Two cases are described in which aberrant carotid arteries were encountered in the middle ear. The course of the arteries through the tympanum was from posterior to anterior at the level of the promontory. In both cases a bony defect was present in the promontory, below the cochlea.

Pre-operative evaluation included carotid arteriograms and jugular venograms. Polytomograms of the middle ear showed the bony defect of the promontory.

The technique of repair stressed maintenance of carotid blood flow. The arteries were covered by a temporalis fascia graft, then compressed into the promontory defect or canal with a bone graft obtained from the posterior wall of the ear canal. The bone graft was then covered by another fascia graft. Because carotid blood flow is not interrupted, danger of cerebrovascular accidents and neurologic sequelae are minimized in this operation. One patient has an unexplained neurosensory hearing loss, while the other has a mild conductive loss. They suffer no other ill effects and have returned to full function.

Reference is made to possible anomalous development of the internal carotid artery.