Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 5, May, p. 601–607

doi: 10.17219/acem/78350

Publication type: original article

Language: English

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The anatomical relation of the extracranial internal carotid artery in the parapharyngeal space

Hanna J. Zając1,A,B,C,D,F, Krzysztof Lachowski2,A,B,C,D,F, Agnieszka Lis2,A,B,C,D,F, Tomasz Kręcicki1,A,C,E,F, Jerzy Garcarek2,A,C,E,F, Maciej Guziński2,A,B,C,E,F, Tomasz Zatoński1,A,C,E,F

1 Department of Otolaryngology, Head and Neck Surgery, Jan Mikulicz-Radecki University Teaching Hospital, Wroclaw Medical University, Poland

2 Department of Radiology, Interventional Radiology and Neuroradiology, Jan Mikulicz-Radecki University Teaching Hospital, Wroclaw Medical University, Poland


Background. The proximity of the internal carotid artery to the pharyngeal wall poses a risk of injury during nasopharyngeal surgery.
Objectives. The aim of this study was to assess the distances between the extracranial internal carotid artery (ICA) and the pharyngeal wall.
Material and Methods. Measurements were taken on certain levels of the pharynx using computed tomography angiography (angio-CT) scans of 97 patients. One-tailed Student’s t-test for independent variables and a comparison of expected values for dependent pairs of observations were applied.
Results. The shortest distance between the ICA and the pharyngeal wall was 1.1 mm. The ICA is closer to the pharyngeal wall at the epiglottis apex level (16.46 ±0.89 mm) than to the Eustachian tube (ET) (19.8 ±0.62 mm) (p < 0.0005). In women, the ICA is closer to the ET (19.44 ±0.78 mm) than in men (20.17 ±0.96 mm) (p = 0.04). In women, the right ICA is closer to the pharyngeal wall than the left ICA at the level of the lower margin of the 2nd cervical corpus vertebra (C2) (right: 17.6 ±1.8 mm; left: 20.7 ±1.7 mm) (p = 0.002) and at the level of the epiglottis apex (right: 15.2 ±1.7 mm; left: 17.4 ±1.4 mm) (p = 0.028). The bifurcation of the common carotid artery (CCA) is higher in men (19.48 ±2.19 mm below the C2) than in women (21.82 ±1.02 mm) (p < 0.001). When the bifurcation is at the level of the epiglottis apex, the ICA is closer to the pharyngeal wall (12.3 ±1.69 mm) than in other cases (16.46 ±0.89 mm) (p = 0.005). In men, the higher the bifurcation is, the closer the ICA is to the pharyngeal wall at the level of the lower margin of the C2 (p = 0.003).
Conclusion. The risk of ICA incision during surgery differs between the pharyngeal levels, genders and sides of the neck. The ICA may be much closer to the pharyngeal wall than described in the literature.

Key words

common carotid artery, internal carotid artery, otorhinolaryngologic surgical procedures, Eustachian tube

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