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Exploring Carotidynia: Symptoms, Diagnosis, and Treatment Options

Orofacial Pain and Oral Medicine
July 13, 2023


In 1927, Fay described a painful condition over the common carotid bifurcation, without any structural abnormality. The condition was described as Fay’s Syndrome or Idiopathic Carotidynia. The pain is located in the anterior part of the neck, over the bifurcation of the carotid artery, and worsens with head movements, chewing, yawning, coughing, or swallowing. There is still controversy if the condition should be classified as a distinct clinical entity, or as a symptom associated with other diseases. Carotidynia has an extensive differential diagnosis, including pharyngitis, otitis, temporomandibular joint arthralgia, and myalgia. It is important to consider that the pain could be attributable to other causes of neck pain, such as carotid dissection or vasculitis, so further evaluation is required to rule out secondary pain. Carotid artery pathology has also been known to occur at high altitudes due to aberrant baroreceptor response in the carotid bulb.

A potential condition is a bifurcation aneurysm, which might affect the internal carotid artery. A close evaluation for carotid stenosis will be required.

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Evaluation of carotid artery bifurcation

Neurological examination: The typical neck pain might be accompanied by other symptoms such as hoarseness, choking when swallowing, and fainting attacks, and a complete neurological examination will be required. The vagus and glossopharyngeal nerves might be affected by inflammation of the carotid sheath.

Palpation: It is possible for a patient to experience transient perivascular inflammation of the carotid artery, which will produce acute pain at the level of the carotid bifurcation. Palpating the area will identify if the source of the pain is the vessel or if there is tenderness of cervical muscles such as SCM which has been implicated with cervical problems. The common carotid artery is palpated on the neck below the jaw and lateral to the larynx/trachea (i.e., mid-point between your earlobe and chin) using the middle and index fingers.

Auscultation: Auscultation of carotid identifies patients with high-risk atherosclerosis. This assessment provides information about cardiac function and the quality of blood flow through the artery. A partial obstruction will produce a sound called bruit.

Imaging: There are reports suggesting that carotidynia is a distinct disease characterized by the presence of enhancing soft tissue in the carotid sheath, supporting the classification as an inflammatory disease. Possible images to validate this diagnosis are positron-emission tomography and CT. The use of ultrasound has also been described, with narrowing of the lumen and thickening of the carotid bulb in the area of tenderness. MRI studies have failed to show atherosclerotic disease of the vessel.

Laboratory tests: To rule out an immunological condition, a panel with ANCA, ANA, and anti-nucleoprotein has been suggested.

Treatment

Treatment with nonsteroidal anti-inflammatory drugs or glucocorticoids usually produces symptom resolution; however, a comprehensive workup of the patient is required to rule out a neurological or vascular etiology.

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