Aberrant internal carotid artery in the oropharynx space poses a life-threatening risk of surgery

Abstract

Background: Tortuosity of the internal carotid artery (ICA) is not a rare condition, but its clinical impact is underestimated. The differences in the course and shape of the ICA in the oropharynx just beneath the mucosa were investigated to determine the possible fatal bleeding for both major oropharyngeal tumor resection and less extensive procedures. We report two cases to reveal that the awareness of such an anatomical variation before performing oropharyngeal procedures.

Methods and results: We report two different pathologies of retropharyngeal ICAs, which presented with otolaryngological symptoms. Case 1 Retropharyngeal right ICA. The vessel's minimum distance to the pharyngeal wall was 1 mm (very high risk of vascular injury) with a tortuous pathway. Case 2 Retropharyngeal right ICA. A tortuous ICA was in contact with the posterior pharyngeal wall (very high risk of vascular injury).

Conclusion: The otolaryngologists surgeons must use caution in evaluating patients with masses in the pharynx and augment a careful and complete head and neck examination with appropriate imaging studies before operating.

Keywords: Aberrant; Internal carotid artery; Oropharynx.