Author(s)
R. B. Lipin
K. Prickett
Affiliation(s)
Emory University School Of Medicine; Children’s Healthcare Of Atlanta
Abstract:
We report a case of internal carotid artery (ICA) injury following myringotomy in a 2-year-old male with DiGeorge syndrome. Immediate bleeding was controlled with nasopharyngeal and external auditory canal packing. Post-operative computed tomography angiography (CTA) showed bilateral lateralized and dehiscent petrous segments of the internal carotid arteries with aberrant branching of small vessels in the hypotympanum. On repeat CTA, a 3mm pseudoaneurysm was demonstrated. The patient was managed conservatively with intubation and staged removal of packing. Serial imaging demonstrated decreasing size of the pseudoaneurysm with spontaneous resolution. He was discharged after two weeks of observation with no neurologic deficits. Carotid injury is rare complication during myringotomy. Post-traumatic pseudoaneuryms have historically been managed invasively by embolization or ligation of the internal carotid artery. Only a single case report of conservative management of traumatic pseudoaneurysm in the middle ear exists in the literature. The authors address the anatomy and unique imaging findings associated with dehiscent carotid arteries, review the literature for management of major vascular injuries during otologic surgery, and describe the multidisciplinary approach used to conservatively manage this complication.