From the Department of Anesthesia, Critical Care and Pain Medicine.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
A A Pract. 2020 Oct;14(12):e01331. doi: 10.1213/XAA.0000000000001331.
Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal cord. Vagus nerve injury can cause vocal cord dysfunction. Intraoperative vocal cord monitoring can detect vagus nerve injury during CEA. A patient with distorted neck anatomy from radiotherapy to treat oropharyngeal cancer and resultant right vocal cord paralysis required left CEA. Anticipating difficult neck dissection risking vagus nerve damage with associate RLN malfunction, we added vocal cord electromyography (EMG) to routine CEA electroencephalography (EEG). We recommend vocal cord EMG in anatomically complex CEA to avoid vagus nerve injury.
迷走神经损伤可能使颈动脉内膜切除术（CEA）复杂化。喉返神经（RLN）发自迷走神经，支配同侧声带。迷走神经损伤可导致声带功能障碍。CEA 术中声带监测可检测迷走神经损伤。一位因治疗口咽癌而接受放疗导致颈部解剖结构扭曲、右侧声带麻痹的患者需要行左侧 CEA。我们预计颈部解剖结构复杂，行颈清扫术可能会损伤迷走神经并导致 RLN 功能障碍，因此在常规 CEA 脑电图（EEG）监测中加入声带肌电图（EMG）监测。我们建议在解剖结构复杂的 CEA 中使用声带肌电图监测，以避免迷走神经损伤。
