DIAGNOSIS AND MANAGEMENT OF BLUNT CAROTID-ARTERY INJURY IN ORAL AND MAXILLOFACIAL SURGERY

Purpose: Traumatic occlusion of the internal carotid artery (ICA) is a rare complication of maxillofacial trauma or surgery. This investigat ion evaluated patient demographics, diagnostic methods, and effective therapeutic modalities associated with blunt carotid injury (BCI). Pat ients and Methods: This was a retrospective analysis of patient record s with an ICD-9-CM diagnosis of carotid injury conducted at MetroHealt h Medical Center during the 24-month period between August 1993 and Ju ly 1995. Carotid injuries attributable to penetrating trauma were-excl uded. Age, gender, cause of injury, Glasgow Coma Scale score, Injury S everity Score, type and location of injury, concomitant injury, diagno stic methods, treatment modalities, and outcome were identified, recor ded, and analyzed. Results: During the 24-month period, 12 patients (s even males and five females) suffered BCI. These patients were divided into two groups based on cause of the problem. In group I, there were 3,214 blunt trauma patients admitted during the 2-year study, of whic h 10 patients had BCI, representing 0.31% of blunt trauma patients, an d 1.2% of patients with head injuries. Seven patients presented with h emiplegia, two with cranial nerve palsy, and one with perceptual negle ct. Ninety percent of the patients had associated injuries. Two patien ts had surgical intervention, three received anticoagulation, and five had only supportive care. Four of the 10 patients died, four had mode rate neurologic deficits, and two survived with only minor neurologic deficits. In group II, two patients developed BCI after surgery. A 52- year-old woman had a carotid injury after right total temporomandibula r joint replacement, and a 48-year-old man who underwent surgical remo val of a third molar became hemiplegic postoperatively. The first pati ent recovered after anticoagulation, whereas the second patient, who r eceived only supportive care, has severe neurologic deficits. Conclusi ons: BCI is an uncommon entity. It is usually recognized when a patien t develops an unexplained neurologic deficit, most often hemiplegia, s ubsequent to trauma or surgery of the head, face, or neck, In the earl y stages, the diagnosis can be missed by carotid ultrasound or compute d tomography. The injury is unrelated to Glasgow Coma Scale score. Sym ptoms may not develop for days after injury in 50% of patients. Antico agulation appears to be the most beneficial therapeutic modality.