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Case report
Submitted: 2020-11-28
Accepted: 2021-01-08
Published online: 2021-01-29
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Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks

M. C. Rusu1, A. M. Jianu2, M. D. Monea2, A. C. Ilie3
DOI: 10.5603/FM.a2021.0007
·
Pubmed: 33559115
Affiliations
  1. Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  2. Department of Anatomy, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
  3. Department of Functional Sciences, Discipline of Public Health, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

open access

Ahead of Print
CASE REPORTS
Submitted: 2020-11-28
Accepted: 2021-01-08
Published online: 2021-01-29

Abstract

Background: Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient.

Materials and methods: During a retrospective study of computed tomography angiograms of 52 adult patients, two cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented.

Results: The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: (1) direct occipital-vertebral arterial anastomosis; (2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; (3) bilateral atresia of posterior communicating arteries; (4) linguofacial and labiomental trunks; (5) terminal trifurcation of the external carotid artery.

Conclusions: The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

Abstract

Background: Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient.

Materials and methods: During a retrospective study of computed tomography angiograms of 52 adult patients, two cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented.

Results: The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: (1) direct occipital-vertebral arterial anastomosis; (2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; (3) bilateral atresia of posterior communicating arteries; (4) linguofacial and labiomental trunks; (5) terminal trifurcation of the external carotid artery.

Conclusions: The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

Get Citation

Keywords

vertebral artery, carotid artery, circle of Willis, maxillary artery, facial artery

