Aberrations of the Cervical Carotid Artery Which May Be Dangerous in Pharyngeal Surgery—A Computed Tomographic Study

DOI: 10.4236/act.2013.21006   PDF   HTML     4,225 Downloads   7,476 Views   Citations


Background: There are recognised variations in the anatomical course of the cervical portion of the internal carotid artery. An aberrant vessel with direct contact to the pharyngeal wall could easily be injured during pharyngeal surgery or may appear as a pharyngeal pseudo mass. Previous anatomical studies predominantly involved older patients. The prevalence of such variations which are at risk of injury during pharyngeal surgery has thus not been established in a general patient population. Material and Methods: The course of the internal carotid artery in relation to the oro and hypopharyngeal walls was retrospectively evaluated bilaterally by simple visual inspection and measurement of the smallest distance between the respective vessels and the adjacent mucosal surface of the pharyngeal wall in 138 consecutive contrast-enhanced computed tomography scans of the neck. Results: 11/138 (7.9%) of patients demonstrated relevant cervical carotid artery aberrations, comprising medial kinking of a vessel with asymmetry of the adjacent pharyngeal lumen and/or an intimate submucous course in the pharyngeal wall with no identifiable separating fat plane. This prevalence increased with age. Simple visual inspection correlated well with the measurement of the smallest distance between an artery and the pharyngeal wall, which was statistically significant (p < 0.0001). Conclusions: The prevalence of about 8% in a general patient population is higher than previously recorded in anatomical studies. Prevalence increases with age. Otorhinolaryngologists should be aware of such variation as a risk factor for haemorrhagic complications during pharyngeal surgery and as a differential diagnosis of pharyngeal mass lesions, especially in older patients. Modern contrast-enhanced CT allows identification and characterisation of any surgically relevant variant vascular anatomy in the pre-operative work-up.

Share and Cite:

