In
Human Anatomy , the is the
Blood Vessel with oxygenated
Blood that supplies the head and neck.
At approximately the level of the third
Cervical Vertebra , the common carotid arteries
Bifurcate into an
Internal Carotid Artery (ICA) and an
External Carotid Artery (ECA). The ICA supplies the brain. The ECA supplies the neck and face.
The thoracic portion of the left common carotid artery ascends from the arch of the aorta through the superior mediastinum to the level of the left
Sternoclavicular joint, where it is continuous with the cervical portion.
In front, it is separated from the manubrium sterni by the Sternohyoideus and Sternothyreoideus, the anterior portions of the left pleura and lung, the left innominate vein, and the remains of the thymus; behind, it lies on the
Trachea ,
Esophagus , left
Recurrent Nerve , and
Thoracic Duct .
To its right side below is the innominate artery, and above, the trachea, the inferior thyroid veins, and the remains of the thymus; to its left side are the left vagus and phrenic nerves, left pleura, and lung. The left subclavian artery is posterior and slightly lateral to it.
The cervical portions of the common carotids resemble each other so closely that one description will apply to both.
Each vessel passes obliquely upward, from behind the sternoclavicular articulation, to the level of the upper border of the thyroid cartilage, where it divides into the external and internal carotid arteries.
At the lower part of the neck the two common carotid arteries are separated from each other by a very narrow interval which contains the trachea; but at the upper part, the
Thyroid Gland , the
Larynx and
Pharynx project forward between the two vessels.
The common carotid artery is contained in a sheath, which is derived from the
Deep Cervical Fascia and encloses also the
Internal Jugular Vein and
Vagus Nerve , the vein lying lateral to the artery, and the nerve between the artery and vein, on a plane posterior to both.
On opening the sheath, each of these three structures is seen to have a separate fibrous investment.
At the lower part of the neck the common carotid artery is very deeply seated, being covered by the integument,
Superficial Fascia ,
Platysma , and
Deep Cervical Fascia , the
Sternocleidomastoideus ,
Sternohyoideus ,
Sternothyreoideus , and
Omohyoideus ; in the upper part of its course it is more superficial, being covered merely by the integument, the superficial fascia,
Platysma , deep cervical fascia, and medial margin of the
Sternocleidomastoideus .
When the latter muscle is drawn backward, the artery is seen to be contained in a triangular space, the
Carotid Triangle , bounded behind by the
Sternocleidomastoideus , above by the
Stylohyoideus and posterior belly of the
Digastricus , and below by the superior belly of the
Omohyoideus .
This part of the artery is crossed obliquely, from its medial to its lateral side, by the sternocleidomastoid branch of the superior thyroid artery; it is also crossed by the superior and middle thyroid veins which end in the
Internal Jugular ; descending in front of its sheath is the descending branch of the
Hypoglossal Nerve , this filament being joined by one or two branches from the
Cervical Nerves , which cross the vessel obliquely.
Sometimes the descending branch of the hypoglossal nerve is contained within the sheath.
The superior thyroid vein crosses the artery near its termination, and the middle thyroid vein a little below the level of the cricoid cartilage; the anterior jugular vein crosses the artery just above the clavicle, but is separated from it by the Sternohyoideus and Sternothyreoideus.
Behind, the artery is separated from the transverse processes of the cervical vertebræ by the
Longus Colli and
Longus Capitis , the sympathetic trunk being interposed between it and the muscles. The inferior thyroid artery crosses behind the lower part of the vessel.
Medially, it is in relation with the esophagus, trachea, and thyroid gland (which overlaps it), the inferior thyroid artery and recurrent nerve being interposed; higher up, with the larynx and pharynx. Lateral to the artery are the internal jugular vein and vagus nerve.
At the lower part of the neck, the right recurrent nerve crosses obliquely behind the artery; the right internal jugular vein diverges from the artery, but the left approaches and often overlaps the lower part of the artery.
Behind the angle of bifurcation of the common carotid artery is a reddish-brown oval body, known as the glomus caroticum (carotid body). It is similar in structure to the glomus coccygeum (coccygeal body) which is situated on the middle sacral artery.
The right common carotid may arise above the level of the upper border of the
Sternoclavicular articulation; this variation occurs in about 12 per cent. of cases.
In other cases the artery may arise as a separate branch from the arch of the aorta, or in conjunction with the left carotid.
The left common carotid varies in its origin more than the right.
In the majority of abnormal cases it arises with the
Innominate Artery ; if that artery is absent, the two carotids arise usually by a single trunk.
It is rarely joined with the left subclavian, except in cases of transposition of the
Aortic Arch .
In the majority of abnormal cases this occurs higher than usual, the artery dividing opposite or even above the hyoid bone; more rarely, it occurs below, opposite the middle of the larynx, or the lower border of the
Cricoid Cartilage ; one case is related by Morgagni, where the artery was only 4 cm. in length and divided at the root of the neck.
Very rarely, the common carotid ascends in the neck without any subdivision, either the external or the internal carotid being wanting; and in a few cases the common carotid has been found to be absent, the external and internal carotids arising directly from the arch of the aorta.
This peculiarity existed on both sides in some instances, on one side in others.
The common carotid usually gives off no branch previous to its bifurcation, but it occasionally gives origin to the
Superior Thyroid or its laryngeal branch, the
Ascending Pharyngeal , the
Inferior Thyroid , or, more rarely, the
Vertebral Artery .
After ligature of the common carotid, the collateral circulation can be perfectly established, by the free communication which exists between the carotid arteries of opposite sides, both without and within the
Cranium , and by enlargement of the branches of the subclavian artery on the side corresponding to that on which the vessel has been tied.
The chief communications outside the skull take place between the superior and inferior thyroid arteries, and the
Profunda Cervicis and
Ramus Descendens of the
Occipital ; the vertebral takes the place of the internal carotid within the cranium.
