Age-associated medialization of the cervical internal carotid artery: CT morphometric findings and an exploratory combined mucosa-midline grading framework
In brief
Age 70 or older identifies almost nine of ten cases of dangerous carotid medialization
In 471 neck CT scans, 14% showed critical internal carotid artery medialization that can limit safety during transoral procedures. Patients aged 70 years or older captured 89% of these cases with 86% specificity and a 98% negative predictive value, while a new five-grade CT grading system remains exploratory and unvalidated.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 16 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Ahmet Çelik, Sıraç Irmak
- PMID
- 42747531
- DOI
- 10.1007/s00405-026-10624-y
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 17 September 2026): CT morphometry of cervical ICA medialization, anatomical safety margins
Abstract
PURPOSE: Cervical internal carotid artery (ICA) medialization may narrow anatomical safety margins during transoral and pharyngeal procedures. We quantified age-associated ICA morphometric changes on computed tomography (CT), assessed age-based discrimination for study-defined critical medialization, and developed an exploratory combined mucosa-midline grading framework. METHODS: This retrospective study included 471 patients. ICA curved length and distances to the neck midline, internal jugular vein, and pharyngeal mucosa were measured. Critical medialization was defined as a mucosa-to-ICA distance ≤ 3 mm or an ICA-to-midline distance ≤ 5 mm. Age-related associations, receiver operating characteristic analysis, and the five-grade framework were evaluated. RESULTS: The cohort included 247 males and 224 females (mean age, 50.0 ± 23.6 years; range, 3-94 years). Age correlated positively with ICA curved length (r = 0.672) and ICA-to-internal jugular vein distance (r = 0.846), and negatively with ICA-to-midline (r = - 0.795) and mucosa-to-ICA distances (r = - 0.814; all p < 0.001). Critical medialization was present in 66 patients (14.0%). Within this cohort, age showed excellent discrimination (AUC = 0.930), with an exploratory Youden-derived threshold of ≥ 70 years (sensitivity, 89.4%; specificity, 85.9%; negative predictive value, 98.0%). Grade III-IV anatomy increased from 1.2% in patients aged < 40 years to 74.6% in those aged ≥ 80 years. CONCLUSION: Older age was strongly associated with ICA elongation, medialization, and reduced pharyngeal mucosal safety margins. The exploratory grading framework may support standardized anatomical description on CT but is not a validated predictor of procedural risk. Independent prospective validation is required before clinical implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.