A Case Report of Kissing Carotid Arteries in the Retropharynx

Document Type : Case Report

Authors

1 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Islamic Science University of Malaysia

2 Department of Otorhinolaryngology, Hospital Kuala Lumpur, Ministry of Health, Malaysia.

3 Otorhinolaryngology Head and Neck Surgery, Surgical-based Department, Faculty of Medicine and Health Sciences, University Sains Islam Malaysia, Negeri Sembilan, Malaysia.

Abstract

Introduction:
An aberrant carotid artery has distinct terms and may exhibit a submucosal mass in the posterior pharyngeal wall.  While it is primarily asymptomatic, an extreme aberrancy doubles the risk of dissection, a cerebrovascular accident (CVA) and an injury intraoperatively.
Case Report:
We report a case of ‘kissing carotid artery’ in a 65-year-old lady who presented with a foreign body sensation felt in the throat for one week.  A finding of flexible nasopharyngolaryngoscopy (FNPLS) showed a bilateral paramedian retropharyngeal pulsating mass.  Radiological examinations, including Computed Tomography (CT) of the neck and an angiogram, revealed an aberrant course of bilateral carotid arteries.  In view of no malignancy and vascular malformations, there was no further intervention done, and the patient was subjected to yearly surveillance.
Conclusion:
Retropharyngeal carotid arteries are clinically significant anatomic variants.  Such anomalies are potentially life-threatening and a risk factor for a severe hemorrhage during the simplest and commonly performed transoral surgeries. Thus, thorough perioperative assessment with accurate imaging techniques and studies are required to evaluate these anomalies and may avoid any disastrous complications.

Keywords

References

  1. Koreckij J, Alvi H, Gibly R, Pang E, Hsu WK. Incidence and risk factors of the retropharyngeal carotid artery on cervical magnetic resonance imaging.  Spine (Phila Pa 1976).  2013 Jan 15;38(2).
  2. Pfeiffer J, Ridder GJ. A clinical classification system for aberrant internal carotid arteries.    2008 Nov 1;118(11):1931–6.
  3. Paulsen F, Tillmann B, Christofides C, Richter W, Koebke J. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 2000 Oct 1;197(3):373–81.
  4. Galletti B, Bucolo S, Abbate G, Calabrese G, Romano G, Quattrocchi C, et al. Internal carotid artery transposition as risk factor in pharyngeal surgery. Laryngoscope. 2002 Oct 1;112(10): 1845–8.
  5. Ozgur Z, Celik S, Govsa F, Aktug H, Ozgur T. A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance. Eur Arch Oto-Rhino-Laryngology. 2007 Dec 19; 264(12): 1483–9.
  6. Fluke MM, Bronfin DR, Superneau DW, Moses MH. Aberrant Retropharyngeal Internal Carotid Artery in a Child with Spondyloepimetaphyseal Dysplasia and Cleft Palate.  Cleft Palate-Craniofacial J. 1996 Jul 15;33(4):337–9.
  7. Rojas R, Palacios E, Hunt J. Anomalous Course of the Cervical Carotid Arteries. Ear, Nose & Throat Journal. 2002;81(6):377-378.
  8. La Barbera G, La Marca G, Martino A, Lo Verde R, Valentino F, Lipari D, et al. Kinking, coiling, and tortuosity of extracranial internal carotid artery: Is it the effect of a metaplasia? Surg Radiol Anat. 2006 Dec 22;28(6):573–80.
  9. Marcucci C, Thomas P, Sewell DA. Retropharyngeal carotid artery: An important anatomic variation for the anesthesiologist.  111, Anesthesiology.  Lippincott Williams and Wilkins; 2009.  p. 454–5.
  10. Zenteno M, Viñuela F, Moscote-Salazar L, Alvis-Miranda H, Zavaleta R, Flores A et al. Clinical implications of internal carotid artery tortuosity, kinking and coiling: a systematic review. Romanian Neurosurgery. 2014;21(1):51-60.
  11. Perdue GD, Barreca JP, Smith RB, King OW. The significance of elongation and angulation of the carotid artery: A negative view.    1975 Jan 1; 77(1):45–52.
  12. Sho E, Nanjo H, Sho M, Kobayashi M, Komatsu M, Kawamura K, et al. Arterial enlargement, tortuosity, and intimal thickening in response to sequential exposure to high and low wall shear stress. J Vasc Surg. 2004 Mar 1;39(3):601–12.
  13. Garg A, Singh Y, Singh P, Goel G, Bhuyan S. Carotid artery dissection following adenoidectomy. Int J Pediatr Otorhinolaryngol.2016 Mar 1;82:98-101.
  14. Jun BC, Jeon EJ, Kim DH, Kim BY, Lee JH, Jin SY, et al. Risk factors for decreased distance between internal carotid artery and pharyngeal wall.  Auris Nasus Larynx.  2012 Dec 1;39(6):615–9.
  15. Eswaran S, Senopher ZN, Saravanam PK. Carotid Anomalies and Their Implication in ENT Surgery. Indian J Otolaryngol Head Neck Surg. 2021 Mar 17;1–4.
  16. Muñoz A, Vergas J De, Crespo J. Imaging and Clinical Findings in Patients with Aberrant Course of the Cervical Internal Carotid Arteries.  Open Neuroimag J. 2013 Jun 21;4:174–81.

 

  1. Avitia S, Hamilton J, Osborne R. Retropharyngeal Carotid Artery.  Ear, Nose & Throat Journal.  2007;86(11):665-665.
  2. Parhar HS, Brody RM, Shimunov D, Rajasekaran K, Rassekh CH, Basu D, et al. Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction.    2021 Mar 1; 131(3): E821–7.
  3. Ballotta E, Thiene G, Baracchini C, Ermani M, Militello C, Da Giau G, et al. Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: A prospective randomized clinical study.  J Vasc Surg. 2005 Nov 1;42(5):838–46.
  4. Lukins DE, Pilati S, Escott EJ.  The moving carotid artery: A retrospective review of the retropharyngeal carotid artery and the incidence of positional changes on serial studies.  Am J Neuroradiol. 2016 Feb 1; 37(2):336–41.
Iranian Journal of Otorhinolaryngology
Volume 34, Issue 3
May and June 2022
Pages 181-185

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