21.1.1 Origin

The internal carotid (Fig. 21.1) begins at the bifurcation of the common carotid, between the hyoid bone and the superior border of the thyroid cartilage, at the level of C3 or C4. It is located lateral and posterior to the external carotid artery as it ascends the neck.

Fig. 21.1 Internal carotid artery.

21.1.2 Pathway

The internal carotid runs superiorly and medially towards the pharynx. It enters the skull through the carotid canal in the petrous part of the temporal bone (foramen lacerum).

21.1.3 Terminal branches

The terminal branches of the internal carotid artery are the:

21.1.4 Comment

The ophthalmic artery provides an indication of the internal carotid dysfunction.

21.1.5 Relations

In the neck, the internal carotid artery has the same positioning as the external carotid, although it is slightly lateral and posterior to it. The internal carotid is initially superficial, covered only by skin, the platysma, and the superficial cervical aponeurosis.

At the base of the skull the glossopharyngeal, vagus, and hypoglossal nerves are positioned posterior to the internal carotid artery. They then circumvent it and are lateral to the internal carotid artery.

21.2.1 Precautions

Use caution in cases of:

21.2.2 Contraindications

The contraindications are:

21.2.3 Indications

Indications for manipulation are cerebral disorders in general, such as:

21.2.4 Palpating the pulse

Palpation of the carotid bifurcation

It is not always easy to distinguish between the internal and external carotid pulses (Fig. 21.2).

Fig. 21.2 Carotid bifurcation.

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