Tri-ramification of left external carotid artery associated with anatomical variation of its branches and aneurysm formation.

Essential sources of arterial vascularisation in the head and neck region are the left and right common carotid arteries (CCA) and their branches. The left CCA (LCCA) originates from the arch of the aorta and the right CCA originates from the brachiocephalic trunk. In this case report, there was a bilateral higher division of CCA at the plane of the greater cornua of the hyoid bone, unilateral tri-ramification of the LCCA and the left external carotid artery (LECA), and the origin of the linguo-facial trunk and the pharyngo-occipital trunk from the LECA. An aneurysm formed in the distal part of LECA before its termination. In this case, we propose a novel categorization called the punnapatla classification for the anatomical variance branching forms of ECA. These kinds of variations are important to the surgeons, and anaesthetists, during the surgeries of the head and neck.