The Assessment of the Location of Carotid Bifurcation

We experienced suicidal hanging cases without a ligature in front of neck and a manual strangulation without facial congestion. In the last case Carotid bifurcation (CB) located between C2-3 and at the upper of muscular bleeding. Carotid sinus stimulation is thought as a cause of syncope. Carotid sinus reflex is attributed to the stimulation, but somebody did not respond to the procedure. We showed the anatomical variation of CB location. Measurements were performed on 100 cadavers by the direct inspection method. CB level was compared to the level of cervical vertebra. Most frequency of CB was found at the level of C3. CB was variously distributed from the intermediate position of C1-2 to lower border of C5 on the vertebral column in Japanese population. The distribution pattern may be different from other population. 54% of the level of CB was asymmetrical between the right and left side. Our findings support the presumption that suicidal hanging and manual strangulation death due to carotid bifurcation stimulation cannot provoke death alone.