You are assisting the surgeon with a neck vascular

You are assisting the surgeon with a neck vascular procedure shown in the image. The surgeon is trying to obtain proximal and distal control of the vessels, but while trying to help with retraction, you pull and crush the structure labeled with the arrow. In the postoperative period, what examination will you perform on the patient to determine if the injury has resulted in any deficit?

A. Check the gag reflex

B. Ask the patient to push the tongue out

C. Ask if the patient can shrug the shoulders

D. Check the position of the uvula

  1. This is the anatomy of the common carotid and its bifurcation. Atherosclerosis is very common at the bifurcation, which often requires surgical removal.

  2. The hypoglossal nerve is sometimes mobilized during carotid surgery, especially when there is a high bifurcation

  3. Traction on the nerve can result in injury. The nerve usually crosses over the internal carotid about 3-5 cm away from the bifurcation

  4. In the post operative period it can present as ipsilateral deviation of the tongue

  5. Sometimes, this may also be associated with speech impairment and dysphagia. Recovery may take months