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Aberrant internal carotid artery

Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

The aberrant internal carotid artery is a variant of the internal carotid artery (ICA) and represents a collateral pathway resulting from involution of the normal cervical portion of the ICA⁵.

There is consequent enlargement of the usually small collaterals which course through the middle ear. The result of this enlargement is an artery that passes lateral to the cochlear promontory and appears during otoscopic examination as a retrotympanic vascular mass. If mistaken for a paraganglioma and biopsied, the results can be disastrous not to mention surprising.

The two vessels that enlarge to form the aberrant ICA are:

inferior tympanic artery: a branch of the external carotid artery (usually maxillary artery or superfical temporal artery) which enters from below via the inferior tympanic canaliculus
caroticotympanic artery: a branch of the petrous portion of the ICA known as the hyoid artery when enlarged

The two vessels enlarge, sometimes with a stenosis producing objective tinitus, and rejoin the horizontal segment of the petrous portion of the ICA.

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