Detection of Aberrant Carotid Arteries Prior to an Adenoidectomy: A Case Report

Aberrant carotid arteries are rare vascular anomalies that can significantly complicate head and neck surgeries, particularly in pediatric patients. These anomalies may be asymptomatic and are often discovered incidentally on imaging studies performed for unrelated conditions. The failure to recognize these anomalies preoperatively can result in life-threatening complications, such as catastrophic hemorrhage. This case report highlights the critical importance of thorough imaging and cautious surgical planning in preventing such outcomes. A female pediatric patient presented with nasal obstruction, recurrent ear infections, and otorrhea. A lateral soft tissue X-ray was performed to assess adenoid size and revealed an unexpected retropharyngeal fullness, initially raising concerns for a retropharyngeal abscess. A subsequent CT scan identified medialized aberrant carotid arteries lying in the posterior oropharynx, posing a significant risk for surgical intervention. In accordance with these findings, the patient underwent adenoidectomy with careful intraoperative assessment and planned contingencies. The patient remained asymptomatic with no vascularity, such as bulging or pulsation, on the posterior pharyngeal wall. Her adenoid was successfully removed, and she recovered without complications. This case underscores the importance of preoperative imaging and vigilance in identifying vascular anomalies that can complicate surgery. The absence of intraoperative vascular signs highlights the potential for occult anomalies to go undetected. Surgeons should consider the possibility of such anomalies when encountering unusual imaging findings. Recognizing aberrant carotid arteries is crucial in preventing catastrophic complications during head and neck surgeries. Preoperative imaging and planning play a vital role in identifying these risks and are essential in ensuring patient safety.