ICA ppt

ABERRANT INTERNAL CAROTID ARTERY

IN MIDDLE EAR

Prof.Gananathan M.S., D.L.O.,Asst.prof:Dr.V.Rajarajan M.S., D.N.B.,Dr.R.Thalapathy Ramkumar M.S.,

D.N.B.,Dr.Shanmuga Ashok M.S.,

ABERRANT INTERNAL CAROTID INVOLVING MIDDLE EAR

58 yr old femaleChief complaints –

hard of hearing – both ears giddiness

on & off for 8yrs right ear tinnitus -6 months

HISTORY

Otoscopic examination of right ear-

A pinkish pulsatile

retrotympanic mass was seen behind an intact tympanic membrane in the antero-inferior quadrant.Left ear : clinically NAD

EXAMINATION

REPORT

Right ear –profound mixed hearing loss

Left ear –mild sensorineural hearing loss

AUDIOGRAM

ABERRANT ICA IN MIDDLE EAR

INTRODUCTION

First reported by MAX in 1899 Incidence is approximately 1%

ABERRANT INTERNAL CAROTID ARTERY IN MIDDLE EAR

Clinical symptomsConductive hearing loss, pulsatile tinnitus and vertigo.

Due to its rarity, aberrant ICA is often misdiagnosed and confused with other conditions like

• Glomus tumour• Dehiscent jugular bulb• Aneurysms.

Anatomy of ICA in middle ear

Congenital or acquired defects in the bony plate that separates the ICA from the middle ear cavity.

Persistence of the embryonal vessels that alter the passage of the ICA.

Due to failure of the carotid canal to develop .

CAUSES OF ABERRANT INTERNAL CAROTID ARTERY

HRCT SCAN-TEMPORAL BONE

Enlarged inferior tympanic canaliculus

Absence of the vertical segment of carotid canal

Dehiscent bony plate along the petrous part of the ICA

Presence of an enhancing mass in the hypotympanum

Main features in angiography:

Reduced diameter of tympanic ICA . In frontal view, the vertical segment

of the ICA is lateral to a line drawn vertically through the vestibule .

MAGNETIC RESONANCE ANGIOGRAPHY

Avoid unnecessary surgical exploration .

MANAGEMENT

Pt. was managed conservatively.Presented for the rarity of the

situation.

Previous references

CONCLUSION

Thank you