A carotid endarterectomy surgical expert was asked to opine on a malpractice case involving a patient who sustained significant nervous damage during his endarterectomy. Originally requiring the endarterectomy to reduce his risk of stroke, the patient began to experience postoperative complications after his surgeon allegedly injured his hypoglossal nerve. After the procedure, there was no mention of any potential nerve damage until the patient was readmitted to the hospital for being incapable of speaking or swallowing properly. His surgeon never referred him to a neurology consult, and instead informed the patient that he ought to undergo speech therapy. The patient continued to suffer multiple complications from the injury, and claimed that he had been a victim of malpractice.
Question(s) For Expert Witness
- 1. How can the risk of this type of patient injury be reduced?
- 2. What measures should be taken intraoperatively and postoperatively when injury to the hypoglossal nerve is suspected?
Expert Witness Response E-050499
On average, I have been performing 2-4 carotid endarterectomies every month for last eleven years. I have never transected the nerve, but I have had temporary stretch injury to the nerve. Typically, the nerve should be visualized and spared every time. If the nerve is injured, and the injury is recognized, then the doctor should consult a surgeon who does nerve repairs, either a neurosurgeon or an otolaryngologist.