颈内动脉(ICA)的非典型先天性途径是一种罕见的解剖学变异,患病率非常低。颈内动脉的中介被认为是罕见的表现。颈内动脉可能在咽壁水平移位,导致咽侧和咽后区结缔组织增大。一名76岁的男性患者,他的身体左侧有虚弱的病史,吞咽困难,由于喉咙疼痛,言语困难被送到耳鼻喉科。他在插入鼻胃管(NGT)时经历了几次失败的尝试,这最终是相当困难的。经评估,该人的左肢均表现出正常的言语和4/5的力量等级。检查喉咙后,在右侧咽后区观察到明显的非搏动性水肿,向前推右扁桃体。在纤维喉镜检查期间观察到咽后肿块。颈动脉的多普勒检查产生了明确的结果。计算机断层扫描血管造影(CTA)显示经咽后途径的颈总动脉。识别颈内动脉的变化具有临床意义,特别是位于咽部粘膜下区域附近的那些。这是因为在涉及咽部操作的手术过程中受伤的风险更高,比如插管,插入鼻胃管,或颈内动脉区域的手术。
The atypical congenital pathway of the internal carotid artery (ICA) is an uncommon anatomical variation with a very low prevalence. The medialization of the internal carotid artery is regarded as an infrequent manifestation. The internal carotid artery may be displaced at the level of the pharyngeal wall, leading to the enlargement of connective tissue in the lateral pharynx and retropharyngeal areas. A 76-year-old male patient with a history of weakness on the left side of his body, difficulty swallowing, and speech difficulties was sent to the otorhinolaryngology department because of pain in his throat. He underwent several unsuccessful attempts at the insertion of a nasogastric tube (NGT), which was eventually done with considerable difficulty. Upon evaluation, the individual displayed regular speech and a strength rating of 4/5 in both of his left limbs. Upon examination of the throat, a significant non-pulsating edema was observed in the right retropharyngeal area, pushing the right tonsil anteromedially. A posterior pharyngeal mass was observed during fiberoptic laryngoscopy. The Doppler examination of the carotid arteries yielded definitive results. Computed tomography angiography (CTA) showed the common carotid arteries via a retropharyngeal route. It is clinically significant to identify variations in the course of the internal carotid artery, particularly those located near the submucosal area of the pharynx. This is because there is a higher risk of injury during procedures involving manipulation of the pharynx, such as intubation, insertion of a nasogastric tube, or surgeries in the internal carotid artery region.