Evaluation of Internal Carotid Artery Malposition with Multi-Slice Computer Tomography: Complication Analysis of Pharyngeal Surgery

Abstract

INTRODUCTION: Internal carotid artery bruising can lead to terrible results during basic pharyngeal surgical procedure. It is aimed to evaluate disposition of cervical internal carotid artery (ICA) to medially and evaluate possible risk factors in the terms of pharyngeal surgical treatments. İt is also aimed to discuss findings with other literatures. METHODS: In this study, tri-dimensional (3D) computer tomography (CT) images of 28 patient whom internal carotid artery indented to pharyngeal wall diagnosed with multi-slice CT was investigated. All patients were older than 15. The study was planned on aberrant medialized cervical internal carotid artery which detected multi-slice CT incidentally in last 12 months. The course of abnormality and distance of carotid artery between pharyngeal wall was evaluated with 3D CT. The cases was divided to 3 groups according to possible surgical complication risk related to distance between aberrant ICA and pharyngeal wall. These groups are classified as: Low risk ( ≥10 mm); moderate risk (5-10mm); high risk ( 2-5 mm); very high risk (< 2mm). Pharyngeal segment was found where the nearest distance between artery and pharyngeal wall was detected. RESULTS: : There were 20 women and 8 men totally 28 patients, ages are between 15-81. There were 23 cases with medialized ICA bilaterally and 5 cases with single-sided ( 2 left, 3 right ICA). According to Weibel and Fields classification 10 cases were in low risk (grade 1), 12 cases were in moderate risk (grade 2), 16 cases were in high risk (grade 3), 13 cases were in very high risk ( grade 4). Distance to pharyngeal wall was measured 0.1 mm as minimum,15 mm as maximum and 5.1 mm as avarage. DISCUSSION AND CONCLUSION: Routine interventional and surgical treatments were made without any preoperative radiological imaging usually. To evaluate the course of ICA before the treatment is very important because of damaging artery during surgery and it is thought that 3D CT is the most effective imaging method for the detect ICA abnormalities.

Keywords

• internal carotid artery
• course anomaly
• multidetector computed tomography