Tonsillectomy and adenoidectomy are among the most common operations performed woldwide. Improvements in anesthesia and surgical techniques over the years have made these operations relatively safe, yet the potential exists for serious complications and even death if the surgeon fails to recognize arterial abnormalities and variations such as the aberrant course of the internal carotid artery. We present a case of an aberrant course of the internal carotid artery which was discovered during adenotonsillectomy in a seven-year-old boy. The significance of the condition and its recognition are discussed. Otolaryngologists should be cognisant of such abnormalities and the serious complications they may cause.
Case ReportA seven-year-old boy with a history of recurrent adenotonsillitis was admitted for adenotonsillectomy under general anesthesia. There was no history of systemic disease, previous surgery or bleeding tendency. Clinical examination was unremarkable except the tonsils which were enlarged. Pre-operative investigations including coagulation profile were within normal limits.The operation was performed under general anesthesia with endotracheal tube. The adenoid was removed by currette, but excessive bleeding was encountered after the operation. Temporary application of nasopharyngeal pack for about 10 minutes was necessary to control the bleeding. During re-examination of the post-nasal space, a pulsating mass was seen extending from the upper pole of the left tonsil to the base of the skull. Tonsillectomy was not performed and the procedure was terminated in order to avoid injury. The patient had an uneventful postoperative course and the relatives were informed about the intraoperative findings. Angiography and magnetic resonance (MR) imaging revealed an aberrant course of the internal carotid artery (Figure 1).
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