We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.
Intraoperative vascular complications during myringotomy or paracentesis of the middle ear occur only rarely. Patients with normal anatomy have vascular structures that are protected from injury by the bony walls. When vascular complications do occur during procedures that enter the mesotympanum, they are even more rarely the result of dehiscent internal carotid arteries. Currently, very few cases of pierced dehiscent internal carotid arteries have been reported.