{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T15:33:05Z","timestamp":1788622385620,"version":"build-2803163510"},"reference-count":55,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The superior thyroid artery (STA) exhibits significant anatomical variability, which is crucial for head and neck surgical procedures, particularly free flap reconstruction. This systematic review synthesizes the current knowledge on STA origin, branching patterns, perfusion territory, and its relationship with the superior laryngeal nerve (SLN), focusing on implications for flap selection and surgical planning. Methods: A comprehensive search of relevant databases was conducted to identify studies reporting on STA anatomy. Data extraction focused on the STA origin variations, relationships with anatomical landmarks, branching patterns, perfusion territory, and the STA-SLN relationship. Emphasis was placed on variations impacting STA\u2019s suitability as a recipient vessel for free flaps. Data were synthesized qualitatively. Results: The STA most commonly originates from the external carotid artery (ECA), with variations from the carotid bifurcation (CB) and common carotid artery (CCA). Sex-based and laterality differences were noted. Branching patterns varied considerably, influencing perfusion of the thyroid gland, larynx, and adjacent musculature. The STA\u2019s relationship with the external branch of the SLN (EBSLN), classified by Cernea\u2019s classification, highlighted the risk of iatrogenic injury. The STA provides perfusion to the thyroid gland, larynx, sternocleidomastoid muscle, and strap muscles, all of which can be raised as flaps. Conclusions: Understanding STA anatomical variations is essential for surgeons planning free flap reconstruction in the head and neck. This review underscores the importance of preoperative imaging to assess STA suitability as a recipient\u2019s vessel and minimize complications. Further research is needed to quantify the impact of STA variations on free flap outcomes.<\/jats:p>","DOI":"10.3390\/jcm14176250","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T07:46:17Z","timestamp":1757058377000},"page":"6250","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anatomical Variations in the Superior Thyroid Artery: A Systematic Review and Implications for Free Flap Surgery"],"prefix":"10.3390","volume":"14","author":[{"given":"Kr\u00f3likowska","family":"Aleksandra","sequence":"first","affiliation":[{"name":"Clinical and Dissecting Anatomy Students\u2019 Scientific Club, Medical Faculty, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Stok\u0142osa","sequence":"additional","affiliation":[{"name":"Clinical and Dissecting Anatomy Students\u2019 Scientific Club, Medical Faculty, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Patkowska","sequence":"additional","affiliation":[{"name":"Clinical and Dissecting Anatomy Students\u2019 Scientific Club, Medical Faculty, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktoria","family":"Rudko","sequence":"additional","affiliation":[{"name":"Clinical and Dissecting Anatomy Students\u2019 Scientific Club, Medical Faculty, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0066-6087","authenticated-orcid":false,"given":"Mateusz","family":"Mazurek","sequence":"additional","affiliation":[{"name":"Clinical and Dissecting Anatomy Students\u2019 Scientific Club, Medical Faculty, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2317-1932","authenticated-orcid":false,"given":"Zygmunt","family":"Domaga\u0142a","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Dolnoslaskie, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","first-page":"e71120","article-title":"Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery","volume":"16","author":"Abdalla","year":"2024","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102823","DOI":"10.1016\/j.amsu.2021.102823","article-title":"Anatomical variations of the thyroid gland: An experimental cadaveric study","volume":"70","author":"Takahashi","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"151789","DOI":"10.1016\/j.aanat.2021.151789","article-title":"Anatomic mapping of the collateral branches of the external carotid artery with regard to daily clinical practice","volume":"238","author":"Cobiella","year":"2021","journal-title":"Ann. Anat.\u2014Anat. Anz."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1590\/S1808-86942011000200016","article-title":"Anatomic relation between the external branch of the superior laryngeal nerve and the thyroid gland","volume":"77","author":"Estrela","year":"2011","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1097\/BRS.0b013e31820408af","article-title":"Clinically relevant anatomy of high anterior cervical approach","volume":"36","author":"Haller","year":"2011","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s00276-005-0053-0","article-title":"Branching patterns of the arterial branches supplying the middle vascular pedicle of the sternocleidomastoid muscle: A topographic anatomical study with surgical applications for the use of pedicles osteomuscular flaps","volume":"28","author":"Hu","year":"2005","journal-title":"Surg. Radiol. Anat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1111\/j.1445-2197.2006.03913.x","article-title":"Anatomical Variations of the Common Carotid Artery Bifurcation","volume":"76","author":"Lo","year":"2006","journal-title":"ANZ J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s12565-014-0246-x","article-title":"An applied anatomical study on the external laryngeal nerve loop and the superior thyroid artery in the neck surgical region","volume":"90","author":"Lu","year":"2014","journal-title":"Anat. Sci. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3126\/jucms.v9i01.37964","article-title":"Anatomical Variations in the Origin of Superior Thyroid Artery and its Relation with External Laryngeal Nerve and their Clinical Importance-A Cadaveric Study","volume":"9","author":"Manjappa","year":"2021","journal-title":"J. Univers. Coll. