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The carotid sheath is an important landmark in head and neck anatomy and contains several vital neurovascular structures, including the carotid artery, jugular vein, vagus nerve, and sympathetic plexus (see Image. Carotid Sheath). It extends upwards from the arch of the aorta and terminates at the skull base.  While the carotid sheath is rarely the primary disease source, understanding its anatomy is essential for clinicians to address problems that may affect the crucial neurovascular structures that travel through it. See Image. Anatomy of the Carotid Sheath.