The cervical course of the internal carotid artery is almost straight in contrast to the intracranial portions which are highly tortuous. The incidence of variations in the cervical course of the internal carotid artery of the population is approximately 10-40 percent. In this case report, a 76-year-old female patient with a pulsatile mass at the posterior oropharyngeal wall and anterior neck was presented. Physical examination revealed a pulsatile anterior neck mass, and a pulsatile mass at the right posterior wall of the oropharynx. Imaging revealed a bilateral tortuous internal carotid artery and segmental left internal carotid arterectomy and distal internal carotid artery - lateral common carotid artery anastamosis were performed with no postoperative complications.
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