Cranial nerve dysfunction following carotid endarterectomy

Background. Carotid endarterectomy (CEA) is the most common surgical proced ure performed for the treatment of symptomatic carotid stenosis greater tha n 70%. Among the recognised complications, such as stroke and myocardial in farction, is injury to cranial nerves. Methods. We report the incidence and follow-up of cranial nerve injury in 2 69 patients who underwent carotid endarterectomy between January 1994 and D ecember 1997 at the Royal Liverpool University Hospital. Results. Fifteen cranial nerve injuries were documented (5.6%). Seven patie nts (2.6%) had unilateral vocal cord paralysis, nine (3.3%) hypoglossal pal sy, two (0.7%) glossopharyngeal nerve injury and one (0.4%) facial nerve pa lsy (marginal mandibular nerve). All patients showed improvement within a f ew weeks and none had residual disability at the last follow-up (two weeks to 14 months). Conclusions. Patients manifesting symptoms of cranial nerve dysfunction sho uld undergo a thorough otolaryngological evaluation and long-term follow-up . Most cranial nerve injuries are transient and result from trauma during d issection, retraction or carotid clamping. Knowledge of cranial nerve anato my is essential if the surgeon is to avoid such injuries.