gms | German Medical Science

According to the international medical literature, variations from the straight course of the internal carotid artery can be found with an incidence of 15 to 40 % and in the majority of the cases symmetrically bilateral. We present here exemplarily the case of an aberrant internal carotid artery adjacent to the tonsillar fossa, which became apparent during tonsillectomy in a two year old infant.

A two year old infant was referred to our department for the evaluation of recurrent upper airway infections and the tentative diagnosis of obstructive sleep apnoea. Within the otorhinolaryngologic examination we could find hyperplastic tonsils and adenoid vegetations as well as a flat tympanogram on either side. Sleep laboratory analysis was carried out and confirmed the incidence of nocturnal phases of apnoea with oxygen desaturation. Hereupon decision was made to perform adenotomy as well as tonsillectomy and paracentesis on either side. Intraoperatively a funicular, pulsatile space occupying mass could be detected below the left tonsil, that was attributed to an aberrant internal carotid artery. Tonsillectomy on the left was therefore carried out microscopically without any complications. The postoperative course was uneventful.

According to literature data, anomalies of the course of the internal carotid artery are considerably more frequent than commonly expected and may exist as elongation, kinking or coiling. Depending on the type of variation, a congenital anomaly or an age-related loss of elasticity in the vessel wall is considered to be causative. As a result of its abnormal displacement an aberrant ICA may be at risk of injury during pharyngeal surgery but can also be of importance as a differential diagnosis of parapharyngeal masses. Thus, the knowledge of possible variations from the straight course of the ICA is of major interest for the otorhinolaryngologist in everyday clinical life.