A Prospective Survey of the Incidence of Cranial and Cervical Nerve Injuries After Carotid Surgery.

BACKGROUND: To prospectively evaluate the involvement of the cranial nerves and cervical plexus branches during carotid surgery and to look for risk factors. METHODS: All patients (n = 50) undergoing carotid endarterectomy between June 1st and October 31st, 2016 in our center were evaluated prospectively. A complete neurological examination was done before the intervention then daily until hospital discharge, and then at 2 months, 6 months and 1 year. A nasal endoscopy was systematically performed postoperatively before discharge by an ear, nose, and throat specialist. RESULTS: Twenty-six patients (52%) had at least one damaged nerve immediately after surgery. There were 15 cases involving the VII nerve (30%), 12 the C2-C3 branches (24%), 7 the XII nerve (14%), and 2 the X nerve (4%). At 2 months, 6 months, and 1 year, 22%, 16%, and 8% of lesions remained, respectively. We found no independent factor for nerve damage at 6 months or 1 year. In the case of dysphonia and/or dysphagia without recurrent nerve paralysis, 6 hematomas and 7 laryngeal edemas were identified under nasal endoscopy and all healed without sequelae. CONCLUSIONS: This prospective study showed cranial and cervical nerve injury to be much more frequent than expected in the short-term, when assessed by independent ear, nose, and throat and nasal endoscopy exam. Though mainly transient, these lesions can cause post-operative functional discomfort and must be disclosed preoperatively to the patient, in view of the judicialization of health care.

A French survey of contraceptive implant migration to the pulmonary artery.

OBJECTIVE(S): To quantify implant migration to the pulmonary artery in France since 2012 and to describe the diagnoses and treatments. STUDY DESIGN: We surveyed 780 physicians of the French national implant-referral network, the French Society of Chest and Cardiovascular Surgery, and the French Radiology Society about diagnosis of implant migration to the pulmonary artery vasculature. We evaluated total implant insertions in France using data from the Medic'AM database. RESULTS: We identified 12 cases from 2012 to 2017. Ten of the cases were asymptomatic. Five devices were removed via interventional radiology, five surgically, and two were left in place. The number of insertions in France during the same years was approximately 1,200,000. CONCLUSION(S): Pulmonary artery migration following contraceptive implant insertion is rare with a migration incidence of 1 in 100,000. Most cases were diagnosed incidentally.