Fig. 19: CT exam before surgery. A) Sagital reformatted CT B) Axial contrastenhanced CT image. White arrow: External carotid artery, 1: Common carotid artery,
2:Internal carotid artery, 3:Necrotic lymphadenopathy
References: Servicio de Radiología. HGU Morales Meseguer
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Fig. 20: CT exam after surgery A) Sagital reformatted CT B) Axial contrast-enhanced
CT image. Black arrow: Supposed location of external carotid artery, 1: Common
carotid artery 2:Internal carotid artery, 4:Right external carotid artery.
References: Servicio de Radiología. HGU Morales Meseguer
Images for this section:
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Fig. 11: A)axial gross-section image B)axial contrast-enhanced CT image White arrow :
Superior thyroid artery, 1:Common carotid artery, 2:Hyoid bone, 3:Thyrohyoid membrane
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Fig. 12: A) Coronal gross-section image B) Axial contrast-enhanced CT image White
arrow:Lingual artery, 1: Hyoid bone, 2: Hyoglossus muscle, 3:Mylohyoid muscle,
4:Tongue
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Fig. 13: A)Coronal gross-section image B)Axial contrast-enhanced CT image. White
arrow: Facial artery,1: Angle of the mandible, 2:Submandibular gland, 3:Mandible
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Fig. 14: A) Axial gross-section image B) Axial contrast-enhanced CT image White arrow:
External carotid artery, 1: Stylopharyngeus muscle, 2:Styloglossus muscle, 3:Stylohioid
muscle,4: Digastricus muscle , 5:Occipital artery,6: Parotid gland, 7: Mandible
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Fig. 15: A) Axial gross-section image B) Axial contrast-enhanced CT image White arrow:
Maxillary artery, 1: Temporal muscle, 2:Lateral pterygoid muscle, 3:Medial pterigoid
muscle, 4:Masseter muscle, 5: Mandible.
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Fig. 16: A) Axial gross-section image B) Axial contrast-enhanced CT image. White
arrow: Superficial temporal artery, 1:Masseter muscle, 2: Mandibular condyle, 3:Lateral
pterygoid muscle, 4:Medial pterygoid muscle.
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Fig. 17: Before selective lymphadenectomy A) Coronal reformatted CT B) Axial contrastenhanced CT image. White arrow: External carotid artery, 1: Tumor, 2: Necrotic
lymphadenopathy, 3: Common carotid artery, 4: Internal carotid artery, 5: Internal yugular
vein.
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Fig. 18: After Lymphadenectomy A) Coronal reformatted CT B) Axial contrast-enhanced
CT image. White arrow: External carotid artery,Triangle: Supposed location of internal
yugular vein 3: Common carotid artery, 4:Internal carotid artery 5: Internal yugular vein
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Fig. 19: CT exam before surgery. A) Sagital reformatted CT B) Axial contrast-enhanced
CT image. White arrow: External carotid artery, 1: Common carotid artery, 2:Internal
carotid artery, 3:Necrotic lymphadenopathy
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Fig. 20: CT exam after surgery A) Sagital reformatted CT B) Axial contrast-enhanced
CT image. Black arrow: Supposed location of external carotid artery, 1: Common carotid
artery 2:Internal carotid artery, 4:Right external carotid artery.
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Conclusion
It is important that general radiologists know the anatomic landmarks of ECA branches
in order to improve anatomical and pathological interpretation of neck CT exams.
In this work we aimed to present those landmarks in anatomical and CT axial slices
helping us to easily identify the main ECA branches in normal and abnormal crosssectional imaging.
Personal information
References
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Aires. Argentina. 2000.
LATARJET M, RUIZ LIARD, A. Human Anatomy. Volume II. Ed Medica Panamericana.
4ª Edition. Mexico, D F. 2004.
MOORE, K. L. Anatomy. Guidance Clinic. Ed Medica Panamericana. Buenos Aires.
Argentina. 2002.
NETTER, F. H. A. Human Anatomy, 3ª Ed. Masson, Barcelona. Spain, 1996.
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