In persistent and exhaustive neuralgia of the fifth nerve, when all other methods have proved ineffectual, ligature of the common carotid should be practised. The external carotid of one or both sides should first be tied, below the lingual (the point of election). If this fails the common trunk upon the affected side may be secured. The operation is contra-indicated when pressure upon ihe common carotid of the affected side does not arrest the pain. SURGICAL HISTORY OF CAROTID ARTERIES. 139 In hemiplegia or headache the ligature of the common carotid is not justifiable. Ligature of both common carotids simultaneously is not justifiable. Ligature of both vessels, with an interval of from one week to one year, is not as dangerous as might be expected, the danger being less as the interval is greater. When the importance of tying the external carotid for all lesions of the regions to which it is distributed is fully appreciated and practised by surgeons, the double ligature of the primitive carotids will probably not appear in the future records of surgery; while ligature of the common carotid, with its startling mortality of 41 per cent., will be confined to those emergencies in which it alone is involved. The relation oF the branches of the external carotid to each other (the average of 121 dissections). <Callout type="warning" title="Dangerous Procedure">Ligature of both common carotids simultaneously can lead to severe complications and should only be performed in extreme cases.</Callout> The thyroid, lingual, on trunk. facial, from a (31 in 121.) (Life size.) trunk. (2 in 121.) (Life size.) relation of the first are branches of the external carotid to each other. (Life size.) arrangement. (Full size.) Surgical Anatomy and Operative Surgery of the Innominate and Subclavian Arteries and Their Branches, The Arch of the Aorta, and Its Relations to the Surgical Anatomy and Operative Surgery of the Neck.
Key Takeaways
- Ligature of the common carotid is a last resort for severe neuralgia when other methods fail.
- Double ligature of both common carotids should only be performed with significant intervals between procedures to reduce risk.
- Tying the external carotid artery is preferred over double ligature of primitive carotids in most cases.
Practical Tips
- Always attempt less invasive methods before considering ligature for neuralgia treatment.
- Monitor patients closely after single common carotid ligature to detect any adverse reactions early.
- Understand the anatomy and branching patterns of external carotid arteries to avoid complications during surgery.
Warnings & Risks
- Ligature of both common carotids simultaneously can result in high mortality rates (41%).
- Double ligature procedures should only be performed with significant intervals between them.
- Pressure on the common carotid artery without pain relief indicates contraindication for this procedure.
Modern Application
While the historical techniques described here are no longer standard practice, understanding their rationale and risks is crucial. Modern medicine has advanced surgical methods that minimize risk and improve patient outcomes. However, knowledge of these older procedures provides valuable context for medical history and can inform contemporary emergency response strategies.
Frequently Asked Questions
Q: What is the recommended procedure for treating persistent neuralgia?
For persistent neuralgia, ligature of the common carotid should be considered if all other methods have failed. However, it must first be determined that pressure on the affected side does not arrest pain.
Q: Why is ligature of both common carotids discouraged?
Ligature of both common carotids simultaneously is highly dangerous and should only be performed in extreme cases due to a high mortality rate of 41%.
Q: What are the risks associated with double ligature procedures?
Double ligature procedures, especially when done without significant intervals between them, can lead to severe complications and increased risk of adverse outcomes.