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Eur Arch Otorhinolaryngol. 2017 Jan;274(1):73-77. doi: 10.1007/s00405-016-4187-y. Epub 2016 Jul 8.

Critical distance between the cartilaginous Eustachian tube and the internal carotid artery.

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Department of Otorhinolaryngology, School of Medicine, University of Tampere, Tampere, Finland.
Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland.
Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Otorhinolaryngology, School of Medicine, University of Tampere, Tampere, Finland.
Department of Ear and Oral Diseases, Tampere University Hospital, PL 200, 33521, Tampere, Finland.


During the last decade, endoscopic surgery of the Eustachian tube (ET) has been advocated for ET dilatory dysfunction and for patulous ET. The internal carotid artery (ICA) and the ET are closely related, and knowledge of their surgical anatomy has become essential. This study was designed to establish the anatomical relationships between the endoscopically critical area along the full length of the cartilaginous ET and its closest association with the ICA. The perpendicular distance between the ET lumen and the ICA was measured from head magnetic resonance images (MRI) at three levels: (A) cartilaginous and bony ET junctional point, (B) mid cartilaginous ET point, and (C) the nasopharyngeal orifice of the cartilaginous ET. Totally, 200 sides were reviewed in MRI scans of 229 patients. The mean distances for each level were: A = 4.3 mm (range 1.6-10.4 mm), B = 25 mm (range 9.0-61.6 mm), and C = 62 mm (range 34.3-84.4 mm). The perpendicular distance between ET and ICA at the nasopharyngeal orifice is large, but the distance shortens quickly while moving from the nasopharyngeal orifice of the ET to the junctional point of the ET. The potential for complications to the ICA rises as the surgical field moves closer to the isthmus of the ET because of the decreasing distance between the ET and the ICA.


Eustachian tube; Internal carotid artery; MRI

[Indexed for MEDLINE]

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