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00276-008-0351-4","article-title":"Anatomic evaluation of the carotid artery bifurcation in cadavers: Implications for open and endovascular therapy","volume":"30","author":"Ozgur","year":"2008","journal-title":"Surg. Radiol. Anat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00276-008-0405-7","article-title":"Clinically relevant variations of the superior thyroid artery: An anatomic guide for surgical neck dissection","volume":"31","author":"Ozgur","year":"2009","journal-title":"Surg. Radiol. Anat."},{"key":"ref_12","first-page":"2875","article-title":"A study of superior thyroid artery in 50 cadavers","volume":"4","author":"Patel","year":"2013","journal-title":"Int. J. Biol. Med. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2535\/ofaj1936.78.2-3_65","article-title":"Bilateral Investigation of the Anatomical Relationships of the External Branch of the Superior Laryngeal Nerve and Superior Thyroid Artery, and also the Recurrent laryngeal Nerve and Inferior thyroid Artery","volume":"78","author":"Poyraz","year":"2001","journal-title":"Okajimas Folia Anat. Jpn."},{"key":"ref_14","first-page":"47","article-title":"Anatomical study of the carotid bifurcation and origin variations of the ascending pharyngeal and superior thyroid arteries","volume":"70","author":"Aal","year":"2011","journal-title":"Folia Morphol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"251","DOI":"10.4103\/JASI.JASI_231_19","article-title":"Cadaveric study on variations in the source and level of origin of superior thyroid artery","volume":"70","author":"Shyamala","year":"2021","journal-title":"J. Anat. Soc. India"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1002\/ca.22198","article-title":"A detailed study of the relationship between the external laryngeal nerve and superior thyroid artery, including its glandular branches","volume":"26","author":"Yalcin","year":"2012","journal-title":"Clin. Anat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1007\/s00595-014-1051-9","article-title":"Blood supply of the terminal part of the external branch of the superior laryngeal nerve","volume":"45","author":"Yalcin","year":"2014","journal-title":"Surg. Today"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5994","DOI":"10.1007\/s12070-021-02643-4","article-title":"Topographic Evaluation of Superior Thyroid Artery-A Terrain to be Well Versed for Surgeon\u2019s Knife","volume":"74","author":"Anand","year":"2021","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_19","first-page":"590","article-title":"Variations of the great arteries in the carotid triangle","volume":"122","author":"Bobinac","year":"2000","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_20","unstructured":"EBSCOhost (2024, November 10). Morphological Considerations on the Origin of the Superior Thyroid Artery. Available online: https:\/\/openurl.ebsco.com\/EPDB%3Agcd%3A8%3A26281032\/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A160189085&crl=c&link_origin=scholar.google.com."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00276-004-0263-x","article-title":"Tip of the greater horn of the hyoid bone: A landmark for cervical surgery","volume":"27","author":"Lemaire","year":"2004","journal-title":"Surg. Radiol. Anat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E569","DOI":"10.1097\/BRS.0b013e31814ce535","article-title":"The safety zone of percutaneous cervical approach: A dynamic computed tomographic study","volume":"32","author":"Lee","year":"2007","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1001\/archsurg.134.2.144","article-title":"The Blood Supply of the Sternocleidomastoid Muscle and Its Clinical Implications","volume":"134","author":"Kierner","year":"1999","journal-title":"Arch. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1001\/archotol.124.3.301","article-title":"The external branch of the superior laryngeal nerve: Its topographical anatomy as related to surgery of the neck","volume":"124","author":"Kierner","year":"1998","journal-title":"Arch. Otolaryngol. Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s12070-011-0411-7","article-title":"Study of Thyro-Lingual Trunk and its Clinical Relevance","volume":"65","author":"Kapre","year":"2011","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4103\/0971-3026.130701","article-title":"Variations in superior thyroid artery: A selective angiographic study","volume":"24","author":"Gupta","year":"2014","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"254","DOI":"10.5115\/acb.2016.49.4.254","article-title":"Variations in the origin of superior laryngeal artery","volume":"49","author":"Devadas","year":"2016","journal-title":"Anat. Cell Biol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Dessie, M.A., and Gadeau, A.-P. (2018). Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197075"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1097\/00005537-199807000-00004","article-title":"Strap muscle neurovascular supply","volume":"108","author":"Wang","year":"1998","journal-title":"Laryngoscope"},{"key":"ref_30","first-page":"328","article-title":"Unmapped landmarks around branches of the Superior Laryngeal Nerve: An exploratory cadaveric study","volume":"16","author":"Devaraja","year":"2021","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11604-017-0710-3","article-title":"Variations in the origins of the thyroid arteries on CT angiography","volume":"36","author":"Esen","year":"2017","journal-title":"Jpn. J. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"906","DOI":"10.31729\/jnma.6419","article-title":"Right External Carotid Artery Originated Right Superior Thyroid Artery in Cadavers of a Medical College in Western Nepal: A Descriptive Cross-sectional Study","volume":"59","author":"Sharma","year":"2021","journal-title":"J. Nepal. Med. