Bilateral Aberrant Internal Carotid Arteries in Parapharyngeal Walls-Case Report

雙側側咽壁異位性內頸動脈－病例報告

吳伯軒(Po-Hsuan Wu) ； 鄭博文(Po-Wen Cheng)

《台灣耳鼻喉頭頸外科雜誌》 52卷4期 (2017/12) Pp. 197-200

https://doi.org/10.6286/2017.52.4.197

摘要

The presentation of bilateral aberrant internal carotid arteries (ICA) in parapharyngeal space is a rare condition. Such an anatomical variation can place the ICA in close proximity to the pharyngeal wall. We reported a case of a 68 year-old female who came to our Outpatient Department due to long-standing foreign body sensation in the throat. A pulsatile protruding mass, about 1.5 cm in diameter, of the right parapharyngeal wall was noted during oral examination. A flexible endoscopic examination revealed pulsating, smooth-surface masses in bilateral parapharyngeal walls. A contrast-enhanced computed tomography showed bilateral extracranial ICAs kinking. The abnormal ICA courses were responsible for the gross appearance at the parapharyngeal walls. Pronounced extracranial ICA aberrations have a reported incidence of about 5% in the general population. The potential causative factors include embryological maldeveloplement and age-related degenerative changes in the vessel wall. The ICA variation poses a risk during oropharyngeal procedures, such as tonsillectomy, adenoidectomy and uvulopalatopharyngoplasty. Injuries to the ICA during pharyngeal procedure can be catastrophic due to massive bleeding.

關鍵字

parapharynx ； aberrant ； internal carotid artery ； pharyngeal procedure

並列摘要

雙側側咽壁之異位性內頸動脈為一極少見情況。此種解剖構造可能會讓內頸動脈與咽壁之距離接近。此篇病例報告1名68歲女性病患因為長期咽喉異物感來門診就診。口腔檢查發現右側側咽壁凸出一直徑約1.5 cm之腫塊。鼻咽內視鏡檢查發現雙側側咽壁各有一表面平滑、脈動性之腫塊。安排注射顯影劑之電腦斷層檢查之後發現雙側內頸動脈折曲並証實側咽壁所見之腫塊為內頸動脈異常走向所造成。根據文獻報告嚴重顱外異位性內頸動脈之發生率在一般人口大約在百分之五。可能造成的原因包括胚胎發展異常及老化相關造成的血管壁退化。內頸動脈的變異造成執行口咽手術比如扁桃腺切除、腺樣體切除及懸壅垂顎咽成型等術式風險增加。在執行咽部手術的過程中若內頸動脈受損會因為大量出血而造成嚴重的後果。

並列關鍵字

parapharynx ； aberrant ； internal carotid artery ； pharyngeal procedure（側咽壁，異位性，內頸動脈，咽部手術）