ABSTRACT
When a carotid artery is being exposed, there are a number of nerves that are potentially vulnerable to injury through lack of anatomic knowledge. These include the hypoglossal nerve, which should be visualized in a high exposure. As mentioned elsewhere in this text, it can be isolated with the vessel loop and retracted gently from the field. The vagus nerve, which lies deep to the CCA and carotid bulb, can be injured by placement of the DeBakey cross-clamp on the proximal CCA if it is not identified. The spinal accessory nerve is very high and customarily out of the field. However, in an extremely high exposure it is conceivable that the spinal accessory nerve could be damaged and this large nerve should be readily identified. The marginal mandibular branch of the facial nerve can be injured by retraction high in the submandibular region, and it may be impossible in a high case to avoid some degree of traction injury to this nerve. However, in my experience this has been a problem that resolved spontaneously. The recurrent laryngeal nerve can be injured by injudicious placement of retractors deep on the medial exposure, and for this reason, as stated elsewhere, I always use blunt retractors and always place them just under the skin on the medial side of the exposure, whereas laterally they can be placed deep under the sternocleidomastoid muscle and under the jugular vein if necessary.
