A 65-year-old man presented in his physician\'s office complaining of frequent h

Question

A 65-year-old man presented in his physician's office complaining of frequent headaches focused primarily on the right side and a series of four episodes of transient dysfunction involving the left side of his body during the last two months. These episodes involved progressive symptoms, beginning with only numbness in his left hand during the first episode, muscle weakness in his left arm and left leg during the second and third episodes, and limb weakness accompanied by slurred speech during the fourth episode. An arteriogram (a radiograph demonstrating the diameter of an artery) revealed stenosis (narrowing) of the right carotid bifurcation and mild left-sided.carotid.st advised that he should undergo a carotid endarterectomy (surgical procedure for removing an occlusion from an artery). immediately in order to prevent an otherwise imminent stroke. The patient submitted to the surgery, which was performed without incident, and has experienced no further headaches or episodes of left-sided dysfunction. sis, The patient was What structures are particularly vulnerable to damage due to their presence in or near the carotid sheath when an endarterectomy is performed? (Consider all of the nerves and vessels in this region)

Explanation / Answer

Vulnerable nerves include hypoglossal nerve, recurrent laryngeal nerve, superior laryngeal nerve, marginal mandibular nerve and greater auricular nerve. During surgery these nerves may be damaged causing either temporary or permanent loss of some functions in the area like hoarseness of voice, weakness or numbness on the side of face.

Others include bleeding at the site of the wound leading to neck haematoma, airway compression are possible. Wound infection, narrowing of carotid artery (restenosis) can also occur.

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