Articulo medico

Surg Radiol Anat (2009) 31:151–159 DOI 10.1007/s00276-008-0405-7

ORIGINAL ARTICLE

Clinically relevant variations of the superior thyroid artery: an anatomic guide for surgical neck dissection
Zuhal Ozgur Æ Figen Govsa Æ Servet Celik Æ Tomris Ozgur

Received: 7 March 2008 / Accepted: 11 August 2008 / Published online: 27 August 2008 Ó Springer-Verlag 2008

Abstract The superior thyroidartery (STA) is the dominant arterial supply of the thyroid gland, upper larynx and the neck region. The knowledge of variations in possible patterns of origin, courses, and branching pattern of the STA is also important for surgical procedures in the neck region, such as emergency cricothyroidotomy, radical neck dissection, catheterization, reconstruction of aneurysm and carotid endarterectomy.The surgical anatomy of the STA was studied in 20 adult Anatolian preserved cadavers between the age of 40 and 70 years. The outer diameter of the STA origin was observed to be 3.53 ± 1.17 mm. The location of the origin of the STA according to the carotid bifurcation was evaluated as above (25%), below (35%) and at the same level (40%). The distribution patterns of the STA were classified into sixtypes depending on the branching pattern. The outer diameter of the infrahyoid branch, superior laryngeal artery, sternocleidomastoid artery and cricothyroid branch at their origins were observed to be 1.13 ± 0.14, 1.42 ± 0.47, 1.54 ± 0.96 and 1.30 ± 0.41 mm, respectively. Typical and variant glandular branching patterns were observed in 85 and 15% of the specimens, respectively. The outerdiameters of anterior, anteromedial, anterolateral and posterior glandular branches were measured as 2.05 ± 0.46, 1.41 ± 0.43, 1.51 ± 0.41 and 1.73 ± 0.53 mm, respectively. It is necessary to understand the surgical anatomy of the STA to carry out successful radical neck dissection and to
Z. Ozgur Ataturk Medical Technology Vocational Training School, Ege University, Izmir, Turkey F. Govsa (&) Á S. CelikÁ T. Ozgur Department of Anatomy, Faculty of Medicine, Ege University, 35100 Izmir, Turkey e-mail: figen.govsa@ege.edu.tr; fgovsa@yahoo.com

minimize postoperative complications in a bloodless surgical field. Keywords Superior thyroid artery Á Superior laryngeal artery Á Cricothyroid branch Á Glandular branch Á Sternocleidomastoid artery Á Neck dissection

Introduction The superior thyroidartery (STA) is the main source of artery for the thyroid gland, upper larynx and neck region, so the anatomic features of the arteries and neighborhoods are important in surgical attempts and approaches, which will be performed in this region [2, 26, 28, 30, 32]. In the treatment of metastasis cancer cases, microcatheterization, congenital wastes, aneurysm, penetrative device and an expansive traumathat require neck dissections and tracheotomy, which cause hemorrhage, is concomitant with high mortality and risk of disability [3, 11, 27, 28]. The surgical procedures for thyroid pathology are total bilateral lobectomy, total unilateral with partial contralateral lobectomy, and partial or subtotal lobectomy. Distruption of the STA or its branches by trauma or malignant invasion of the vesselwall can result in death by bleeding. Each surgical technique has inherent risks and complications including air leaks, bleeding, chylous fistula, facial and cerebral edema, coma and mortality [3, 7, 11, 15, 22, 23]. Therefore, understanding the anatomy of the STA and its possible variations is paramount to safe and effective surgery. Several anatomic studies have described in detail such as thediameters of the origin of STA in detail; however, a detailed description of topoanatomic relations with the

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Surg Radiol Anat (2009) 31:151–159

neck region is limited. Distances between STA and its surrounding landmarks are important including carotid bifurcation (CB), internal branch superior laryngeal nerve, thyroid cartilage, origin locations of the facial and lingual...