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1097\/00005537-199806000-00013","article-title":"Tracheal Transplantation: Superior and Inferior Thyroid Artery Perfusion Territory","volume":"108","author":"Salmeron","year":"1998","journal-title":"Laryngoscope"},{"key":"ref_34","unstructured":"EBSCOhost (2024, November 11). The Morphology and Topography of the Superior Laryngeal Artery. Available online: https:\/\/web-1p-1ebscohost-1com-15kyuz1800070.han.bg.umw.edu.pl\/ehost\/pdfviewer\/pdfviewer?vid=110&sid=1fe85999-6f48-42f0-bfa7-62e9b243b014%40redis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/0007-1226(85)90051-7","article-title":"The cutaneous blood supply of the neck: Relevance to incision planning and surgical reconstruction","volume":"38","author":"Rabson","year":"1985","journal-title":"Br. J. Plast. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1002\/ca.21207","article-title":"Variant origin of the superior thyroid artery in a Kenyan population","volume":"25","author":"Ongeti","year":"2011","journal-title":"Clin. Anat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1007\/s00586-013-2713-9","article-title":"Topographical anatomy of the anterior cervical approach for c2-3 level","volume":"22","author":"Park","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1007\/s12070-020-01949-z","article-title":"Relation of Superior Laryngeal Nerve and Superior Thyroid Artery with Superior Pole of Thyroid During Thyroid Surgery","volume":"74","author":"Ahmad","year":"2020","journal-title":"Indian J. Otolaryngol. Head. Neck Surg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Burger, F., Fritsch, H., Zwierzina, M., Prommegger, R., and Konschake, M. (2019). Postoperative Hypoparathyroidism in Thyroid Surgery: Anatomic-Surgical Mapping of the Parathyroids and Implications for Thyroid Surgery. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-52189-3"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.4103\/ajns.AJNS_162_19","article-title":"Do Asians have Higher Carotid Bifurcation? A Computed Tomographic Angiogram Study of the Common Carotid Artery Bifurcation and External Carotid Artery Branching Patterns","volume":"14","author":"Jitpun","year":"2019","journal-title":"Asian J. Neurosurg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"9214104","DOI":"10.1155\/2021\/9214104","article-title":"Quantitative Prediction of the Location of Carotid Bifurcation and Neurovascular Structures in the Carotid Region: A Cross-Sectional Cadaveric Study","volume":"2021","author":"Griepp","year":"2021","journal-title":"Comput. Math. Methods Med."},{"key":"ref_42","first-page":"28","article-title":"Relation of the external laryngeal nerve to superior thyroid artery in an African population","volume":"1","author":"Magoma","year":"2012","journal-title":"Anat. J. Afr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/00005537-200202000-00033","article-title":"Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery","volume":"112","author":"Monfared","year":"2002","journal-title":"Laryngoscope"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s00276-020-02507-6","article-title":"Origin variations of the superior thyroid, lingual, and facial arteries: A computed tomography angiography study","volume":"42","year":"2020","journal-title":"Surg. Radiol. Anat."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1002\/hed.25186","article-title":"External laryngeal nerve landmarks revisited","volume":"40","author":"Ortega","year":"2018","journal-title":"Head. Neck"},{"key":"ref_46","first-page":"e35624","article-title":"Morphometric Study and Branching Patterns of External Carotid Artery Using Computed Tomography Angiography Among the South Indian Population: A Retrospective Study","volume":"15","author":"Sasikumar","year":"2023","journal-title":"Cureus"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1590\/1677-5449.004218","article-title":"Origin of superior thyroid artery: Under the surgeon\u2019s knife","volume":"17","author":"Sreedharan","year":"2018","journal-title":"J. Vasc. Bras."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1080\/2000656X.2017.1281820","article-title":"An anatomical study on the availability of contralateral recipient vessels in hemi-mandibular reconstruction with vascularised free fibula transfer","volume":"51","author":"Kasai","year":"2017","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/scs.0b013e3181572524","article-title":"Determination of the recipient vessels in the head and neck using multislice spiral computed tomography angiography before free flap surgery: A preliminary study","volume":"18","author":"Tan","year":"2007","journal-title":"J. Craniofacial Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"269","DOI":"10.7181\/acfs.2020.00339","article-title":"Recipient vessel selection for head and neck reconstruction: A 30-year experience in a single institution","volume":"21","author":"Chung","year":"2020","journal-title":"Arch. Craniofacial Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1002\/micr.30752","article-title":"Recipient vessel selection for multiple free flap transfers in head and neck reconstruction at different periods","volume":"41","author":"Lai","year":"2021","journal-title":"Microsurgery"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"047","DOI":"10.1055\/s-0030-1267829","article-title":"An algorithm for recipient vessel selection in microsurgical head and neck reconstruction","volume":"27","author":"Chia","year":"2010","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1016\/j.joms.2015.07.027","article-title":"The Sternocleidomastoid Flap for Oral Cavity Reconstruction: Extended Indications and Technical Modifications","volume":"73","author":"Chen","year":"2015","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/PRS.0b013e3182402eb2","article-title":"The superior thyroid artery perforator flap: Anatomical study and clinical series","volume":"129","author":"Wilson","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.","DOI":"10.1136\/bmj.n71"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6250\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:39:49Z","timestamp":1760035189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":55,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176250"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176250","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}