Gossner, J., Manka, R. and Larsen, J. (2013) Aberrations of the Cervical Carotid Artery Which May Be Dangerous in Pharyngeal Surgery—A Computed Tomographic Study. Advances in Computed Tomography, 2, 29-33. doi: 10.4236/act.2013.21006.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] N. A. Ovchinnikov, R. T. Rao and R. R. Rao, “Unilateral Congenital Elongation of the Cervical Part of the Internal Carotid Artery with Kinking and Looping: Two Case Reports and Review of the Literature,” Head & Face Medicine, Vol. 3, 2007, p. 26. http://www.head-face-med.com/content/3/1/29
[2] B. Galletti, S. Bucolo, G. Abbate, et al., “Internal Carotid Transposition as Risk Factor in Pharyngeal Surgery,” Laryngoscope, Vol. 112, No. 10, 2002, pp. 1845-1848. doi:10.1097/00005537-200210000-00026
[3] M. Jackel, “Variations in the Clinical Course of the Internal Carotid Artery—A Differential Diagnosis of Parapharyngeal Masses,” HNO, Vol. 45, No. 12, 2007, pp. 1018-1021.
[4] J. N. Lin, T. C. Tsai, C. H. Lin and F. C. Hsieh, “A Dangerous Variant Causing Retropharyngeal Space Enlargement, Retropharyngeal Internal Carotid Artery: A Case Report,” Chinese Journal of Radiology, Vol. 32, No. 1, 2007, pp. 27-30.
[5] F. Calzolari and A. Salett, “Retropharyngeal Internal Carotid Artery. Diagnosis by CT Angiography in 5 Cases,” Radiologia Medica, Vol. 95, No. 4, 1998, pp. 383-385.
[6] J. Vega, C. Gervas, G. Vega-Hazas, et al., “Internal Carotid Artery Transposition: Another Cause of Widening of the Retropharyngeal Space,” European Radiology, Vol. 9, No. 2, 1999, pp. 347-348. doi:10.1007/s003300050678
[7] E. Aydin, G. Akkuzu, B. Akkuzu and L. N. Ozlüoglu, “Tortuous Internal Carotid Artery Indenting the Piriform Sinus: A Case Report,” European Archives of Oto-Rhino-Laryngology, Vol. 262, No. 5, 2005, pp. 351-352.
[8] B. Tillmann, C. Christofides, “The ‘Dangerous Loop’ of the Internal Carotid Artery. An Anatomic Study,” HNO, Vol. 43, No. 10, 1995, pp. 601-604.
[9] G. E. Poulias, B. Skoutas, N. Doundoulakis, et al., “Kinking and Coiling of Internal Carotid Artery with and without Associated Stenosis. Surgical Considerations and Long-Term Follow-Up,” Panminerva Medica, Vol. 38, No. 1, 1996, pp. 22-27.
[10] P. Pancera, M. Ribul, B. Presciutti and A. Lechi, “Prevalence of Carotid Artery Kinking in 590 Consecutive Subjects Evaluated by Echocolordoppler. Is There a Correlation with Arterial Hypertension?” Journal of Internal Medicine, Vol. 248, No. 1, 2000, pp. 7-12. doi:10.1046/j.1365-2796.2000.00611.x
[11] R. C. Lam, S. C. Lin, B. DeRubertis, et al., “The Impact of Increasing Age on Anatomic Factors Affecting Carotid Angioplasty and Stenting,” Journal of Vascular Surgery, Vol. 45, No. 5, 2007, pp. 875-880. doi:10.1016/j.jvs.2006.12.059
[12] F. Paulsen, B. Tillmann, C. Christofides, et al., “Curving and Looping of the Internal Carotid Artery in Relation to the Pharynx: Frequency, Embryology and Clinical Implications,” Journal of Anatomy, Vol. 197, No. 3, 2000, pp. 373-381. doi:10.1046/j.1469-7580.2000.19730373.x
[13] Z. Ozgur, S. Celik, F. Govsa, et al., “A Study of the Internal Carotid Artery in the Parapharyngeal Space and Its Clinical Importance,” European Archives of Oto-Rhino-Laryngology, Vol. 264, No. 12, 2007, pp. 1483-1489. doi:10.1007/s00405-007-0398-6
[14] W. Steinmann, “Makroskopische Praperationsmethoden in der Medizin,” Thieme Publishers, Stuttgart, 1982.
[15] B. C. Jun, E. J. Jeon, D. H. Kim, et al., “Risk Factors of Decreased Distance between Internal Carotid Artery and Pharyngeal Wall,” Auris Nasus Larynx, Vol. 39, No. 6, 2012, pp. 615-619. doi:10.1016/j.anl.2011.10.018
[16] G. La Barbera, G. La Marca, A. Martino, et al., “Kinking, Coiling, and Tortuosity of Extracranial Internal Carotid Artery: Is It the Effect of Metaplasia?” Surgical and Radiologic Anatomy, Vol. 28, No. 6, 2006, pp. 573-580. doi:10.1007/s00276-006-0149-1
[17] I. Steinberg, “The Arteriosclerotic Aorta: Clinical and Roentgen Observations,” Angiology, Vol. 7, No. 5, 1956, pp. 405-418.
[18] P. J. W. Wensing, F. G. Scholten, P. C. Buijs, et al., “Arterial Tortuosity in the Femoropoliteal Region during Flexion: An MRA Study,” Journal of Anatomy, Vol. 187, No. 1, 1995, pp. 133-139.
[19] P. Franceschini, A. Guala, D. Licata, et al., “Arterial Tortuosity Syndrome,” American Journal of Medical Genetics, Vol. 91, No. 2, 2000, pp. 141-143. doi:10.1002/(SICI)1096-8628(20000313)91:2<141::AID-AJMG13>3.0.CO;2-6
[20] J. F. Platt and G. M. Glazer, “IV Contrast Material for Abdominal CT: Comparison of Three Methods of Administration,” American Journal of Roentgenology, Vol. 51, No. 2, 1998, pp. 275-277.
[21] L. Pellegrino, G. Prencipe and F. Vairo, “Dolicho-Arteropathies (Kinking, Coiling, Tortuosity) of the Carotid Arteries: Study by Color Doppler Ultrasonography,” Minerva Cardioangiology, Vol. 46, No. 1-2, 1998, pp. 69-76.
[22] R. Corti, M. Alerci, R. Wyttenbach, et al., “Usefulness of Multiplanar Reconstructions in Evaluation of Carotid CT Angiography,” Radiology, Vol. 226, No. 1, 2003, pp. 290-291. doi:10.1148/radiol.2261020548

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.