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Risk of internal carotid injury due to peritonsillar abscess drainage
Hamdi Tasli1, Alptug Ozen2, Mehmet Ege Akca1
1University Of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya 43000, Turkey.
Insights
Peritonsillar abscess (PTA) drainage carries a risk of internal carotid artery (ICA) injury. This study measured distances and angles between PTA and ICA, revealing mild to moderate risks, emphasizing surgical caution.
Area of Science:
- Otolaryngology
- Radiology
- Surgical Anatomy
Background:
- Peritonsillar abscess (PTA) is a common ENT emergency.
- Internal carotid artery (ICA) injury is a severe complication of PTA treatment.
Purpose of the Study:
- To determine the anatomical relationship between PTA and ICA.
- To assess the risk of ICA injury during PTA management.
- To guide surgical approaches for preventing complications.
Main Methods:
- 34 adult patients with PTA underwent neck CT scans.
- Radiologists measured distances (DIP, DIT) and angles (AIP) between PTA and ICA.
- Patients were classified by risk of ICA injury.
Main Results:
- Mean distance between PTA and ICA (DIP) was 13.39 mm; between contralateral tonsil and ICA (DIT) was 9.61 mm (p<0.05).
- Mean distance from PTA anterior border to ICA was 36.18 mm.
- Mean angle (AIP) was 33.40°.
- 82.4% of patients were low risk, 17.6% were moderate risk for ICA injury.
Conclusions:
- The risk of ICA injury in PTA patients is mild to moderate based on anatomical measurements.
- Surgeons must carefully consider incision depth and angle during abscess drainage to minimize ICA injury risk.
Objective:
Peritonsillar abscess (PTA) is one of the most commonly seen ear nose and throat (ENT) emergencies. The most catastrophic complication that may occur due to surgical treatment of PTA is injury of internal carotid artery. The aim of this study is to determine distance and angle between PTA with ICA; and to prevent possible complications.
Methods:
A total of 34 adult patients with PTA were enrolled in this study. Neck computed tomographies of the patients with PTA were evaluated by a radiologist. The distance between PTA and ICA (DIP), and contralateral tonsil side and ICA (DIT) were measured and compared with each other. Also angle between PTA and ICA (AIP) was examined.
Results:
This study contained 20 (58.8%) males and 14 (41.2%) females with a mean age of 32.20 ± 12.75 years (range 18-60 years). Mean DIP and DIT scores were 13.39 ± 3.7 mm (min: 5.32, max: 19.07) and 9.61 ± 3.17 mm (min: 4.95, max: 16.35) respectively, and the difference was statistically significant (p<0.05). Mean distance between anterior border of PTA and ICA was 36.18 ± 6.42 mm (min: 17.12 max: 47.43). The AIP was 33.40 ± 2.29° (min: 30.10° and max: 40.71°). According to risk classification system, the 28 (82.4%) patients constituted low risk, and 6 (%17.6) patients constituted moderate risk.
Conclusion:
According to the distance between the PTA and ICA, the risk of ICA injury was found to be mild and moderate in PTA patients. It is crucial for the surgeon to pay attention to the depth and angle of the incision during drainage of the abscess.
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