About this article
Title

Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Case report

Published online

2021-01-29

DOI

10.5603/FM.a2021.0007

Pubmed

33559115

Keywords

vertebral artery
carotid artery
circle of Willis
maxillary artery
facial artery

Authors

M. C. Rusu
A. M. Jianu
M. D. Monea
A. C. Ilie

References (40)
  1. Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry. 1959; 81(4): 409–418.
  2. Anangwe D, Saidi H, Ogeng'o J, et al. Anatomical variations of the carotid arteries in adult Kenyans. East Afr Med J. 2008; 85(5): 244–247.
  3. Illustrated encyclopedia of human anatomic variation: Opus ii: Cardiovascular system: Arteries: Head, neck, and thorax. Maxillary artery. 2013. https://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/Maxillary.shtml.
  4. Bergman RA, Tubbs RS, Shoja MM, Loukas M. Bergman's comprehensive encyclopedia of human anatomic variation. John Wiley & Sons, Hoboken, New Jersey 2016.
  5. Cappabianca S, Scuotto A, Iaselli F, et al. Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches. Surg Radiol Anat. 2012; 34(5): 393–399.
  6. Carels K, Cornelissen SA, Robben D, et al. Smaller caliber of the internal carotid artery in patients with ipsilateral aplasia of the A1 segment of the anterior cerebral artery: a study with CTA. Acta Neurol Belg. 2018; 118(2): 297–302.
  7. Devadas D, Pillay M, Sukumaran TT. A cadaveric study on variations in branching pattern of external carotid artery. Anat Cell Biol. 2018; 51(4): 225–231.
  8. Gumus T, Onal B, Ilgit ET. Bilateral persistence of type 1 proatlantal arteries: Report of a case and review of the literature. AJNR Am J Neuroradiol. 2004; 25: 1622–1624.
  9. Gunnal SA, Farooqui MS, Wabale RN. Anatomical variability of the posterior communicating artery. Asian J Neurosurg. 2018; 13(2): 363–369.
  10. Hackett ER, Wilson CB. Congenital external carotid-vertebral anastomosis. A case report. Am J Roentgenol Radium Ther Nucl Med. 1968; 104(1): 86–89.
  11. Harada J, Kuwayama N, Nishijima M, et al. Symptomatic occipital-vertebral anastomosis - a case report. Interv Neuroradiol. 2000; 6(4): 317–320.
  12. Herrera-Núñez M, Menchaca-Gutiérrez JL, Pinales-Razo R, et al. Origin variations of the superior thyroid, lingual, and facial arteries: a computed tomography angiography study. Surg Radiol Anat. 2020; 42(9): 1085–1093.
  13. Holodny AI. Supply of the unilateral circulation of the brain by an occipital artery anastomosis--a case report. Angiology. 2005; 56(1): 93–95.
  14. Jinkins JR. Atlas of neuroradiologic embryology, anatomy, and variants. Lippincott Williams & Wilkins, Philadelphia 2000.
  15. Krmpotić-Nemanić J. Anatomie, Variationen und Mißbildungen der Gefäße im Kopf- und Halsbereich (Erläuterungen zum Referat). Archives Of Oto-Rhino-Laryngology. 1978; 219(2): 285–305.
  16. Lasjaunias P, Théron J, Moret J. The occipital artery. Anatomy -- normal arteriographic aspects -- embryological significance. Neuroradiology. 1978; 15(1): 31–37.
  17. Lee HJ, Won SY, O J, et al. The facial artery: a comprehensive anatomical review. Clin Anat. 2018; 31(1): 99–108.
  18. Lee SH, Lee HJ, Kim YS, et al. What is the difference between the inferior labial artery and the horizontal labiomental artery? Surg Radiol Anat. 2015; 37(8): 947–953.
  19. Li M, Su C, Fan C, et al. Internal jugular vein stenosis induced by tortuous internal carotid artery compression: two case reports and literature review. J Int Med Res. 2019; 47(8): 3926–3933.
  20. Lippert H, Pabst R. Arterial variations in man: Classification and frequency. Springer 1985.
  21. McEachen JC, Obrzut M, Bokhari SJ. A rare combination of carotid artery congenital abnormalities: understanding the embryology and clinical associations. Emerg Radiol. 2009; 16(5): 411–414.
  22. Miyachi S, Negoro M, Sugita K. The occipital-vertebral anastomosis as a collateral pathway: Hemodynamic patterns-case report. Surg Neurol. 1989; 32(5): 350–355.
  23. Morimoto K, Nagahata M, Ono S, et al. Incidence of unilateral distal vertebral artery aplasia: evaluation by combining basiparallel anatomic scanning-magnetic resonance imaging (BPAS-MRI) and magnetic resonance angiography. Jpn J Radiol. 2009; 27(3): 151–155.
  24. Natsis K, Raikos A, Foundos I, et al. Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature. Clin Anat. 2011; 24(6): 699–705.
  25. Osborn AG. Diagnostic cerebral angiography. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA 1999.
  26. Ozgur Z, Govsa F, Ozgur T. Assessment of origin characteristics of the front branches of the external carotid artery. J Craniofac Surg. 2008; 19(4): 1159–1166.
  27. Paulsen F, Tillmann B, Christofides C, et al. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 2000; 197 (Pt 3): 373–381.
  28. Pretterklieber ML, Krammer EB, Mayr R. A bilateral maxillofacial trunk in man: an extraordinary anomaly of the carotid system of arteries. Acta Anat (Basel). 1991; 141(3): 206–211.
  29. Quain R. The anatomy of the arteries of the human body. Taylor and Walton, London 1844.
  30. Richter HR. Collaterals between the external carotid artery and the vertebral artery in cases of thrombosis of the internal carotid artery. Acta Radiol. 1953; 40(2-3): 108–112.
  31. Rusu MC, Măru N, Rădoi PM, et al. Trifurcated external carotid artery and complete gamma-loop of its maxillary branch. Surg Radiol Anat. 2019; 41(2): 231–234.
  32. Rusu MC, Vasilescu A, Nimigean V. A rare anatomic variant: the lateral position of the external carotid artery. Int J Oral Maxillofac Surg. 2006; 35(11): 1066–1067.
  33. Saeki N, Rhoton AL. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg. 1977; 46(5): 563–578.
  34. Schechter MM. The occipital-vertebral anastomosis. J Neurosurg. 1964; 21: 758–762.
  35. Suzuki S, Kuwabara Y, Karasawa S. [The developmental mechanism of occipital-vertebral anastomosis (author's transl)]. No To Shinkei. 1980; 32: 69–79.
  36. Tanaka Y, Hara H, Momose G, et al. Proatlantal intersegmental artery and trigeminal artery associated with an aneurysm. Case report. J Neurosurg. 1983; 59(3): 520–523.
  37. Uchino A, Nomiyama K, Takase Y, et al. Anterior cerebral artery variations detected by MR angiography. Neuroradiology. 2006; 48(9): 647–652.
  38. Uchino A, Saito N, Mizukoshi W, et al. Anomalous origin of the occipital artery diagnosed by magnetic resonance angiography. Neuroradiology. 2011; 53(11): 853–857.
  39. Vannix R, Joergenson EJ, Carter R. Kinking of the internal carotid artery. Am J Surg. 1977; 134(1): 82–89.
  40. Zümre O, Salbacak A, Ciçekcibaşi AE, et al. Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann Anat. 2005; 187(4): 361–369.

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