颈动脉内膜切除术治疗颈动脉高位分叉及广泛病变后的首次咬伤综合征:2例报告及文献复习。

NMC Case Report Journal Pub Date : 2022-08-20 eCollection Date: 2022-01-01 DOI:10.2176/jns-nmc.2022-0141
Tomoaki Akiyama, Tsutomu Hitotsumatsu
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摘要

第一咬综合征(FBS)是颈动脉内膜切除术(CEA)极为罕见的并发症。FBS表现出独特的特征,在每顿饭的第一口时,同侧腮腺区出现短暂而剧烈的疼痛,并随着随后的咀嚼而改善。在此,我们报告两例CEA后的FBS。两例均有颈动脉高分叉和颈高病变的解剖困难。舌动脉和面动脉(或其共同动脉干)从颈外动脉(ECA)分叉,靠近颈动脉高分叉。手术需要将颈动脉远端暴露于这两个分支和颈动脉远端(ICA),并进行更大范围的剥离以夹紧血管。CEA后几天或几周,患者出现FBS,并在随后的几周内他们的进餐相关疼痛完全消失。特别是在颈动脉分叉高的患者中,ECA的几个分支往往起源于ECA的近端,类似于章鱼臂。在CEA期间,在这些患者中,需要在更大范围内解剖ECA及其分支周围,以暴露每条血管并放置交叉钳。这些手术可能导致颈外神经和神经丛损伤,可能导致FBS。此外,由于颈上神经节、颈外神经和ICA远端位置近,操作暴露高斑块远端可增加颈交感神经损伤的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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First Bite Syndrome after Carotid Endarterectomy for High Carotid Bifurcation and Extensive Lesions: Two Case Reports and Literature Review.

First bite syndrome (FBS) is an extremely rare complication of carotid endarterectomy (CEA). FBS presents with unique characteristics, development of brief and intense pain in the ipsilateral parotid region at the first bite of each meal, and improvement with subsequent mastication. Here, we report two cases of FBS following CEA. Both cases had anatomical difficulty of a high carotid bifurcation and a high cervical lesion. The lingual and facial arteries (or their common arterial trunk) branched off the external carotid artery (ECA) close to a high carotid bifurcation. The operations required exposure of the ECA distal to these two branches and the distal internal carotid artery (ICA) with a wider range of dissection for clamping the vessels. Several days or weeks after CEA, the patients developed FBS, and their meal-related pain completely resolved in the ensuing weeks. Especially in patients with a high carotid bifurcation, several branches of the ECA tend to originate from the proximal portion of the ECA, similar to octopus arms. During CEA, in these patients, dissection around the ECA and its branches in a wider range is required for exposure of each vessel and placement of the cross-clamp. These procedures can lead to injury to the external carotid nerve and plexus, possibly causing FBS. Additionally, because of the close location of the superior cervical ganglion, external carotid nerves, and distal ICA, manipulation for exposure of the distal end of a high plaque can increase the risk of injury to the cervical sympathetic nerves.

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