Bilateral retropharyngeal internal carotid artery: A rare and potentially fatal anatomic variation

Common carotid artery medialization and fracture dislocation of the cervical spine

PURPOSE

To describe the management of the discovery of a retropharyngeal carotid artery in the context of a cervical dislocation.

DESCRIPTION OF THE CASE

A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast-enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular variation and an anterior C5-C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis.

DISCUSSION/CONCLUSION

Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.

Aberrant internal carotid artery in the oropharynx space poses a life-threatening risk of surgery

BACKGROUND

Tortuosity of the internal carotid artery (ICA) is not a rare condition, but its clinical impact is underestimated. The differences in the course and shape of the ICA in the oropharynx just beneath the mucosa were investigated to determine the possible fatal bleeding for both major oropharyngeal tumor resection and less extensive procedures. We report two cases to reveal that the awareness of such an anatomical variation before performing oropharyngeal procedures.

METHODS AND RESULTS

We report two different pathologies of retropharyngeal ICAs, which presented with otolaryngological symptoms. Case 1 Retropharyngeal right ICA. The vessel's minimum distance to the pharyngeal wall was 1 mm (very high risk of vascular injury) with a tortuous pathway. Case 2 Retropharyngeal right ICA. A tortuous ICA was in contact with the posterior pharyngeal wall (very high risk of vascular injury).

CONCLUSION

The otolaryngologists surgeons must use caution in evaluating patients with masses in the pharynx and augment a careful and complete head and neck examination with appropriate imaging studies before operating.

Retropharyngeal internal carotid artery: a review of three cases

INTRODUCTION

The internal carotid artery (ICA) can take multiple pathways as it extends from the carotid bifurcation to the skull base. An aberration of its normal pathway may place the ICA in a retropharyngeal position in close proximity to the posterior pharyngeal wall. Radiographic classification is based on its proximity to the pharynx and/or pathway. We present a series of three cases of retropharyngeal ICAs, our goal is to report and classify these variations.

CASE PRESENTATION

CASE 1: Retropharyngeal right ICA. Minimum distance to the pharyngeal wall was ~ 4.9 mm (high risk of vascular injury) with a tortuous pathway. CASE 2: Bilateral retropharyngeal ICA. ICAs were in contact with the posterior pharyngeal wall (very high risk of vascular injury). The left has a kinking pathway, the right tortuous. CASE 3: Bilateral retropharyngeal ICA. Minimum distances of the right and left ICAs to the posterior pharyngeal wall were ~ 3.5 mm and ~ 3.3 mm, respectively (high risk of vascular injury). The right has a kinking pathway, the left tortuous.

DISCUSSION

Closeness of the vessel to the retropharyngeal wall increases the risk of surgical and non-surgical complications. Noteworthy is that the position of the artery is not constant and can change in position over periods of time.

CONCLUSION

Knowledge of the anatomy and variations of the ICA is important for oral and maxillofacial radiologists and surgeons to enable clinicians to take necessary precautions to decrease complications if performing any procedure in the region.

Tubercular Retropharyngeal Abscess in Association with Aberrant Retropharyngeal Internal Carotid Arteries - A Rare Entity: Imaging Diagnosis and a Word of Caution

Retropharyngeal (RP) abscess is rarely encountered in adults. Still rare is an abscess of tubercular etiology especially without involvement of the underlying cervical spine. We present a case of an immunocompetent woman with a tubercular RP abscess diagnosed on contrast-enhanced cervical computed tomography and confirmed on cytology. Another interesting feature was an aberrant RP course of the internal carotid arteries in this patient. This case report stresses the importance of imaging in establishing an unexpected diagnosis of an RP abscess, suggesting its likely cause, and also in demonstrating the aberration in regional vascular anatomy, and warns the clinician of life-threatening hemorrhagic complication in the event of any diagnostic or therapeutic intervention.