Internal carotid artery transposition as risk factor in pharyngeal surgery

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.