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.