Objective:

Vagus nerve injury is one of the most feared and highly prevalent complications of carotid endarterectomy (CEA). The aim of this study is to demonstrate the bilateral positional variations of the common carotid artery (CCA), vagus nerve and internal jugular vein (IJV) inside the carotid sheath in postmortem cadaveric specimens.

Method:

Carotid endarterectomy procedure was performed bilaterally step by step in 20 cadavers and every step was photographed. Positional variations of vagus nerve, CCA and IJV inside right and left carotid sheaths were evaluated.

Results:

In all dissections anatomical relations between vagus nerve and vascular structures were identified. The right vagus nerve was positioned posteriorly, medially, and anteriorly to IJV and CCA in 8 (40%), 4 (20%) and 4 (20%) of the specimens, respectively. In 2 (10%) specimens right vagus nerve was posterior to the IJV and in 2 (10) specimens’ right vagus nerve was positioned posterior to the CCA. The left vagus nerve was positioned anteriorly, centrally, and posteriorly to IJV and common carotid artery in 10 (50%),2 (10%) and 5 (25%) of the specimens, respectively. In 2 (10%) specimens left vagus nerve was positioned posterior to IJV. In 1 (5%) specimen the vagus nerve was located posterior to CCA.

Conclusion:

In right and left anatomical relations between vagus nerve and vascular structures, considerable asymmetry was seen in anterior and middle positioning of vagus nerve. During CEA, taking this asymmetry into consideration is important to prevent possible cranial nerve injury complications.

Keywords: anatomy, vagus nerve, carotid artery, endarterectomy, cadaveric study