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Unusual course of the vagus nerve in the neck passing anterior to the common carotid artery

Albert Gradev, Alexander K. Angelov, Miroslav Dragolov, Taner I. Shahin, Lazar Jelev*

Along its cervical part, the vagus nerve can be identified within the carotid sheath, usually in a position posterolateral to the artery and posteromedial to the vein. Herewith, we report a dissection case of a variant left vagus nerve, passing anterior to the common carotid artery. At the level of hyoid bone, the vagus nerve emerged from the space between the internal and external carotid arteries and the internal jugular vein. Then the nerve spiraled on the lateral surface of the common carotid artery and took an anterior position to the vessel. Such anterior course of the vagus nerve to the carotid artery is reported in the literature with varying incidence from 0.7% to 5% at ultrasonographic studies or during surgery. This variant course can be explained as an imperfect posterior shifting during embryonic development. When present this aberrant position of the vagus might hamper surgical neck dissection.

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