Abstract
AbstractA retrospective study of 100 consecutive cases of carotid endarterectomy was performed. Special attention was given to the incidence, clinical significance, and prevention of cranial nerve injury. The operative mortality was 1%, and there were no perioperative strokes. There was clinical evidence of 22 cranial nerve injuries. Nineteen injuries were temporary, resulting in a 3% incidence of permanent cranial nerve deficit.The clinical anatomy of cranial nerves encountered during carotid endarterectomy is reviewed. Technical suggestions to minimize cranial nerve injury based on a thorough knowledge of this anatomy are provided.The relationship of laryngeal physiology and vagus nerve anatomy indicates that unilateral vocal cord dysfunction may be asymptomatic. Bilateral nerve injury can cause potentially fatal airway obstruction, which may be unrecognized until after the second operation. Preoperative laryngoscopy prior to carotid endarterectomy is suggested in patients with a history of prior cardiac or neck surgery and those scheduled for the second of staged bilateral carotid procedures.
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