Henry Gray (18251861). Anatomy of the Human Body. 1918.
Relations.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.
Peculiarities as to Origin.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.
Peculiarities as to Point of Division.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.
Occasional Branches.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.
Collateral Circulation.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.
The external carotid artery begins opposite the upper border of the thyroid cartilage, and, taking a slightly curved course, passes upward and forward, and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. In the child, it is somewhat smaller than the internal carotid; but in the adult, the two vessels are of nearly equal size. At its