Diagnosis of blunt carotid injury in patients with facial trauma.

OBJECTIVES

The purpose of this study was to review the clinical and diagnostic findings associated with blunt carotid artery injury, provide information related to clinical outcome, and report the findings of a retrospective study comparing patients with nonpenetrating and penetrating carotid artery injuries and the attendant facial injuries.

STUDY

DESIGN

Twenty-one patients admitted to the hospital nonelectively with a subsequent diagnosis of penetrating (11 patients) or nonpenetrating (10 patients) carotid artery injuries were included in the study. Records were analyzed for demographic data, mechanism of injury and time to diagnosis, neurologic status, presence of facial injuries, and outcome.

RESULTS

Five patients had facial injuries associated with a blunt carotid artery abnormality; six patients had penetrating carotid wounds. Time from carotid injury by all mechanisms to diagnosis was 20 minutes to 12 hours (mean 4 hours). Seventeen patients survived their injury.

CONCLUSION

Patients with completely asymptomatic head injuries and severe closed-head injuries must be given careful initial evaluation and subsequent secondary evaluation. The relatively high frequency of facial injuries associated with blunt carotid injury should alert the maxillofacial surgeon to consider the diagnosis.