Spontaneous external carotid artery occlusion

The case of a 64-year-old man who presented with severe left sided facial pain and cyanosis of the left ear, preauricular region and tongue is described. Digital subtraction angiography confirmed complete occlusion of the left external carotid artery. The patient was anticoagulated and his symptoms resolved over the following month, presumably due to improvement of collateral blood supply to the ischaemic areas. The literature on the clinical manifestations of external carotid ischaemia is reviewed and the relationship between facial pain, internal and external carotid atherosclerosis is emphasised.