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Paulsen F, Tillman B, Christofides C, Richter W, Koebke J. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 2000; 197: 373–381. References Background: Because of the close anatomical relation between internal carotid artery ICA and Eustachian tube (ET) it is critical for a surgeon to have accurate orientation of the ICA during endoscopic nasopharyngectomy (ENP). Objective: To identify the ICA average distance and variations due to gender and age in relation to ET which is removed during nasopharyngectomy. Methods: We analyzed the relation of the ICA by studying its distance from the midline (M) and medial pterygoid plate (MPP) in 100 CT scans. Measurements were taken high from the carotid artery at the entrance of the carotid canal (CC) to midline and to a line drawn parallel to the MPP, and low at the level of the hard palate to the pharyngeal carotid (PC) in 40 females (median age 62.5) and 60 males (median age 55.5). Results: The average distance in the superior plane of skull base was CC-MPP 11.4mm (range 4.69 to 19.6) and M-CC 25.98mm (range 11.4-35.2). For lower plane of skull base, the average distance of MPC was 25.3mm (range 18-31.8) and MPP-PC was 10.2mm (range 4.69-19.6) for PTT. Discussion: Our findings indicate that the carotid may be encountered in a plane parallel to the medial pterygoid plate in some patients, but there is usually 1cm distance. Partial resection of the ET should not be performed without knowing the relative location of the carotid to avoid carotid injury during nasopharyngectomy. Abstract

Complete or Partial Eustachian Tube Resection during Endoscopic Nasopharyngectomy: Importance of Anatomic Variance of the Carotid Artery