Otorrhagia from the “Aberrant Internal Carotid” Artery in the Middle Ear

Abstract

<jats:p> Agenesis of the cervical portion of the internal carotid artery (ICA) may result in blood supply to the ipsilateral cerebral hemisphere being provided by an enlarged inferior tympanic branch of the ascending pharyngeal artery. This enlarged vessel, passing through Jacobson's canal and anastomosing with the likewise enlarged caroticotympanic branch of the ICA in front of the promontorium, may simulate a middle ear mass. </jats:p><jats:p> We present five patients with this unusual anatomical variant, three of which underwent biopsy of what was believed to be a middle ear tumour. </jats:p><jats:p> One patient experienced rupture of an arterial aneurysm in the middle ear successfully treated with endovascular application of detachable platinum coils. </jats:p><jats:p> It is mandatory for ENT-surgeons and radiologists who perform head-and-neck examinations to recognize this anatomical variant, not mistaking it for a tumour, since biopsy of a large artery supplying the brain may have disastrous consequences. </jats:p><jats:p> In patients with otorrhagia, an arterial aneurysm must be considered as a possible source of bleeding, in some cases amenable for treatment with an endovascular technique. </jats:p><jats:p> The diagnosis of “aberrant internal carotid artery” is usually made with CT of the temporal bone or MR of the skull base. Cerebral angiography is in most cases not necessary, unless an endovascular procedure is planned. </jats:p>

Persistent Stapedial Artery

“…According to this theory, the inferior tympanic branch of the ascending pharyngeal artery assumes the role of the ICA and enters the tympanic cavity through Jacobson's canal. It anastomoses with the caroticotympanic artery (the remnant of the hyoid artery) and connects to the ICA proper distal to the segmental agenesis (24). Three of our five cases of PSA were associated with an aberrant ICA, which is much greater than the frequency generally reported.…”

Unusual presentation of internal carotid artery aneurysm in the middle ear

“…2 The treatm m ment for a confirmed aneurysm would be embolizam m tion by filling the aneurysm with detachable platinum coils. 16 The patient should have regular follow up after hemostasis.…”

Unusual presentation of internal carotid artery aneurysm in the middle ear

“… 2 The treatment for a confirmed aneurysm would be embolization by filling the aneurysm with detachable platinum coils. 16 The patient should have regular follow up after hemostasis.…”