Münks S, Wallscheid A, Pickuth D
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Caritasklinik St. Theresia, Saarbrücken.
Laryngorhinootologie. 2008 Dec;87(12):874-7. doi: 10.1055/s-2008-1077451. Epub 2008 Jul 15.
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.
报告一例78岁患有咽异感症的男性病例，该患者因右侧咽旁壁肿瘤被转诊至我科。影像学和内镜检查显示，肿瘤是由右侧颈内动脉颅外段扭曲所致。
在诸如腺样体切除术、扁桃体切除术等常规耳鼻喉手术或诊断性活检的内镜手术过程中，咽旁间隙内颈内动脉解剖位置的变异存在潜在风险。关于咽侧壁背外侧颈内动脉临床走行变异频率的数据，文献报道从4%到66%不等。通过经济有效的超声和双功超声、计算机断层扫描、磁共振血管造影或传统血管造影，可以获得多种不同的诊断成像方法。虽然颈内动脉盘绕归因于胚胎发育畸形，但动脉的伸长和扭曲是由于动脉粥样硬化或纤维肌发育不良。这些变异通常无症状，但也可引起从咽异感症到脑血管供血不足导致缺血性发作或梗死等症状。本病例报告强调了颈内动脉临床走行变异作为咽旁肿瘤鉴别诊断的临床重要性，因为文献中经常报道常规咽部手术中发生的医源性损伤并导致灾难性后果。应警告经验不足的耳鼻喉科医生，并提醒经验丰富的耳鼻喉科医生注意这些危险的变异情况。
