Cranial and cervical nerve injuries: local complications of carotid artery surgery.

Injury to the nervous structures extending through the operative field or in areas adjacent to it constitutes a local complication in surgery of the carotid artery. These lesions may become, after an otherwise well-tolerated reconstruction, the source of severe and, occasionally even permanent, complaints. In a series of 536 operations of the carotid artery, 14.4% of transient and 6% of permanent injuries to some of the distal cranial and cervical nerves occurred. The highest injury rate was observed in the hypoglossal nerve (8.6%), followed by the marginal mandibular branch of the facial nerve (6.2%) and the vagus nerve with its superior and recurrent laryngeal branches (3.7% of cases). Injury to the glossopharyngeal nerve and the greater auricular nerve occurs very rarely. A thorough knowledge of the topographic and anatomical situation combined with a cautious operation technique may lower the frequency of these lesions. That is why the essential data on the anatomy, function and the most frequent causes of injury to the individual nerves sustained during surgery within the trigonum caroticum are presented in this article.