ABSTRACT
Arterial spasm is rarely encountered in the uncomplicated cervical lymphadenectomy. Intense, often dramatic, vasospasm of the internal carotid artery, however, is not infrequently observed in the removal of skull-base lesions. This myogenic reaction is independent of autonomic innervation, occurs more frequently in younger patients, and appears to be due mainly to longitudinal arterial traction and prolonged arterial contact with fresh blood. A case of severe internal carotid artery spasm, which led to a fatal stroke in a young woman who underwent removal of a large glomus jugulare tumor, is presented to emphasize not only the lethal potential of carotid spasm, but intraoperative changes in the character of the artery which suggest the need for immediate spasmolysis. Perioperative guidelines for the prevention and treatment of arterial spasm--including topical and systemic pharmacotherapy and refined surgical techniques--are outlined on the basis of our subsequent experience.
Subject(s)
Carotid Artery Diseases/etiology , Cerebrovascular Disorders/etiology , Glomus Jugulare Tumor/surgery , Paraganglioma, Extra-Adrenal/surgery , Spasm/etiology , Vasoconstriction , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/physiopathology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/physiopathology , Cerebrovascular Disorders/physiopathology , Female , Humans , Intraoperative Complications , Middle Aged , RadiographyABSTRACT
The risks of causing further harm to the facial nerve are greater in surgery for partial facial paralysis. We present a new active and passive reconstruction technique for paralysis of the buccal-mandibular divisions of the facial nerve. Our fascial pulley technique of reanimation and suspension of the oral commissure produces no further injury to the facial nerve and the eyelids. In addition, it adds a better technique to the armamentarium of the reconstructive surgeon dealing with partial lower facial nerve paralyses.
