External carotid artery ligation surgery

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The external carotid artery is one of the two branches of the original carotid artery, which supplies blood to the facial neck region. Surgical ligation of the external carotid artery to stop bleeding in the ear, nose, throat, molars, skull

1. Indications for surgery

Surgical ligation of the external carotid artery is indicated when:
Injury to the carotid artery in the head and neck area. Nose bleeding, bleeding after tonsillectomy persists after using conventional hemostatic measures to no avail, bleeding in oral cancer. Prophylactic ligation in major head and neck surgery: Surgery to remove maxilla, cut tongue cancer, parotid gland cancer, nasopharyngeal fibroma...

2. Preparing for surgery

Performer: A grade I otolaryngologist with experience in external carotid artery ligation stands on the operating side, the assistant stands opposite the surgeon.
Means: 01 normal scalpel; 10 Kocher pliers; 10 Halstead pliers; 01 surgical pliers with teeth and 01 without teeth; 01 gutter clearance; thread pliers (01 Derchan), 02 balls Farabeuf ; 01 needle and needle pair pliers; 05 surgical towel pliers; 01 straight scissors; 01 curved stretch; 01 Kocher pliers 20 cm long; just.
Patients: Be prepared urgently and actively resuscitated, blood transfusion. If the patient has not lost a lot of blood, dolargan 0.10 can be injected intramuscularly; pipolphen 0.05; atropine 1/4mg x 2 ampoules.
Medical record: Full medical record of basic tests, tilt neck film, if there is an ultrasound, the better.

3. Steps to perform surgery

Anesthetize 1% xylocaine along the anterior border of the sternoclavicular-mastoid muscle 10 cm long. The patient lies supine on the table with padded shoulders and head turned to the non-operative side. Use an antiseptic solution, spread the surgical towel.
Stage 1: Skin incision and shallow neck fascia
Skin incision is 8cm long, starting at the level of the lower jaw angle and 1cm posterior to this jaw angle. The incision runs along the anterior border of the sternoclavicular muscle to the level of the cricoid cartilage. The first stroke makes an incision in the skin, subcutaneous tissues, skin-attached muscles and fat. The second stroke cuts the superficial cervical fascia along the anterior border of the sternoclavicular-mastoid muscle. If the jugular vein outside the pair is tied. Stage 2: Find the triangle Farabeuf
Pull the sternum - clavicle - mastoid to the outside, peel gently into the carotid trough. Farabeuf's triangle is defined by the internal jugular vein, the trunk of the thyroid gland, and the 12th nerve (transversely below the abdomen of the biceps muscle). Stage 3: Find the external carotid artery through 2 criteria
The external carotid artery is inside the internal carotid artery outside. The branched artery is the external carotid artery. (Find immediately in the Farabeuf triangle) Stage 4: External carotid ligation
Inject novocaine into the carotid capsule at the dihedral angle between the internal and external carotid arteries to compress and stimulate the carotid corpuscles. Use surgical forceps to thread, insert vicryl or perlon thread. The position of ligation of the external carotid artery will be about 1-2 cm above the carotid division in the external carotid artery. (do not tie at the division). It is possible to selectively tie each branch separately, armor or tongue or face. Then 5: Stitching: Using catgut thread to tie the paired small vessels, stitching to restore 2 layers, the inner layer is catgut, the outer layer is linen or nylon thread.

4. Monitoring and handling of accidents

Change the dressing every 3 days, 1 week after thread trimming.
Rare complications:
One-sided ligation:
Cerebral vascular occlusion: due to blood clot moving into the internal carotid system to the brain. Excessive reflexes of carotid sinus cause dizziness, deafness in the lateral region, pale face on the same side: injection of xylocaine will cure, but sometimes death. Brain complications: paralysis of 1/2 person, aphasia. Bilateral ligation: it's normal, but it can cause pale people and can be fatal in a few hours.
Timely performing external carotid artery ligation will prevent blood from flowing into the branches of this artery, stopping bleeding in the areas covered by this artery. Helps to effectively treat disease to increase the patient's recovery ability.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. examination and treatment at the Hospital.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
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