Dissection Technique for Carotid Endarterectomy Based on Cervical Layer Structure

Abstract

The adequate exposure of the distal portion of the internal carotid artery is not always easy, especially in high-positioned carotid endarterectomy. The layered structure surrounding the internal carotid artery consists of the retromandibular space, which includes the parotid gland, deep cervical fascia, sternocleidomastoid muscle, carotid sheath, and lymph nodes wrapped in fat tissue over the internal jugular vein. A precise understanding of these complex layered structures is essential for performing carotid endarterectomy safely. Dissection around the parotid gland along with the deep cervical fascia from the anterior edge of the sternocleidomastoid muscle is a crucial technique in high-positioned carotid endarterectomy. This procedure facilitates a wide opening of the retromandibular space. Dissecting between the deep cervical fascia and the lymph nodes wrapped in fat tissue prevents damage to the parotid gland in the retromandibular space.

This procedure also facilitates early exposure of the posterior belly of the digastric muscle, hypoglossal nerve, and the distal portion of the external carotid artery. Their early exposure greatly improves intraoperative orientation and ensures safe dissection of the deep cervical lymph nodes wrapped in fat tissue over the internal jugular vein. These dissection procedures, based on the cervical layer structure, consistently ensure a wide opening of the upper portion of the retromandibular space and adequate exposure of the distal portion of the internal carotid artery, even in high-positioned carotid endarterectomy.