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Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation

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Abstract

Purpose

To investigate the potential risk of the retropharyngeal internal carotid artery (RICA) during nasotracheal intubation (NTI).

Methods

We retrospectively surveyed 2028 patients and 90 healthy controls (HC) with neck computed tomography angiography (CTA). The incidence of RICA was analyzed, as well as the correlation between the average minimum carotid-pharyngeal distance (CPD) and the carotid-median plane distance (CMD). We also compared CPD between RICA and HC.

Results

RICA was observed in 91 out of the 2028 patients, reaching an incidence of 4.5% (91/2028). RICA in female patients was 65.9% (60/91) compared to 34.1% (31/91) in male patients. The incidence of RICA at nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) was 31.9% (29/91), 61.5% (56/91), and 6.6% (6/91), respectively. The incidence of the mucosal eminence of the posterior wall of the pharynx in RICA was 30.8% (28/91). In 15 cases, RICA caused the pharyngeal cavity to become narrow, with an incidence of 16.5% (15/91). Moreover, CPD and CMD was positively correlated (r = 0.56, p < 0.01). The average minimum CPD of RICA was only 2.25 ± 1.26 mm, which was much shorter than HC (17.62 ± 1.98 mm) (t = 62.46, p < 0.01). Some CPD of RICA was even less than 1 mm, with an incidence of 20.9% (19/91).

Conclusion

RICA is not uncommon in asymptomatic adults. It is very close to the midline and posterior wall of the pharynx and is more likely to occur in the nasopharynx (NP) and oropharynx (OP). RICA tear is likely to occur during NTI.

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Acknowledgements

We thank Ce Lin, a student at Zhejiang University of Technology, Hangzhou, China, for hel** us to draw a schematic diagram of RICA formation (Fig. 3) and a schematic diagram of NTI (Fig. 5).

Funding

This study was supported by Education of Zhejiang Province, China. The scientific research fund number is (No. Y202043273).

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Authors and Affiliations

  1. Post Anesthesia Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Hangzhou, 310016, China

    Wan-** Zhu

  2. Anesthesiology Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    **-Zhu-Aff1">Wan-** Zhu

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  3. **ao Fang
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  4. Outesh Chooah
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  5. Samar Mohamed Albaqali
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  6. Wei Lin
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Contributions

W-pZ: Manuscript writing. XF: Project development and design. OC: Data collection and manuscript editing. SMA: Data collection and manuscript editing. WL: Data management and analysis.

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Correspondence to Wan-** Zhu.

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Zhu, Wp., Fang, X., Chooah, O. et al. Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation. Surg Radiol Anat 43, 1769–1776 (2021). https://doi.org/10.1007/s00276-021-02784-9

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