Introduction <p>Retropharyngeal internal carotid artery is a clinically relevant important variant for otorhinolaryngologists and can pose serious implications if fail to identify.</p> Case report <p>An 85 years old woman presented with left parotid swelling for 1 year with no other associated symptoms. Noted to have incidental finding of right posterior pharyngeal wall pulsatile mass during flexible scope. Computed tomography of the neck done which shows retropharyngeal internal carotid artery. Due to her advanced age and several comorbidities, the patient and her family were not interested in receiving any additional treatment, hence no further treatment was given.</p> Discussion <p>Retropharyngeal internal carotid artery is normally an incidental finding as most patients are asymptomatic. Nevertheless, it can pose serious implications in otolaryngology surgery if it is missed pre-operatively.</p> Conclusion <p>Knowledge of retropharyngeal internal carotid artery variant may result in heightened awareness among otorhinolaryngologists and therefore aid in the prevention of complications associated with this anatomic variant especially during otorhinolaryngology surgery. Hence, it is important for otorhinolaryngologists to perform flexible scope pre- operatively to detect retropharyngeal internal carotid artery to reduce risk of complications during surgery in the region.</p>