Oral motor dysfunction after carotid endarterectomy: Challenges in diagnosing marginal mandibular nerve injury and effectiveness of rehabilitation

Introduction: Post-operative injury of the marginal mandibular branch of the facial nerve is consider a complication in neck dissection and can be related to different factors including traction, devascularisation or the conduction block due to diathermy. Material and Methods: Prospective, crossover study including patients treated bilateral selective neck dissection of level IIa during a 12 months-period, was performed to evaluate the efficacy of the Hayes-Martin manoeuvre to prevent nerve injury during the use of cold or monopolar diathermy dissection. Results: 20 patients met the inclusion criteria (40 neck dissections). Just one case of a right temporal MMN weakness in the post-operative period was observed (1/40 = 2,5%). There were no cases of permanent marginal mandibular nerve weakness using the Hayes-Martin manoeuvre Conclusion: The Hayes-Martin manoeuvre is a safe way to preserve MMN during neck dissection of level IIa, regardless of the type of dissection.

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Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance

Head & Neck ◽

10.1002/hed.21013 ◽

2009 ◽

Vol 31 (5) ◽

pp. 673-678 ◽

Cited By ~ 27

Author(s):

Martin D. Batstone ◽

Barry Scott ◽

Derek Lowe ◽

Simon N. Rogers

Keyword(s):

Neck Dissection ◽

Nerve Injury ◽

Patient Perception ◽

Mandibular Nerve ◽

Marginal Mandibular Nerve

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Carotid Endarterectomy

Neurosurgery ◽

10.1227/neu.0000000000000356 ◽

2014 ◽

Vol 75 (2) ◽

pp. 110-116 ◽

Cited By ~ 8

Author(s):

George A. C. Mendes ◽

Joseph M. Zabramski ◽

Ali M. Elhadi ◽

M. Yashar S. Kalani ◽

Mark C. Preul ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Nerve Injury ◽

Neurological Complication ◽

Skin Incision ◽

Nerve Injuries ◽

Transverse Incision ◽

Longitudinal Incision ◽

Marginal Mandibular Nerve ◽

Increased Risk ◽

Transverse Skin Incision

Abstract BACKGROUND: Cranial nerve injury (CNI) is the most common neurological complication associated with carotid endarterectomy (CEA). Some authors postulate that the transverse skin incision leads to increased risk of CNI. OBJECTIVE: We compared the incidence of CNI associated with the transverse and longitudinal skin incisions in a high-volume cerebrovascular center. METHODS: We reviewed the charts of 226 consecutive patients who underwent CEAs between January 2007 and August 2009. Pre- and postoperative standardized neurological evaluations were performed by faculty neurologists and neurosurgeons. RESULTS: One hundred sixty nine of 226 (75%) CEAs were performed with the use of a transverse incision. The longitudinal incision was generally reserved for patients with a high-riding carotid bifurcation. Mean patient age was 69 years (range, 45–91 years); 62% were men; 59% of patients were symptomatic and had high-grade stenosis (70%-99%). CNI occurred in 8 cases (3.5%): 5 (3%) in transverse and 3 (5.3%) with longitudinal incisions (P = .42). There were 2 marginal mandibular nerve injuries, 1 (0.6%) transverse and 1 longitudinal; 5 recurrent laryngeal nerve injuries, 4 transverse and 1 longitudinal; and 1 case of hypoglossal nerve injury associated with longitudinal incision. One hematoma was associated with CNI. All injuries were transient. Fourteen wound hematomas required surgical evacuation. CONCLUSION: The transverse skin incision for CEAs is not associated with an increased risk of CNI (P =.42). In this study, the incidence of CNI associated with the transverse incision was 3% (n = 5) vs 5% (n = 3) for longitudinal incisions. All CNIs were temporary.

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