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Chirurgia 2014 April;27(2):97-9

language: English

Injury to the marginal mandibular branch of the facial nerve during carotid endarterectomy: a case report

Sato K. 1, Shimizu S. 2, Oka H. 1, Osawa S. 1, Fujii K. 1

1 Department of Neurosurgery Kitasato University School of Medicine Sagamihara, Kanagawa, Japan;
2 Department of Neurosurgery Yokohama Stroke and Brain Center, Yokohama, Japan


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A 69-year-old man was underwent carotid endarterectomy (CEA). We made a skin incision 2 cm below the margin of the mandible along the sternocleidomastoid muscle, exposing the right internal carotid artery 2.5 cm distally from its bifurcation using a blunt-pronged self-retraining retractor. Postoperatively, there was ipsilateral paralysis of the lower mouth. Electrophysiological study revealed that the compound muscle action potential of the mentalis muscle evoked by stimulation of the marginal mandibular branch (MMB) of the facial nerve was low in amplitude and delayed in terminal latency in the affected side. The MMB palsy gradually improved within 3 months. Injury to the MMB due to compression by the reatractor should be kept in mind during CEA, especially in cases requiring to expose the high positioned plaque.

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