Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT.
ABSTRACT The goal of our study was to measure the prevalence of anomalies in the extracranial segment of internal carotid artery (ICA), to measure the carotid-pharyngeal distance (CPD).
Computed tomography (CT) angiography images of 607 patients were retrospectively examined. The course anomaly and CPD were obtained at different image plane. The patients were divided into four groups according to their age.
The incidence of course anomaly in ICA was shown to be 60.3 %. Prevalence of course anomaly showed an increase with age (p < 0.001). Women had more ICAs with a course anomaly than men (p < 0.001). Mean CPD among all ICAs was found to be 11.13 mm. When CPD values were compared between the groups, group 1 and group 2 did not have a significant difference, however, there was a significant difference between other groups (p < 0.05). The CPD significantly decreased with age (p < 0.001). In ICAs that showed a straight course, the mean CPD was 13.0 mm, while in ICAs that showed course anomaly, the mean CPD was determined to be 9.49, showing a significant difference (p < 0.05).
In conclusion, the number of ICAs that show a course anomaly increases with age, while the CPD decreases. The CPD is decreased in groups that show anomalies. The detection of a decreased CPD before surgery may lower the chance of a perioperative hemorrhage due to artery damage during pharyngeal procedures. Hence, while reporting neck CT angiographies, it may be valuable to also report the presence of ICA anomalies and CPD.
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ABSTRACT: Variations of the course of the internal carotid artery in the parapharyngeal space and their frequency were studied in order to determine possible risks for acute haemorrhage during pharyngeal surgery and traumatic events, as well as their possible relevance to cerebrovascular disease. The course of the internal carotid artery showed no curvature in 191 cases, but in 74 cases it had a medial, lateral or ventrocaudal curve, and 17 preparations showed kinking (12) or coiling (5) out of a total of 265 dissected carotid sheaths and 17 corrosion vascular casts. In 6 cases of kinking and 2 of coiling, the internal carotid artery was located in direct contact with the tonsillar fossa. No significant sex differences were found. Variations of the internal carotid artery leading to direct contact with the pharyngeal wall are likely to be of great clinical relevance in view of the large number of routine procedures performed. Whereas coiling is ascribed to embryological causes, curving is related to ageing and kinking is thought to be exacerbated by arteriosclerosis or fibromuscular dysplasia with advancing age and may therefore be of significance in relation to the occurrence of cerebrovascular symptoms.Journal of Anatomy 11/2000; 197 Pt 3:373-81. · 2.23 Impact Factor
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ABSTRACT: Injuries to the internal carotid artery during simple pharyngeal surgical procedures can be catastrophic for the risk of massive bleeding. The aims of the study were 1) to report five cases of congenital and asymptomatic anomalies of the internal carotid artery with a review of the literature, 2) to assess the relationships between these anomalies and the possible risk in "routine" pharyngeal surgery, and 3) to determine the most accurate imaging techniques to evaluate these anomalies. Retrospective study of five patients with congenital anomalies of the internal carotid artery bulging the pharyngeal wall. METHODS Clinical records, pathology reports, and original imaging features of these kind of vascular lesions (computed tomography scans, three-dimensional time-of-flight magnetic resonance angiogram, and Doppler ultrasonography) were reviewed for each patient; vascular lesions were related to possible risk factors for pharyngeal surgery; and a review of the literature was made. All the patients were admitted for other diseases. The five anomalies, except one, were bulging the posterior pharyngeal wall and were asymptomatic. The peculiar literature referred 14 previous descriptions of similar anomalies. 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.The Laryngoscope 11/2002; 112(10):1845-8. · 2.03 Impact Factor
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ABSTRACT: The differences in the course and shape of the internal carotid artery (ICA) in the parapharyngeal space were investigated to determine the possible risks for serious hemorrhage during tonsillectomy, drainage of peritonsillar abscess, soft palate injuries, adenoidectomy and velopharyngeoplasty. The course of the ICA was studied in the parapharyngeal spaces of 50 adult cadavers. From each specimen, circumferential sections were obtained and they stained with hematoxylin-eosin and Verhoeff's elastic staining. The cervical course of the ICA showed no curvature in 70 cases; but in 25 cases it had a medial curve, and five cases showed kinking out of a total 100 dissected carotid sheaths. In two cases, kinking of the ICA was related to the pharyngeal wall. The histological examination of all kinking specimens demonstrated depletion and decreasing muscle tissue in tunica media and an increase was observed in vasa vasorum numbers in the tunica adventitia of ICA. The dissections and integrity losses were seen in tunica media and tunica adventitia. The vessel wall of histological structure change were detected in kinking specimens and lays the groundwork for the vessel wall to get easily harmed or torn either directly or indirectly by decreasing the elasticity and soundness of the wall. The transposition of the ICA artery in submucous position becomes important for otorhinolaryngologists when its aberrant course causes a widening in the retropharyngeal or parapharyngeal tissues and an impression on the pharyngeal wall. Curving and kinking of the ICA can constitute a risk factor for acute hemorrhage in routine surgical procedures, which are performed by inexperienced surgeons.Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 01/2008; 264(12):1483-9. · 1.61 Impact Factor