Diagnosis of traumatic internal carotid artery injury: the role of craniofacial fracture

Optimally, internal carotid artery (ICA) injury associated with craniofacial trauma should be treated soon after diagnosis. However, diagnosis is difficult and often delayed. The typical symptoms and signs for diagnosis of traumatic ICA injuries are sometimes easily neglected. Clinically, some patients were initially diagnosed by craniofacial fracture nearby the course of ICA. This investigation retrospectively reviews clinical experience in patients with traumatic ICA injury with a focus on the importance of craniofacial fracture nearby the course of ICA observed on brain or facial bone computed tomography. Eighteen patients with traumatic ICA injury were diagnosed at Chang Gung Memorial Hospital, Taiwan, from June 1998 to April 2004, including 10 patients with pseudoaneurysm formation, seven patients with occlusion, and one patient with laceration. Brain or facial bone computed tomography was reviewed retrospectively. The sample included 14 (78%) patients with skull base fractures involving the intracranial course of ICA and three (17%) patients with mandibular and cervical spine fractures near the course of extracranial ICA. Only one (5%) patient did not have evident fracture. Fractures involving the carotid canal were noted in three (17%) patients. Eight patients received interventional treatments. No further interventional treatments for traumatic ICA occlusion were performed as a result of good collateral flow from contralateral ICA or large infarction noted when diagnosed. Three patients with pseudoaneurysm received expectant management. One patient with arterial laceration with extravasation received no further management. Through meticulously evaluating routine brain and facial bone computed tomography, craniofacial fracture involving intracranial or extracranial course of ICA may be an adjuvant indicator of traumatic ICA injury for early diagnosis.