CRANIAL CERVICAL NERVE DYSFUNCTION AFTER CAROTID ENDARTERECTOMY/

Purpose: The purpose of this article is to review the results of patie nts who had cranial and cervical nerve dysfunction after undergoing ca rotid endarterectomy. Methods: The prospective study reviewed 183 cons ecutive carotid endarterectomies. Preoperative and postoperative crani al nerve assessments were accomplished on all patients. Neurologic eva luation included direct fiberoptic laryngoscopy. Patients found to be neurologically intact had no further follow-up. Patients with postoper ative neuropraxia were entered into regular long-term follow-up to ass ess delayed recovery. Results: Twenty-six (14.2%) nerve injuries were identified in 21 patients. There were 14 recurrent laryngeal, 8 hypogl ossal, 2 marginal mandibular, and 2 greater auricular nerve dysfunctio ns. Two patients were lost to follow-up. Eighteen (9.8%) nerve injurie s were transient, whereas two (1.1%) were permanent. Pour patients are currently undergoing extended follow-up to assess delayed recovery. T wo patients with recurrent laryngeal nerve dysfunction were found to h ave prolonged full recovery intervals: 20 months and 50 months, respec tively. Conclusions: The incidence of focal neuropraxia after carotid endarterectomy is presented. Most injuries are transient. However, per manent injuries can lead to significant disability. Extended follow-up will identify the small subset of patients with delayed complete nerv e recovery.