{"title":"Facial Swelling and Neuritis After Internal Carotid Endarterectomy in an 81-Year-Old Woman With Type 2 Diabetes Mellitus: A Case Report.","authors":"Jennifer A Simpson","doi":"10.1093/ptj/pzae118","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Patients with type 2 diabetes mellitus (DM2) may develop carotid artery stenosis (CAS), requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized post-operative side effect. This case report describes the diagnostic process and rehabilitation course of a patient with greater auricular and trigeminal neuritis symptoms following internal CEA.</p><p><strong>Methods: </strong>The patient is an 81-year-old woman with DM2 who underwent a left internal CEA. She subsequently developed swelling in her left neck and face, and pain along the greater auricular and trigeminal nerve pathways. Pertinent examination findings included incision placement across the path of the greater auricular nerve and cervical lymphatic vessels that drain the face, with overlying scar adhesion. A course of physical therapy was initiated 12 days after surgery, and included mobilization and manual lymphatic drainage, modalities, and application of kinesiotape.</p><p><strong>Results: </strong>The Patient Specific Functional Scale (PSFS) improved from 10/30 at evaluation to 27/30 at discharge. Swelling and pain were significantly reduced, with patient reporting no difficulty with sleeping, chewing, or talking at discharge. The reported pain level consistently correlated with fluctuations in face swelling throughout treatment.</p><p><strong>Conclusion: </strong>Patients with DM2 may present with symptoms of cardiovascular disease, requiring invasive surgical procedures. DM2 can cause damage to neural and vascular structures, predisposing patients to nerve injuries or hypersensitivity following procedures. This case report demonstrates a likely connection between post-operative facial swelling and nerve irritation in the head and neck. Mobilization and manual lymphatic drainage, modalities, and kinesiotape were effective to reduce pain and swelling.</p><p><strong>Impact: </strong>Physical therapists are uniquely qualified to identify, evaluate, and treat post-operative swelling and nerve pain associated with CEA.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physical Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ptj/pzae118","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Patients with type 2 diabetes mellitus (DM2) may develop carotid artery stenosis (CAS), requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized post-operative side effect. This case report describes the diagnostic process and rehabilitation course of a patient with greater auricular and trigeminal neuritis symptoms following internal CEA.
Methods: The patient is an 81-year-old woman with DM2 who underwent a left internal CEA. She subsequently developed swelling in her left neck and face, and pain along the greater auricular and trigeminal nerve pathways. Pertinent examination findings included incision placement across the path of the greater auricular nerve and cervical lymphatic vessels that drain the face, with overlying scar adhesion. A course of physical therapy was initiated 12 days after surgery, and included mobilization and manual lymphatic drainage, modalities, and application of kinesiotape.
Results: The Patient Specific Functional Scale (PSFS) improved from 10/30 at evaluation to 27/30 at discharge. Swelling and pain were significantly reduced, with patient reporting no difficulty with sleeping, chewing, or talking at discharge. The reported pain level consistently correlated with fluctuations in face swelling throughout treatment.
Conclusion: Patients with DM2 may present with symptoms of cardiovascular disease, requiring invasive surgical procedures. DM2 can cause damage to neural and vascular structures, predisposing patients to nerve injuries or hypersensitivity following procedures. This case report demonstrates a likely connection between post-operative facial swelling and nerve irritation in the head and neck. Mobilization and manual lymphatic drainage, modalities, and kinesiotape were effective to reduce pain and swelling.
Impact: Physical therapists are uniquely qualified to identify, evaluate, and treat post-operative swelling and nerve pain associated with CEA.
目的：2 型糖尿病（DM2）患者可能会出现颈动脉狭窄（CAS），需要手术治疗。颈动脉内膜剥脱术（CEA）后的神经损伤是一种罕见的术后副作用，而且往往未被认识到。本病例报告描述了一名内CEA术后出现大耳廓和三叉神经炎症状的患者的诊断过程和康复过程：患者是一名 81 岁的女性，患有 DM2，接受了左内 CEA 手术。随后，她的左颈部和面部出现肿胀，沿大耳廓和三叉神经通路出现疼痛。相关检查结果显示，切口位于大耳廓神经和颈部淋巴管的路径上，并有疤痕粘连。术后12天开始进行物理治疗，包括活动和人工淋巴引流、各种模式和运动磁带的应用：结果：患者特定功能量表（PSFS）从评估时的10/30提高到出院时的27/30。肿胀和疼痛明显减轻，出院时患者在睡眠、咀嚼或说话方面没有任何困难。在整个治疗过程中，患者报告的疼痛程度与脸部肿胀的波动一致：结论：DM2患者可能会出现心血管疾病症状，需要进行侵入性手术治疗。DM2 可导致神经和血管结构受损，使患者在手术后容易出现神经损伤或过敏。本病例报告显示，术后面部肿胀与头颈部神经刺激之间可能存在联系。调动和人工淋巴引流、各种方式和运动胶带都能有效减轻疼痛和肿胀：物理治疗师在识别、评估和治疗与 CEA 相关的术后肿胀和神经疼痛方面具有独特的资质。
期刊介绍：
Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.
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