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Mandibular subluxation for distal internal carotid exposure: technical considerations
G T Simonian1, P J Pappas, F T Padberg
1Division of Vascular Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2714, USA.
Journal of Vascular Surgery
|December 10, 1999
Summary
Mandibular subluxation (MS) improves surgical access for carotid endarterectomy (CEA) in challenging cases. Ivy loop/circumdental wiring is the preferred MS technique, enhancing distal internal carotid artery exposure without complications.
Area of Science:
- Vascular Surgery
- Oral and Maxillofacial Surgery
- Neurosurgery
Background:
- Carotid endarterectomy (CEA) is a common vascular procedure with proven benefits.
- Challenging CEA cases, including distal occlusive disease and high bifurcations, can limit surgical exposure.
- Limited surgical access may increase the risk of cranial nerve palsies.
Purpose of the Study:
- To determine and illustrate a preferred method of mandibular subluxation (MS).
- To assess the utility of MS as an adjunct to CEA for improved surgical exposure.
- To evaluate the safety and efficacy of MS in patients undergoing CEA.
Main Methods:
- MS techniques were chosen based on dental stability and periodontal health.
- All patients received general anesthesia with nasotracheal intubation.
- MS was performed in 10 patients requiring enhanced surgical access for CEA.
Main Results:
- Various stabilization methods were employed, with Ivy loop/circumdental wiring used in 7 patients.
- No cases of mandibular dislocation or postoperative cranial nerve palsies were observed.
- Transient temporomandibular joint discomfort occurred in 3 patients, resolving within 2 weeks.
Conclusions:
- Mandibular subluxation, combined with nasotracheal intubation, effectively enhances surgical exposure of the distal internal carotid artery.
- Ivy loop/circumdental wiring is recommended as the preferred MS technique.
- Alternative MS methods are suitable for patients with poor dental health.
