Damage to local structures Flashcards
Types of Injury
Bisection from sharp dissection
Blunt injury from instrumentation or retraction
Diathermy injury from the instrument directly or burns from the pads
Entrapment pressure or incarceration due to suturing or closure of structures
In addition, remember that damage to local areas can cause damage elsewhere. For example, embolisation during carotid surgery can cause a stroke, whereas embolisation during aortic aneurysm repair to the lower limb can cause acute limb ischaemia.
Damaged in Appendicectomy
Iliohypogastric & Ilioinguinal nerves → chronic groin pain.
Inferior epigastric vessels → hematoma formation.
Damaged in Cholecystectomy
Risk: Common bile duct → bile leak, jaundice.
Vascular: Right hepatic artery → liver ischemia.
Damaged in Inguinal Hernia Repair
Nerves: Ilioinguinal, Iliohypogastric, Genitofemoral → numbness, pain.
Vascular: Spermatic cord vessels → testicular atrophy.
Damaged in Colectomy
Ureters → urinary complications.
Duodenum
Vascular: Inferior mesenteric artery → colonic ischemia
Damaged in Thoracotomy
Nerves: Long thoracic nerve → winged scapula.
Vascular: Intercostal arteries → hemothorax.
Damaged in Lobectomy
Nerves: Recurrent laryngeal nerve → hoarseness.
Vascular: Pulmonary vessels → bleeding or infarct.
Damaged in Craniotomy
Nerves: Cranial nerves depending on site (e.g., CN VII in acoustic neuroma).
Vascular: Middle cerebral artery branches → stroke risk.
Damaged in Spinal Surgery
Nerves: Spinal nerve roots → radiculopathy.
Vascular: Segmental arteries → spinal cord ischemia.
Damaged in Hip replacement
Sciatic nerve → foot drop.
Damaged in knee arthroscopy
Nerves: Saphenous nerve → sensory loss on medial leg.
Vascular: Popliteal artery → limb ischemia.
Damaged in shoulder surgery
Nerves: Axillary nerve → deltoid weakness.
Vascular: Circumflex humeral vessels → bleeding.
Damaged in Thyroidectomy
Nerves: Recurrent laryngeal nerve → hoarseness, airway issues.
Vascular: Superior thyroid artery → bleeding risk.
Damaged in Parotidectomy
Nerves: Facial nerve → facial asymmetry.
Greater auricular nerve (often sacrificed) - numbess to ear lobe and angle of jaw
Aurculotemporal nerve (branch of V3) - frey’s syndrome - (Gustatory sweating) due to aberrant reinnervation of sweat glands.
External Carotid Artery and its Branches
Risk: Superficial temporal and maxillary arteries run adjacent to the parotid.
Retromandibular Vein
Risk: Lies posterior to the gland and can cause significant bleeding if damaged.
Damaged in tonsillectomy
Nerves: Glossopharyngeal nerve → referred otalgia.
Vascular: External palatine vein → postoperative bleeding.
Damaged in submandibular gland excision
🧠 Nerves (Most Commonly Affected)
Marginal Mandibular Branch of the Facial Nerve (CN VII)
Injury Risk: Travels along the mandible, often just below the lower border.
Consequence: Weakness of the depressor anguli oris → asymmetrical smile or inability to depress the lower lip.
Prevention: Careful dissection above the mandibular border and identification of the nerve early in the procedure.
Lingual Nerve (Branch of CN V3)
Injury Risk: Lies superior to the submandibular duct and can be damaged during duct dissection.
Consequence: Loss of sensation and taste in the anterior two-thirds of the tongue.
Prevention: Gentle retraction of the nerve while ligating the duct.
Hypoglossal Nerve (CN XII)
Injury Risk: Runs deep to the posterior part of the gland.
Consequence: Ipsilateral tongue weakness with deviation to the affected side.
Prevention: Stay superficial and lateral to the mylohyoid muscle during dissection.
Great Auricular Nerve (C2–C3)
Injury Risk: During skin flap elevation.
Consequence: Sensory loss over the ear and angle of the mandible.
Prevention: Identify and preserve the nerve early when raising the flap.
🩸 Vascular Structures
Facial Artery and Vein (primary blood supply to the gland)
Injury Risk: Artery is often ligated during gland excision, but care is needed to avoid excessive bleeding.
Consequence: Hemorrhage or hematoma formation.
Lingual Artery (branch of external carotid artery)
Injury Risk: Proximity to the gland’s posterior aspect.
Consequence: Profuse bleeding if accidentally severed.
🦴 Other Structures
Submandibular Duct (Wharton’s Duct)
Injury Risk: Easily transected during dissection.
Consequence: Salivary leakage, fistula, or sialocele.
Prevention: Identify and ligate the duct properly.
Mylohyoid Muscle (forms the floor of the mouth)
Injury Risk: During dissection of the gland’s deep portion.
Consequence: Impaired oral floor integrity.
⚠️ Postoperative Complications
Facial asymmetry (marginal mandibular nerve)
Tongue numbness or dysgeusia (lingual nerve)
Tongue deviation and speech issues (hypoglossal nerve)
Salivary fistula or sialocele (duct injury)
Hematoma or bleeding (facial/lingual artery)
