Persistent stapedial artery
{{Short description|Blood vessel anomaly}}
{{Use dmy dates|date=January 2023}}
{{Use British English|date=February 2023}}
{{Infobox medical condition
|name = Persistent stapedial artery
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|image = File:Gray474.png
|image_size = 200
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|caption = The main branches of the carotid arteries, the stapedial artery is visible in the top right in grey.
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|specialty = Otolaryngology, angiology
|symptoms = Pulsatile tinnitus, conductive hearing loss
|complications =
|onset = From birth
|duration =
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|diagnosis = CT scan, angiography, radiography
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|treatment = Coagulation, hearing aids
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|frequency = Extremely rare
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A persistent stapedial artery (PSA) is a rare anomaly in human anatomy where the stapedial branch of posterior auricular artery, or simply stapedial artery, remains within the ear of a fetus after the first ten weeks of pregnancy. Whilst not problematic for the majority of people with the anomaly, it can cause difficulties with hearing.
Signs and symptoms
Most cases of PSA cases remain asymptomatic for a person's life; however, symptoms can include vertigo,{{cite journal|title=An atypical stapedial artery|vauthors=Sanjuan M, Chapon F, Magnan J|doi=10.5152/iao.2019.4002|doi-access=free|pmc=7419084|pmid=32510458|date=August 2020|volume=16|issue=2|pages=274–277|journal=The Journal of International Advanced Otology}} pulsatile tinnitus, conductive hearing loss or sensorineural hearing loss via bone erosion of the otic capsule in rare cases. Hearing loss in children can also cause developmental delays.{{cite journal|title=Clinical Experience of bone-anchored hearing aid in a patient with Persistent Stapedial Artery|date=15 December 2016|journal=Acta Otorrinolaringológica|issn=2340-3438|volume=9|issue=1|pages=140–145|vauthors=Santos M, Esteves SS, Pinto A, Mendes GJ, Coutinho MB, Sousa CA|display-authors=3}}
Cause
During pregnancy, the stapedial artery originates as a branch of the hyoid artery in the dorsal branch of the second aortic arch, which is in turn connected to the internal carotid artery. The stapedial artery after passing through the stapes splits into two vessels, the supraorbital branch and the maxillomandibular branch, the latter of which has a smaller mandibular branch. The former later anastomoses with the ophthalmic artery and becomes the middle meningeal artery, the latter anastomoses with the internal maxillary branch of the external carotid artery, becoming the inferior alveolar artery and infraorbital artery, respectively.{{cite journal|title=Persistent Stapedial Artery|journal=Otology & Neurotology|vauthors=Tien HC, Linthicum FH|date=November 2001|pages=975–976|volume=22|issue=6|doi=10.1097/00129492-200111000-00044 |pmid=11698828 }}
Diagnosis
Since most cases of PSA do not present with symptoms, it is usually discovered incidentally upon middle ear surgery, or during postmortem temporal bone dissections.{{cite journal|title=Stapedial Artery: From Embryology to Different Possible Adult Configurations|doi-access=free|doi=10.3174/ajnr.A6738|vauthors=Bonasia S, Smajda S, Ciccio G, Robert T|display-authors=3|date=September 2020|journal=American Journal of Neuroradiology|volume=41 |issue=10 |pages=1768–1776 |pmid=32883664 |pmc=7661070 }} The absence of the foramen spinosum is sometimes associated with a PSA,{{cite journal|title=Radiology of the Persistent Stapedial Artery|vauthors=Guinto FC, Garrabrant EC, Radcliffe WB|doi=10.1148/105.2.365|volume=105|issue=2|date=November 1972|journal=Radiology|pages=365–369 |pmid=5079662 }} although the prevalence of a missing foramen spinosum is much higher than the prevalence of a PSA.{{cite journal|doi=10.1136/neurintsurg-2021-018607|pages=910–919|vauthors=Klostranec JM, Krings T|title=Cerebral neurovascular embryology, anatomic variations, and congenital brain arteriovenous lesions|journal=Journal of NeuroInterventional Surgery|year=2022|volume=14|issue=9|pmid=35169032|s2cid=246829491|doi-access=free}} On the other hand, a foramen spinosum may be present if the maxillomandibular artery originates from the stapedial artery.{{cite journal|title=Persistent stapedial arteries in human: from phylogeny to surgical consequences|vauthors=Hitier M, Zhang M, Labrousse M, Barbier C, Patron V, Moreau S|display-authors=3|doi=10.1007/s00276-013-1127-z|journal=Surgical and Radiologic Anatomy|year=2013 |volume=35|issue=10 |pages=883–891|pmid=23640742 |s2cid=21065191 }} A differential diagnosis can help eliminate other possible conditions such as glomus tumour of the tympanicum, facial nerve schwannoma, and aberrant internal carotid artery (ICA) based on results of high-resolution computed tomograms, angiograms, or magnetic resonance angiograms.{{cite journal|title=Persistent Stapedial Artery: MR Angiographic and CT Findings|vauthors=Yilmaz T, Bilgen C, Savas R, Alper H|journal=American Journal of Neuroradiology|date=June 2003|volume=24|issue=6|pages=1133–1135|pmid=12812939 |pmc=8148996 }} An aberrant ICA refers to when agenesis of the cervical portion of the ICA occurs, causing the inferior tympanic artery to anastomose with the caroticotympanic artery. This causes the internal carotid artery to enter the middle ear through the same canal as the tympanic nerve, rather than the normal carotid canal.{{cite journal|title=A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis|vauthors=Hatipoglu HG, Cetin MA, Yuksel E, Dere H|display-authors=3|journal=Ear, Nose & Throat Journal|doi=10.1177/014556131109000513|pmid=21563075|date=May 2011|volume=90|issue=5|pages=17–20|doi-access=free}} Aberrant internal carotid arteries are often found alongside a PSA,{{cite journal|title=Arterial Anomalies of the Middle Ear: A Pictorial Review with Clinical-Embryologic and Imaging Correlation|vauthors=Sullivan AM, Curtin HD, Moonis G|doi=10.1016/j.nic.2018.09.010|journal=Neuroimaging Clinics of North America|date=February 2019|volume=29|issue=1|pages=93–102|pmid=30466646 |s2cid=53716332 }} although both anomalies can occur independent of each other.
