Variation in the Caudal Branches of the External Carotid Artery: Comparison of Sex and Side

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Sara Heltzel Leandra Jelinek David Jaynes


Background: The branching pattern of vessels emerging from the external carotid artery varies considerably. Knowledge of this variation is critical for clinicians who perform neck procedures. This study assessed the origin of the four primary caudal branches of the external carotid artery (superior thyroid, lingual, facial, and occipital arteries) with regard to sex and side. The position of common carotid artery bifurcation was also analyzed with regard to sex and side.

 Methods: The carotid arterial system of 79 cadavers from the eastern United States (37 male, 42 female) was dissected bilaterally. The position of carotid bifurcation relative to a midpoint between the suprasternal notch and mastoid process was measured with digital fractional calipers. Origin of the caudal branches was determined and the distance from the carotid bifurcation measured.

 Results: On the right, the superior thyroid artery emerged from the carotid bifurcation/external carotid more frequently than it did from the common carotid (67% and 31%, respectively); however, on the left, it emerged more frequently from the common carotid (57% and 43%, respectively) (p = 0.003). No side-dependent differences were observed for the remaining three caudal branches. The occipital artery emerged below the origin of the facial artery more frequently than at/above (55% and 44%, respectively). No significant differences were found for the origin of the caudal four branches with regard to sex. There was no significant difference in the location of the carotid bifurcation with regard to sex or side.

Conclusions: The origin of the superior thyroid artery differed when comparing neck side, while the origin of the occipital artery frequently emerged caudal to that of the facial artery. Both findings are inconsistent with most anatomical atlases. The positions of the carotid bifurcation as well as the origin of the remaining caudal branches were no different with regard to either parameter.

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How to Cite
HELTZEL, Sara; JELINEK, Leandra; JAYNES, David. Variation in the Caudal Branches of the External Carotid Artery: Comparison of Sex and Side. Medical Research Archives, [S.l.], n. 1, jan. 2015. ISSN 2375-1924. Available at: <>. Date accessed: 22 july 2018.
external carotid artery; arterial variation; sex; side; superior thyroid artery; occipital artery
Research Articles


Chleborad, W. P., and Dawson, D. L. (1990) The profunda femoris artery: variations and clinical applications. Clin Anat, 3:33-40.

Drake, R. L, Vogl, W., and Mitchell, A. W. (2005) Gray's anatomy for students. 1st Ed. Philadelphia: Churchill Livingstone, pp. 909- 912.

Eden, S. V., Meurer, W. J., Sánchez, B. N., Lisabeth L. D., Smith, M. A., Brown, D. L., and Morgenstern, L. B. (2008) Gender and ethnic differences in subarachnoid hemorrhage. Neurology, 71:731-735.

Gilroy, A., MacPherson, B., Ross, L., Schuenke, M., Schulte, E., and Schumacher, U. (2008) Atlas of anatomy. 1st Ed. New York: Thieme Medical Publishers, pp. 491-495.

Gluncic, V., Petanjek, Z., Marusic, A., and Gluncic, I. (2001) High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery. Surg Radiol Anat, 23:123-125.

Gupta, P., Bhalla, A. S., Thulkar, S., Kumar, A., Mohanti, B. K., Thakar, A., and Sharma, A. (2014) Variations in superior thyroid artery: A selective angiographic study. Indian J Radiol Imaging, 24:66-71.

Hayashi, N., Hori, E., Ohtani, Y., Ohtani, O., Kuwayama, N., and Endo, S. (2005) Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir (Tokyo), 45:25-9; discussion 30.

Kamenskiy, A. V., MacTaggart, J. N., Pipinos, I. I., Bikhchandani, J., and Dzenis, Y. A. (2012) Three-dimensional geometry of the human carotid artery. J Biomech Eng 134, (6), 064502.

Kirkman, T. W. (1996) Statistics to use. URL:

Kitagawa, W. (1993) Arterial supply of the thyroid gland in the human fetuses. Nippon Ika Daigaku Zasshi, 60:140-155.

Klosek, S. K., and Rungruang, T. (2008) Topography of carotid bifurcation: considerations for neck examination. Surg Radiol Anat, 30:383-387.

