Aberrant Carotid Artery: Presentation in the Near Midline Pharynx

Abstract

\s=b\Three cases of an aberrant internal carotid artery presenting at or near the midline in the posterior part of the pharynx occurred. In all three cases, the anomalous finding was not correlated with the presenting symptoms of the patient. In two of the three cases intraoral pulsations were detected during initial examination. In the third case, pulsations were appreciated on reexamination after roentgenographic evaluation. Intraoral photographs, computed tomographic scan, magnetic resonance imaging, and arteriography of these findings are shown. A review of the literature and the embryology of the lateral pharyngeal carotid artery are presented along with the rare finding of the near midline carotid artery and the clinical implications of this anomaly. (Arch Otolaryngol Head Neck Surg 1989;115:519-522) The congenitally tortuous internal carotid artery is an uncommon but important anomaly for the otolaryngologist/head and neck surgeon to recognize. The aberrant carotid artery poses a risk during both major oro¬ pharyngeal tumor resections and less extensive procedures, such as tonsillectomy, adenoidectomy, and palatopharyngoplasty.1Of the general population, 1% to 16%"' have a surgically vulnerable internal carotid artery manifested clinically as detectable lateral pha¬ ryngeal wall pulsations. Dramatic

A Clinical Classification System for Aberrant Internal Carotid Arteries

“…In 1995 Deutsch et al prospectively analyzed MRI studies of 100 children to obtain normative data on the distance between the tonsillar fossa and the ICA: The tonsillocarotid distance in children can be estimated from age and weight parameters and increases in a regular fashion with growth from averaged 14 mm in a 1‐year‐old child to approximately 25 mm in adults 4 . ICA injury during adenotonsillectomy was first described by Pean in the 1780s 3,17 . A series of clinical descriptions of acute hemorrhage and lethal complications after injury of aberrant ICA segments at the pharyngeal wall came from otorhinolaryngologists in the early 20th century 3,5,17 .…”

“…A series of clinical descriptions of acute hemorrhage and lethal complications after injury of aberrant ICA segments at the pharyngeal wall came from otorhinolaryngologists in the early 20th century 3,5,17 . Since then, single descriptions of more or less impressive extracranial ICA aberrations have been reported in the literature at regular intervals 3,5,7,10,17,18 . However, systematic studies of these anomalies came from neurologists and anatomists 4,5,7,15 .…”

“…The etiology of ICA anomalies remains controversial. Potential causative factors include embryological maldevelopment and age‐related loss of elasticity in the vessel wall 3,5,7–9,17 . Particularly high‐grade aberrations have often been attributed to a congenital malformation.…”

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

“…It should be noted that these anomalies do occur in the oropharynx and the nasopharynx [158], a finding that has been described in detail by Stupka [171]. Only few cases have been described [172], [173], [174], and contemporary studies are rare (Figure 1 (Fig. 1)), although Demme’s description dates back to 1901 [175].…”

Aberrant extracranial internal carotid arteries: New insights, implications, and demand for a clinical grading system

“…In recent years, the clinical relevance of ICA anomalies for transoral and open surgery and interventions in the head and neck region has only been highlighted by single reports or series of cases from otorhinolaryngologists that appear at regular intervals in the international medical literature. Aberrations in the course of the ICA may place the vessel into close relationship with the pharyngeal wall where it is at risk of injury during routine pharyngeal procedures, like tonsillectomies, adenoidectomies, and transoral tumor surgery . Iatrogenic ICA damage during surgery or as a secondary complication from vessel erosion in the postoperative course may have fatal consequences or result in neurological sequelae.…”