2023 Volume 51 Issue 5 Pages 390-396
We advocate early identification of the posterior belly of the digastric muscle for dissecting the distal internal carotid artery (ICA) during carotid endarterectomy (CEA). This method is characterized by early identification of the posterior belly of the digastric muscle and extensive utilization of the adjacent space. It avoids harm to the marginal mandibular branch of facial nerve and hypoglossal nerve, both of which are particularly susceptible to injury during the dissection of the distal ICA, and facilitates the creation of a substantial working space around it. In this study, we validated the outcomes of this technique in 191 consecutive patients. The incidence of damage to the marginal mandibular branch of facial nerve and hypoglossal nerve was 0.5%. This rate is lower than those reported in previous studies. The incidence of ipsilateral cerebral infarction within 30 days postoperatively did not increase even in cases of high-positioned CEA using this technique. We posit that this technique is also beneficial for mastering the procedure for dissecting the distal ICA, both safely and efficiently.
