Gill Jaskirat K, Sadiq Mehrin, Badar Zain, Ezhapilli Sajeev
SUNY Upstate Medical Center, Syracuse, NY.
Aventura Hospital and Medical Center, Aventura, FL.
Radiol Case Rep. 2017 Jul 14;12(3):514-518. doi: 10.1016/j.radcr.2017.05.008. eCollection 2017 Sep.
Although interpatient variations in the course and anatomy of extracranial internal carotid arteries (EICAs) have been described previously, intrapatient variability is rarely cited in the literature. Distance between EICAs and the pharyngeal wall is an important determinant of vascular injury risk. A retropharyngeal EICA has crucial implications in patients undergoing pharyngeal procedures, and important in otorhinolaryngology and emergency medicine. Surgical exploration without identification of anatomical landmarks, or emergent intubation in the emergency room poses high risk for EICA injury. Other critical clinical considerations include intra-arterial involvement of tonsillitis, peritonsillar abscesses, or parapharyngeal neoplasms due to close proximity to the EICA. We present 2 cases with short-term change in retropharyngeal course of EICA to highlight this further. Although no clear etiology for these changes has been identified, we hypothesize that embryology, weight alterations, atherosclerotic disease, and postradiation changes are contributory. Thus, one radiologic study does not exclude variation in vascular anatomy.
尽管此前已描述过颅外颈内动脉（EICA）走行和解剖结构的患者间差异，但文献中很少提及患者内的变异性。EICA与咽壁之间的距离是血管损伤风险的重要决定因素。咽后EICA对接受咽部手术的患者具有关键意义，在耳鼻喉科和急诊医学中也很重要。在未识别解剖标志的情况下进行手术探查，或在急诊室进行紧急插管，均会给EICA损伤带来高风险。其他关键的临床考量还包括因与EICA距离过近，扁桃体炎、扁桃体周围脓肿或咽旁肿瘤的动脉内受累情况。我们展示2例EICA咽后走行出现短期变化的病例，以进一步强调这一点。尽管尚未明确这些变化的病因，但我们推测胚胎学、体重改变、动脉粥样硬化疾病和放疗后变化是其成因。因此，一项影像学研究并不能排除血管解剖结构的变异。