Lindekleiv, H. M., Valen-Sendstad, K., Morgan, M. K., Mardal, K., Faulder, K., Magnus, J. H., Waterloo, K., Romner, B., and Ingebrigtsen, T. (2010) Sex differences in intracranial arterial bifurcations. Gend Med, 7:149-155.

Lo, A., Oehley, M., Bartlett, A., Adams, D., Blyth, P., and Al-Ali, S. (2006) Anatomical variations of the common carotid artery bifurcation. ANZ J Surg, 76: 970-972.

LuČev, N., Bobinac, D., Marič, I., and Drešćik, I. (2000) Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg, 122:590-591.

Malnar, D., Klasan, G. S., Miletić, D., Bajek, S., Vranić, T. S., Arbanas, J., Bobinac, D., and Čoklo, M. (2010) Properties of the celiac trunk - anatomical study. Coll Antropol, 349:17-921.

Mangla, S., and Sclafani, S. J. A. (2008) External carotid arterial injury. Injury, 39:1249-1256.

Moore, K., Dalley, A., and Agur A. (2009) Clinically oriented anatomy. 6th Ed. Baltimore: Lippincott Williams & Wilkins, pp. 1001-1004.

Müller, H. R., Brunhölzl, C., Radü, E. W., and Buser, M. (1991) Sex and side differences of cerebral arterial caliber. Neuroradiology, 33: 212-216.

Natsis, K., Raikos, A., Foundos, I., Noussios, G., Lazaridis, N., and Njau, S. N. (2011) Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature. Clin Anat, 24:699-705.

Netter, F. H. (2010) Atlas of human anatomy. 5th Ed. Teterboro: Saunders, pp. 69-71.

Nicoucar, K., Popova, N., Becker, M., Dulguerov, and P. (2008) Pseudoaneurysm of the external carotid artery after a blunt facial trauma. J Trauma, 65:E24-27.

Ongeti, K. W., and Ogeng'o, J. A. (2012) Variant origin of the superior thyroid artery in a Kenyan population. Clin Anat, 25(2):198-202.

Ozgur, Z., Govsa, F., and Ozgur, T. (2008) Assessment of origin characteristics of the front branches of the external carotid artery. J Craniofac Surg, 19:1159-1166.

Sanjeev, I. K, Anita, H., Ashwini, M., Mahesh, U., and Rairam, G. B. (2010) Branching pattern of external carotid artery in human cadavers. J Clin Diag Res, 4:3128-3133.

Schulz, U. G., and Rothwell, P. M. (2001) Sex differences in carotid bifurcation anatomy and the distribution of atherosclerotic plaque. Stroke, 32:1525-1531.

Shintani, S., Terakado, N., Alcalde, R. E., Tomizawa, K., Nakayama, S., Ueyama, Y., Ichikawa, H., Sugimoto, T., and Matsumura, T. (1999) An anatomical study of the arteries for intraarterial chemotherapy of head and neck cancer. Int J Clin Oncol, 4:327-330.

Toni, R., Della Casa, C., Castorina, S., Malaguti, A., Mosca, S., Roti, E., and Valenti, G. (2004) A meta-analysis of superior thyroid artery variations in different human groups and their clinical implications. Ann Anat, 186: 255-262.

Vázquez, T., Cobiella, R., Maranillo, E., Valderrama, F. J., McHanwell, S., Parkin, I., and Sañudo, J. R. (2009) Anatomical variations of the superior thyroid and superior laryngeal arteries. Head Neck, 31:1078-1085.

von Hagens, G., Tiedemann, K., Kriz, and W. (1987) The current potential of plastination. Anat Embryol (Berl), 175:411-421.

Yonenaga, K., Tohnai, I., Mitsudo, K., Mori, Y., Saijo, H., Iwai, T., Yonehara, Y., Ota, Y., Torigoe, K., Takato, T. (2011) Anatomical study of the external carotid artery and its branches for administration of superselective intra-arterial chemotherapy via the superficial temporal artery. Int J Clin Oncol, 16(6):654-659.

Zümre, Ö., Salbacak, A., Çiçekcibaşi, A., Tuncer, I., Seker, M. (2005) Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann of Anat, 187:361-369.

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