Approach to Ligation of the External Carotid Artery

Overview

Ligation of the external carotid artery (ECA) is a surgical procedure used to control severe bleeding, manage certain vascular malformations, or as part of tumor resection. Understanding the anatomy, indications, and procedural details is crucial for successful outcomes.

Anatomy of the External Carotid Artery and Branches

The external carotid artery originates from the common carotid artery and supplies blood to the neck and face. Its branches include:

Variations in branching patterns and anatomical relationships with surrounding structures are common.

Indications

1. Control of severe hemorrhage

In cases of trauma or tumor bleeding.
2. Management of vascular malformations

Such as arteriovenous malformations (AVMs).
3. Tumor resection

To reduce blood supply to tumors.

Contraindications

1. Inadequate collateral circulation

Risk of cerebral ischemia or infarction.
2. Certain vascular diseases

Such as severe atherosclerosis.

Procedure of Ligation of the External Carotid Artery

Anesthesia

General anesthesia is typically used to ensure patient comfort and control.

Patient Positioning

The patient is positioned supine with the head slightly extended and rotated to the opposite side.

Skin Incision

A skin incision is made along the anterior border of the sternocleidomastoid muscle, typically at the level of the carotid bifurcation.

Dissection

1. Subcutaneous tissues and fascia

Dissection is carried through the platysma and deep cervical fascia.
2. Carotid sheath

The carotid sheath is identified and opened to expose the carotid arteries.

Identification of the External Carotid Artery

The ECA is identified by its branches and location anterior and medial to the internal carotid artery.

Ligation

1. Level of ligation

The ECA is ligated distal to the bifurcation and proximal to the branching point of significant collateral vessels.
2. Method

Double ligation with non-absorbable sutures (e.g., silk or polypropylene) is performed to ensure secure occlusion.
3. Suture type

2-0 or 3-0 sutures are commonly used.

Closure

The wound is closed in layers, approximating the sternocleidomastoid muscle and platysma, followed by skin closure.

Use of Drain

A drain may be placed to prevent hematoma formation.

Nasal Packing

If the procedure is related to nasal or facial bleeding, nasal packing may be used to control bleeding.

Postoperative Monitoring

1. Vital signs

Close monitoring of blood pressure, heart rate, and neurological status.
2. Wound care

Monitoring for signs of infection or hematoma.
3. Follow-up

Regular follow-up to assess the effectiveness of the procedure and manage any complications.

Ligation of the external carotid artery is a complex procedure requiring precise anatomical knowledge and surgical skill. Understanding the indications, procedural details, and postoperative care is essential for achieving successful outcomes and minimizing complications.

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