Ruptur, Notligatur und elektive Ligatur der Arteria carotis

Sentinel ear bleed as a presenting sign for carotid artery blowout due to aspergillus abscess in parapharyngeal space in an immunocompetent infant

Parapharyngeal abscesses leading to complications, although rare after the advent of antibiotics, can lead to serious complications. One such complication is carotid erosion that can lead to a potentially fatal carotid artery blowout. We report a case of a previously healthy infant who presented with fever, ear bleed and progressively increasing swelling in the right side of his neck that led to airway compromise. The child required immediate securing of the airway at presentation. Imaging revealed lobulated abscess with multiple bleeding points eroding the carotid vessels, along with internal jugular venous thrombus. Surgical exploration was done and abscess debulked. Histopathology revealed aspergillus, which was treated with antifungals. He was discharged on oral warfarin after 40 days of hospital stay and remains well on follow-up. Sentinel ear bleed warrants close observation for possibility of carotid artery blowout in children with parapharyngeal abscesses.

Carotid artery erosion in a 4-year child

The carotid erosion occurs most commonly in patients receiving radiotherapy for head and neck cancer and is associated with high mortality. We report a case of carotid blow out in a 4-year-old child who presented with massive parapharyngeal space abscess. The common carotid artery (CCA) was ligated and child recovered without any neurological sequel.

Rupture of supra-aortic neck arteries due to lesions caused by tracheal tubes

Haemorrhages from the common carotid or innominate artery caused by tracheal tubes are rare but dramatic complications of head and neck surgery. Patients with metal tracheostomy cannulas or patients in the phase of wound healing after radical tumour resections of the pharynx and larynx run a greater risk. Following extensive tumour resections and radiation of the upper respiratory and digestive tracts in 680 patients, acute bleeding of the larger neck arteries occurred in 18 patients. In four of these cases, fistulae developed in the innominate or common carotid artery. These ruptures were caused by both plastic and metal tracheal tubes.