A 79-year-old male diagnosed with right buccal squamous cell carcinoma T2N0M0 Stage II underwent malignant tumor resection, level I–III neck lymph node dissection, and reconstruction with a left forearm free flap. A search for recipient arteries revealed that the superior thyroid artery (STA) did not originate from the right external carotid artery (ECA). The first ECA branch originated from the cranial side of the digastric muscle and hypoglossal nerve. Therefore, the right common carotid artery (CCA) was detached in the operative field, but the STA could not be identified (Figure 1). Finally, the ECA and radial artery were anastomosed from side to end (Figure 2 a-c). A neck contrast computed tomography (CT) scan showed that the STA originated from the CCA, which was located 2.6 cm proximal to the internal and external carotid bifurcation (CB) and the first ECA branch, which was located in the linguofacial trunk (Figure 3).
Schema after neck dissection. LF: linguofacial trunk, EJV: external jugular vein, IJV: internal jugular vein, SCM: sternocleidomastoid muscle, DM: digastric muscle, HB: hyoid bone, HGN: hypoglossal nerve.
2a and 2b After vascular anastomosis. 2b) The defect of the buccal mucosa was reconstructed with a forearm free flap.
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