This lawsuit stems from the devastating nerve damage caused by a surgeon attempting to remedy his patient’s ulcerated plaque with a left carotid endarterectomy. During the procedure, the only hypoglossal nerve had been identified, and was believed to be high enough above the split between the right internal carotid artery to avoid any damage. Nevertheless, signs of debilitating nerve harm began to appear after the procedure, when the patient complained of a globus sensation, difficulty swallowing liquids, vocal hoarseness, left lip numbness, and a facial droop. Eventually, the patient was diagnosed with left vocal cord paralysis and dysfunction of the left marginal mandibular branch of the facial nerve. An expert was asked to review the patient’s records for the lawsuit, and opine on whether the standard of care of the operative technique used was met, and whether anything could have been done differently to improve the patient’s plaque without initiating further harm.
Question(s) For Expert Witness
- 1. How many carotid endarterectomies do you perform per month?
- 2. What anatomical landmarks need to be identified during a carotid endarterectomy, and what nerves are usually present in the operative field?
Expert Witness Response E-046368
I have lectured and published on the subject of carotid endarterectomy, but not specifically on this complication – though I have seen similar cases before. A responsible pre-operative evaluation typically includes imaging to determine where the carotid bifurcation is and what the extent of the disease is to ensure that there is normal carotid artery distal to the disease that will be accessible in surgery.
Expert Witness Response E-098302
I perform 3-5 carotid endarterectomies per month, and have taught this topic to medical students and residents. Anatomical landmarks that must be identified during such a procedure are the vagus nerve throughout its course with the dissection, the ansa, and the greater auricular nerve during initial incision. Awareness of the hypoglossal nerve is important but it does not necessarily need to be identified.