Comparison of Mandibular Surgical Techniques for Accessing Cranial Base Vascular Lesions

This study compared mandibular distraction and vertical ramus osteotomy in terms of their effectiveness at increasing access to the cranial base and distal internal carotid artery. Five fresh-frozen cadavers were used to obtain a total of ten cranial base exposures. The following two techniques were evaluated on each of the ten exposures: (1) anterior distraction of the mandible without violation of the temporomandibular joint capsule, and (2) vertical ramus osteotomy of the mandible with distraction of the proximal and distal segment. The neutrally positioned mandible with the condyle seated in the glenoid fossa served as the control. The area of surgical access defined by bony and cartilaginous landmarks was determined for each technique using the nondistracted control as a baseline.The vertical ramus osteotomy group provided greater increase in surgical access with approximately a 99.64 % increase compared with the control and a mean area of exposure of 14.653 cm(2). Mandibular distraction provided only a 28.32 % increase with a mean area of 9.252 cm(2). The control or nondistracted baseline mean area of exposure was 7.214 cm(2). Vertical ramus osteotomy significantly increased access to cranial base vascular lesions with minimal morbidity. It afforded greater and more reliable access than that achieved by the mandibular distraction technique. The procedure can be completed rapidly with no additional skin incisions.