Do neck incisions influence nerve deficits after carotid endarterectomy?

J. J. Skillman, K. C. Kent and E. Anninos
Department of Surgery, Beth Israel Hospital, Boston, Mass.

OBJECTIVES: To determine whether transverse neck incisions for carotid endarterectomy were associated with a similar or greater incidence of cranial nerve complications when compared with vertical skin incisions, and to assess the patient's perception of the appearance of the incision. DESIGN: Prospective, but not randomized. SETTING: A university-affiliated tertiary care hospital. PATIENTS/INTERVENTIONS: Eighty-five consecutive carotid endarterectomy procedures were evaluated prospectively in 80 patients. Although patients were not randomly assigned, consideration was given to having approximately the same number of patients who had carotid endarterectomy performed through transverse neck incision as through vertical neck incision. Forty-four carotid endarterectomies were performed with a vertical incision and 41 procedures were performed with a transverse incision. MAIN OUTCOME MEASURE: To determine the incidence of cranial nerve dysfunction (primarily nerves VII and XII) after operation. RESULTS: The incidence of palsies of cranial nerves VII and XII in the two groups was similar; there was no statistical significance (the seventh nerve palsy, 32% transverse vs 25% vertical; the 12th nerve palsy, 15% transverse vs 20% vertical). Seventy-two percent of the deficits had disappeared by the 3- to 6-month follow-up. Patients expressed a clear preference for the transverse incision (P = .04). CONCLUSIONS: Although surgical exposure was simpler with the vertical incision, adequate exposure with the transverse incision was always possible. The incidence of mostly temporary deficits of cranial nerves VII and XII was similar. Patients favored the transverse incision.