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Double Mandibular Osteotomy for Access to High-Carotid Pathology
Michael Buckley1, Eric Carlson2, Eric Heidel3
1Division of Vascular Surgery, University of Tennessee, Knoxville, TN.
Annals of Vascular Surgery
|September 1, 2020
Summary
Double mandibular osteotomy (DMO) offers improved surgical access for high carotid artery pathology. While complications like dysphagia and malocclusion occurred, DMO provides acceptable outcomes for complex cases.
Area of Science:
- Vascular Surgery
- Head and Neck Surgery
- Surgical Anatomy
Background:
- Standard surgical techniques face limitations for superiorly located carotid pathology due to mandibular obstruction.
- High-carotid pathology necessitates enhanced surgical exposure for effective treatment.
- Double mandibular osteotomy (DMO) is a technique to improve access, but outcomes data are limited.
Purpose of the Study:
- To evaluate the outcomes of patients undergoing DMO for high-carotid pathology.
- To assess early and late complications associated with DMO.
- To compare DMO outcomes with previously reported techniques.
Main Methods:
- Retrospective case series of patients undergoing surgery for carotid pathology from 2011-2019.
- Inclusion criteria: carotid pathology requiring DMO for surgical access.
- Primary outcome: early and late complications; predictor variable: need for DMO.
Main Results:
- 16 DMOs performed in 15 patients for stenosis, aneurysms, or tumors.
- Early complications included dysphagia (5 patients) and malocclusion (2 patients).
- Late complications included osteomyelitis and screw exposure in one patient; no statistically significant differences in complications based on patient demographics or comorbidities.
Conclusions:
- DMO provides excellent surgical access to the distal internal carotid artery for complex vascular pathology.
- Outcomes and long-term complications are acceptable compared to alternative methods.
- Recommended for symptomatic patients unsuitable for medical or endovascular therapy, and for tumor resection.
