Punjabi A P, Plaisier B R, Haug R H, Malangoni M A
University of Miami/Jackson Memorial Hospital, FL, USA.
J Oral Maxillofac Surg. 1997 Dec;55(12):1388-95; discussion 1396. doi: 10.1016/s0278-2391(97)90634-0.
Traumatic occlusion of the internal carotid artery (ICA) is a rare complication of maxillofacial trauma or surgery. This investigation evaluated patient demographics, diagnostic methods, and effective therapeutic modalities associated with blunt carotid injury (BCI).
This was a retrospective analysis of patient records with an ICD-9-CM diagnosis of carotid injury conducted at MetroHealth Medical Center during the 24-month period between August 1993 and July 1995. Carotid injuries attributable to penetrating trauma were excluded. Age, gender, cause of injury, Glasgow Coma Scale score, Injury Severity Score, type and location of injury, concomitant injury, diagnostic methods, treatment modalities, and outcome were identified, recorded, and analyzed.
During the 24-month period, 12 patients (seven males and five females) suffered BCI. These patients were divided into two groups based on cause of the problem. In group I, there were 3,214 blunt trauma patients admitted during the 2-year study, of which 10 patients had BCI, representing 0.31% of blunt trauma patients, and 1.2% of patients with head injuries. Seven patients presented with hemiplegia, two with cranial nerve palsy, and one with perceptual neglect. Ninety percent of the patients had associated injuries. Two patients had surgical intervention, three received anticoagulation, and five had only supportive care. Four of the 10 patients died, four had moderate neurologic deficits, and two survived with only minor neurologic deficits. In group II, two patients developed BCI after surgery. A 52-year-old woman had a carotid injury after right total temporomandibular joint replacement, and a 48-year-old man who underwent surgical removal of a third molar became hemiplegic postoperatively. The first patient recovered after anticoagulation, whereas the second patient, who received only supportive care, has severe neurologic deficits.
BCI is an uncommon entity. It is usually recognized when a patient develops an unexplained neurologic deficit, most often hemiplegia, subsequent to trauma or surgery of the head, face, or neck. In the early stages, the diagnosis can be missed by carotid ultrasound or computed tomography. The injury is unrelated to Glasgow Coma Scale score. Symptoms may not develop for days after injury in 50% of patients. Anticoagulation appears to be the most beneficial therapeutic modality.
颈内动脉（ICA）创伤性闭塞是颌面创伤或手术中一种罕见的并发症。本研究评估了与钝性颈动脉损伤（BCI）相关的患者人口统计学特征、诊断方法及有效的治疗方式。
这是一项对1993年8月至1995年7月期间在地铁健康医疗中心进行的ICD - 9 - CM诊断为颈动脉损伤的患者记录的回顾性分析。排除穿透性创伤所致的颈动脉损伤。确定、记录并分析患者的年龄、性别、损伤原因、格拉斯哥昏迷量表评分、损伤严重程度评分、损伤类型及部位、合并损伤、诊断方法、治疗方式及预后。
在这24个月期间，12例患者（7例男性和5例女性）发生了BCI。这些患者根据问题原因分为两组。在第一组中，在为期2年的研究期间收治了3214例钝性创伤患者，其中10例发生了BCI，占钝性创伤患者的0.31%，占头部损伤患者的1.2%。7例患者出现偏瘫，2例出现脑神经麻痹，1例出现感知忽视。90%的患者有合并损伤。2例患者接受了手术干预，3例接受了抗凝治疗，5例仅接受了支持治疗。10例患者中有4例死亡，4例有中度神经功能缺损，2例存活且仅有轻微神经功能缺损。在第二组中，2例患者在手术后发生了BCI。一名52岁女性在右侧全颞下颌关节置换术后发生颈动脉损伤，一名48岁男性在接受第三磨牙手术切除后术后出现偏瘫。首例患者抗凝治疗后康复，而第二例患者仅接受支持治疗，有严重神经功能缺损。
BCI是一种不常见的情况。通常在患者头部、面部或颈部创伤或手术后出现无法解释的神经功能缺损（最常见的是偏瘫）时被识别。在早期阶段，颈动脉超声或计算机断层扫描可能会漏诊。损伤与格拉斯哥昏迷量表评分无关。50%的患者在受伤数天后可能才出现症状。抗凝似乎是最有益的治疗方式。
