Motor speech malfunction following carotid endarterectomy

Cranial nerve injury during carotid endarterectomy is a well-recognized complication of this procedure. The evaluation of the extent of the injury and the persistence of the malfunction is difficult to accomplish with conventional methods. A protocol designed to evaluate motor speech function was administered to 36 patients prior to carotid endarterectomy, 2 days after surgery, and 6 weeks postoperatively. The protocol included assessments of hypoglossal nerve function, superior-recurrent laryngeal function, glossopharyngeal nerve function, and integrated motor speech ability. Direct laryngoscopy also was performed at the same time intervals. The total number of operations was 40. Hypoglossal nerve palsy was present in eight (20%) and superior-recurrent laryngeal nerve palsy was found in 11 (27.5%). Seven (17.5%) had malfunction of the vocal cords by the second postoperative day. Only seven (17.5%) of the above cases were detected by the spontaneous speech sample. The malfunction persisted by the sixth postoperative week in one patient (2.5%) with hypoglossal palsy and in two (5%) with superior-recurrent laryngeal palsy (one of them with ipsilateral vocal cord paralysis). We think that motor speech-related difficulties are far more common following carotid endarterectomy than is generally believed, and although these difficulties are, by far, temporary in course, they deserve attention, especially in cases of planned bilateral carotid endarterectomy.