Internal Carotid Artery Transposition as Risk Factor in Pharyngeal Surgery

Abstract

Some of the anomalies of the internal carotid artery can determine a bulge of the posterior pharyngeal wall. Because of the submucous position of the carotid artery at this level, such anomalies can constitute a risk factor for serious hemorrhage in routine surgical procedures that have become outpatient procedures and are often performed by inexperienced surgeons. The three-dimensional time-of-flight magnetic resonance angiogram together with Doppler ultrasonography were shown to be the most accurate imaging techniques to evaluate these anomalies.

BILATERAL TORTUOUS INTERNAL CAROTID ARTERIES – a case report, otorhinolaryngologic and general clinical implications

“…Obstructive sleep apnoea has also been noted [44,45]. In the physical examination of the oral cavity and oropharynx, a protruding and pulsating retropharyngeal mass can be noticed as a result of an intimate contact of the tortuous arteries with the pharyngeal mucosa [10,18,28,46,47]. When the carotid arteries are deviated laterally, the pulsation within the neck region might be observed [46].…”

“…Not only the level of ICAs tortuosity is compelling, but also their relation to the posterior pharyngeal wall [1,6,23,47]. Direct proximity to the tunica mucosa may be visible in the physical examination as a pulsing widening of the retropharyngeal soft tissue [6], that poses a risk of laceration of the arteries during diagnostic or surgical procedures within the upper airways.…”

“…The pseudoaneurysm formation succeeding tonsillectomy has been also noted [13]. However, the cases of post-operative, sometimes life-threatening bleeding due to tortuosity of the extracranial neck arteries, though uncommon, are reported in the literature as well, more often in relation to tonsillectomy [1,21,23,47,52]. When an atypical course of ICAs is recognised prior the planned tonsillectomy, the operation might be postponed [43].…”

“…When an atypical course of ICAs is recognised prior the planned tonsillectomy, the operation might be postponed [43]. Most of these surgical interventions are performed by young, less experienced doctors which increases a risk of potential intra-operative injury [47]. Owing to the fact that the diagnostic imaging is not typically provided before tonsils and adenoids removal, the accurate and conscientious initiatory oropharyngeal examination, including assessment of the peritonsillar region, is essential [21,43,47].…”

Clinical implications of internal carotid artery tortuosity, kinking and coiling: a systematic review

“…(20,37) The ICA anomalies may be dangerous and represent a risk factor for massive bleeding. (3,43) Suture ligatures can penetrate and occlude torn vessels, scalpels or biting instruments can lacerate vessels, and indirectly conducted electric cauterization can burn the soft of bony tissues. (44) Angioplasty in carotid disease At present there are no studies addressing the kinking treatment by angioplasty with stent, the available information comes from studies performed on carotid angioplasty in atherosclerotic stenotic carotid disease.…”