Verlaufsvarianten der Arteria carotis interna als wichtige Differenzialdiagnose von Raumforderungen im Pharynxbereich

Abstract

A case of a 78-year-old man with globus syndrome is reported who was referred to our department because of a tumor of the right parapharyngeal wall. Radiological and endoscopic examination revealed that the tumor was caused by an extracranial kinking of the right internal carotid artery. Variations of the anatomical position of the internal carotid artery in the parapharyngeal space are potentially at risk during routine ENT-procedures such as adenoidectomy and tonsillectomy or during endoscopic procedures with diagnostic biopsies. Data about the frequency of variations of the clinical course of the internal carotid artery dorsolateral of the lateral pharyngeal wall vary in literature from 4% to 66%. By cost-effective ultrasound and duplex-ultrasound, computed-tomography, magnetic resonance imaging with angiography or by conventional angiography a wide variety of different diagnostic imaging methods is available. While coiling of the internal carotid artery is ascribed to embryological malformation, elongation and kinking of the artery are due to atherosclerosis or fibromuscular dysplasia. These variations are often asymptomatic but they can also cause symptoms from globus syndrome to cerebrovascular insufficiency producing ischemic attacks or infarction. This case report emphasizes the clinical importance of variations of the clinical course of the internal carotid artery as a differential diagnosis of parapharyngeal tumors since iatrogenic injuries during routine pharyngeal surgery with disastrous outcome were frequently reported in literature. Unexperienced ENT-surgeons should be warned and experienced ENT-surgeons should be reminded of those dangerous variations.