To understandbetter the vascular events that occur during normal erection, we used color flow Doppler sonography to examine the erectile process in seven normal subjects. To examine systolic/diastolic velocities and spectral waveform changes before and dunng erection, we used color flow Doppler sonography because of its ability to visualize small vessels with low flow. Subjects and MethodsSeven normal volunteers (age range, 31 -55 years; mean age 40 years) with no known vascular disease or medical conditions were included in the study. All had a history of having normal sexual intercourse as reported by the subjects and their partners, normal erectile response documented by normal nocturnal penile tumescence (NPT), and normal cavemosometry performed after intracorporal injection of papaverine (Eli Lilly, Indianapolis, IN) and Regitine(phentolamine mesylate; Ciba-Geigy; Summit, NJ). Institutional human subjects' approval and informed consent were obtained for all participants.Color flow imaging and spectral waveform analysis of the penile arteries were performed both before and after intracorporal injection of papaverine and Regitmne. Two 21 -gauge needles were placed into the midshaft of the left corpus cavernosum.One needle was used

\s=b\Three cases of an aberrant internal carotid artery presenting at or near the midline in the posterior part of the pharynx occurred. In all three cases, the anomalous finding was not correlated with the presenting symptoms of the patient. In two of the three cases intraoral pulsations were detected during initial examination. In the third case, pulsations were appreciated on reexamination after roentgenographic evaluation. Intraoral photographs, computed tomographic scan, magnetic resonance imaging, and arteriography of these findings are shown. A review of the literature and the embryology of the lateral pharyngeal carotid artery are presented along with the rare finding of the near midline carotid artery and the clinical implications of this anomaly. (Arch Otolaryngol Head Neck Surg 1989;115:519-522) The congenitally tortuous internal carotid artery is an uncommon but important anomaly for the otolaryngologist/head and neck surgeon to recognize. The aberrant carotid artery poses a risk during both major oro¬ pharyngeal tumor resections and less extensive procedures, such as tonsillectomy, adenoidectomy, and palatopharyngoplasty.1Of the general population, 1% to 16%"' have a surgically vulnerable internal carotid artery manifested clinically as detectable lateral pha¬ ryngeal wall pulsations. Dramatic

The trumpet maneuver, a technique to inflate the hypopharynx with air, allows visualization of the pyriform sinuses and retrocricoid area during both fiberoptic examination and CT scanning. The technique is useful in delineating both normal and abnormal anatomy, and is especially useful in the evaluation of patients with hypopharyngeal symptoms in whom there is a low suspicion of anatomic disease. The methods, endoscopic photographs, and CT scan images are presented.

The penile arteries were studied with color Doppler flow sonography in 10 subjects with normal and 39 patients with abnormal erectile function. The relationships of systolic and diastolic velocities to spectral waveform changes in the penile arteries in response to tumescence were studied before and after intracorporal injection of vasoactive medications that induce erection. In normal subjects, a characteristic spectral waveform pattern corresponded to increasing intracorporal pressure. Patients with abnormal arterial inflow and/or abnormal venous sinusoidal leakage demonstrated deviation from the patterns noted in normal subjects. Patients with abnormal arterial inflow had lower mean peak systolic velocities than normal subjects. Patients with severe venous sinusoidal incompetence had an arrest of waveform progression with evolution to but not beyond phases 1 or 2 (diastolic flow remained positive). Patients with abnormal arterial inflow and abnormal venous sinusoidal outflow had waveform changes that reflected both processes. Systolic/diastolic velocity and waveform relationships can be used to define the integrity of both the cavernosal artery inflow and venous sinusoidal outflow occlusion mechanisms.

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