This case involves a 62-year-old man who was diagnosed with a benign growth at the base of his skull. The patient underwent a neck dissection with resection of the tumor by an ENT. The ENT had originally intended to schedule a vascular surgeon to assist him with the surgery. On the day of the operation, the vascular surgeon did not show up, and it was discovered that he had never been called by the ENT. During the operation, there was a tear in the patient’s carotid artery. No vascular surgeon was available to help during the carotid injury. The patient subsequently suffered a stroke. It was alleged that the ENT surgeon did not know how to properly manage this complication and used an improper technique in order to repair the injury.
Question(s) For Expert Witness
- 1. What is your experience performing neck dissection for resection of vagal schwannomas?
- 2. When a tumor is encasing the carotid artery, is the ENT required to have a vascular surgeon available to assist?
- 3. Is the failure to obtain proximal and distal control of the carotid artery prior to resection of a tumor encasing the artery a deviation from the standard of care?
- 4. Once a tear in the carotid artery is recognized intra-operatively, what are the appropriate next steps in management?
Expert Witness Response E-037472
Neck dissection for resection of vagal schwannomas is common in my practice. When a tumor is encasing the carotid artery, you should have a vascular surgeon available to assist. You should also have proximal and distal control of the carotid artery prior to resection. Once a tear in the carotid artery is recognized intra-operatively, the next step is either primary repair or graft.
This highly qualified board-certified expert completed his residency in otolaryngology at an Ivy League university medical school and completed a fellowship in head and neck surgical oncology at a prestigious research hospital. He has published more than 180 peer-reviewed articles pertaining to thyroid and parathyroid diseases and is a member of multiple professional societies. He is currently the director of the multidisciplinary thyroid tumor center, the director of the division of head and neck endocrine surgery, the director of the head and heck fellowship and an endowed professor of otolaryngology at a top medical university.