Congenital pharyngeal vascular malformation is an anomaly of embryonic development. Under normal developmental conditions, there is a bend between the two components of the primitive internal carotid artery, namely the third aortic arch and the dorsal aortic arch. As the heart descends, this bend straightens and disappears. If it fails to straighten and persists, it will form a vascular loop or vascular tortuosity deep to the lateral or posterior pharyngeal wall, close to the tonsillar fossa and posterior pharyngeal wall, making it prone to injury during tonsillectomy or adenoidectomy.

bubble_chart Clinical Manifestations

Mild cases may be asymptomatic or present with a foreign body sensation, obstruction, or pulsation in the throat. Examination may reveal bulging in the posterior pharyngeal wall or around the tonsils, with noticeable pulsation. Palpation may detect a pulsating sensation.

bubble_chart Diagnosis

The diagnosis can be initially made based on clinical manifestations and palpable pulsation. X-ray cervical angiography can confirm the location and shape of vascular malformations.

bubble_chart Treatment Measures

When symptoms are not obvious or do not affect functions such as breathing or swallowing, treatment may not be necessary. During tonsillectomy and adenoidectomy, care should be taken to avoid injuring these vascular malformations. For this purpose, preoperative and intraoperative examinations should include: ① Checking for pulsations in the pharyngeal wall and tonsils, and performing palpation of the tonsils or adenoids if necessary. ② If significant pulsations are observed during surgery, vascular abnormalities should be considered. Careful dissection of the tonsils is required to avoid injuring the vessels, or the pulsating vessels should be isolated and ligated. ③ The adenotome and curette are less likely to cause injury to pulsating vessels, but biting forceps should not be used when removing residual tissue. ④ In case of significant bleeding during surgery, immediate local compression or posterior nasal packing should be performed to achieve hemostasis. To prevent airway obstruction due to bleeding, a tracheotomy may be necessary. Compression of the common carotid artery in the neck or ligation can also be performed, along with blood transfusion to correct hypovolemia.

Attention should be paid to differentiating it from infectious internal carotid artery pseudoaneurysm, retropharyngeal abscess eroding the vascular wall, and false pseudoaneurysm.