Base of skull internal carotid and internal jugular gunshot wounds treated conservatively: inadequate treatment, or was well enough left alone?

Zone three carotid injuries present problems of access in emergency situations. Not only are the methods time consuming, but they also put certain structures in the neck at risk. A patient was treated at this institution with a large calibre gunshot injury of the right internal carotid and internal jugular vein. He was neurologically intact and his bleeding had been completely controlled. A decision was made to treat him conservatively and he recovered uneventfully with no neurological deficit and no further bleeding. Emergency exposure of the distal carotid artery involves dislocating the mandible, putting the facial nerve and parotid gland at risk of injury. Base of skull carotid injuries are best treated expectantly if there is no active bleeding or progressive neurological impairment. Careful follow-up is required to diagnose and treat carotid-jugular fistulas, false aneurysms and stenoses early.