An aberrant internal carotid artery (a-ICA) in the middle ear is rare, but it may be injured during routine otological procedures. This review examines 48 publications on its embryological basis, clinical presentation, imaging diagnosis, and management. The a-ICA results from agenesis of the first embryonic segment of the internal carotid artery, with collateralisation through the inferior tympanic artery....
✦ The floor
Discussion
Signed responses from readers of the wire.
Surgeons performing middle-ear procedures should be aware of aberrant ICA as a rare but catastrophic anatomical variant; pre-operative imaging to identify this anomaly is advisable when suspected.
Unrecognised aberrant ICA during otological surgery can cause life-threatening haemorrhage, making systematic awareness and pre-surgical screening critical for patient safety.
- 01Aberrant internal carotid artery (a-ICA) in the middle ear is a rare but surgically dangerous anatomical variant.
- 02Review synthesises findings from 48 publications, representing the broadest literature summary to date.
- 03Risk of inadvertent vascular injury during routine otological procedures is the primary concern.
- 04Pre-operative imaging (CT or MRI) is essential for identifying this anomaly before middle-ear surgery.
- 05Clinicians should include a-ICA in the differential diagnosis of pulsatile middle-ear masses.
Aberrant ICA in the middle ear poses a significant risk of injury during routine otological procedures.
studysupported- PMID
- 42543430
- DOI
- 10.1007/s00405-026-10500-9.
- Journal
- European Archives of Oto-Rhino-Laryngology
- Publication type
- review
- Evidence level
- 2a
- Sample size
- 48
- Population
- Literature-derived cases of aberrant internal carotid artery in the middle ear
- Intervention
- Review of aberrant ICA anatomical presentations and surgical risks
Primary outcomes
Prevalence and anatomical characteristics of aberrant ICA in the middle ear; Surgical risk and reported injury events during otological procedures