Treatment
File:Apparaat voor electrocoagulatie 2.jpg machine]]
Treatment of PSA usually involves some form of coagulation, either laser coagulation or electrocoagulation.{{cite journal|title=Persistent stapedial artery in PHACE syndrome|vauthors=Quarte R, Manipoud P, Schmerber S|date=June 2019|volume=136|issue=3|journal=European Annals of Otorhinolaryngology, Head and Neck Diseases|pages=215–217|doi=10.1016/j.anorl.2019.02.015|pmid=30876851 |doi-access=free}} Palliative care such as the installation of hearing aids can help resolve hearing loss caused by a PSA;{{cite journal|title=Persistent Stapedial Artery with Ankylosis of the Stapes Footplate|vauthors=Hill FC, Teh B, Tykocinski M|journal=Ear, Nose & Throat Journal |year=2018 |doi=10.1177/014556131809700702|doi-access=free|volume=97|issue=7|pages=227–228 |pmid=30036438 }} conversely, the PSA may prevent the insertion of cochlear implants meant to alleviate the hearing loss.{{cite journal|title=Persistent stapedial artery preventing successful cochlear implantation: a case report.|vauthors=Wardrop P, Kerr AI, Moussa SA|journal=The Annals of Otology, Rhinology, and Laryngology|date=September 1995|pmid=7668745|pages=443–445|volume=166}} Ablation of the PSA is also an option, although this treatment carries the risk of potential facial nerve damage and haemorrhage.
The central hospital of the University of Porto reported in 2016 the first successful implementation of a bone-anchored hearing aid in an 8-year-old patient without complications, successfully resolving their hearing loss. Further successful insertions of cochlear implants to resolve hearing loss have also been reported.{{cite journal|title=Persistent Stapedial Artery Encountered during Cochlear Implantation|vauthors=Jones H, Hintze J, Gendre A, Wijaya C, Glynn F, Viana L, Walshe P|display-authors=3|doi=10.1155/2022/8179062|doi-access=free|journal=Case Reports in Otolaryngology|year=2022 |volume=2022 |pages=1–3 |pmid=35242393 |pmc=8888055 }}
Epidemiology
The prevalence of persistent stapedial arteries is thought to be somewhere between 0.02 and 0.48% of the general population;{{cite journal|journal=The Laryngoscope|title=Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: A report of 1000 temporal bones|vauthors=Moreano EH, Paparella MM, Zelterman D, Goycoolea MV|display-authors=3|doi=10.1288/00005537-199403000-00012|date=2 March 1993|volume=104 |issue=3 Pt 1 |pages=309–320|pmid=8127188 |s2cid=10575546 }}{{refn|group=N|0.02% by incidence during surgery, 0.48% histopathologically.{{cite journal|title=Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula|vauthors=Jehl J, Jeunet L, Berraiah M, Bonneville JF|display-authors=3|journal=Interventional Neuroradiology|year=2006 |volume=12|issue=4 |pages=327–334|doi=10.1177/159101990601200406 |pmid=20569590 |pmc=3354603 }}}} a study in the American Journal of Radiology in 2000 stated that only fifty-six cases of PSA had been reported since the first report of PSA was published in 1836 by Austrian anatomist Josef Hyrtl.{{cite journal|url=http://www.ajnr.org/content/21/3/572|title=The Persistent Stapedial Artery|vauthors=Silbergleit R, Quint DJ, Mehta BA, Patel SC, Metes JJ, Noujaim SE|display-authors=3|date=March 2000|volume=21|issue=3|pages=572–577|journal=American Journal of Radiology|pmid=10730654 |pmc=8174972 }}
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Notes
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References
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{{medical resources
| ICD11={{ICD11|LA22.3}}
| ICD10={{ICD10|Q16.3}}
}}