Mandibular subluxation for high carotid exposure.

Area of Science:

• Neurosurgery
• Vascular Surgery
• Otolaryngology

Background:

• Surgical access to internal carotid artery lesions above the second cervical vertebra can be challenging.
• Traditional methods for mandibular positioning are time-consuming and may have limitations.

Purpose of the Study:

• To evaluate the efficacy of mandibular subluxation for improved surgical exposure of the internal carotid artery.
• To assess the safety and efficiency of a modified wiring technique for mandibular subluxation.

Main Methods:

• Twenty-four patients with internal carotid artery lesions underwent mandibular subluxation.
• A novel circummandibular/transnasal wiring technique replaced the previous bilateral arch bar wiring.
• Mandibular condyle subluxation was performed to achieve anterior displacement of the mandibular ramus.

Main Results:

• The modified wiring technique reduced application time from 90 minutes to approximately 10 minutes.
• Mandibular subluxation provided increased exposure of the internal carotid artery up to the skull base.
• The technique transformed the surgical field from triangular to rectangular, enhancing visualization.

Conclusions:

• Mandibular subluxation is an effective technique for increasing surgical exposure of the internal carotid artery.
• The modified wiring technique is rapid, simple, and does not cause temporomandibular joint dysfunction.
• This approach offers a significant advantage for managing complex internal carotid artery pathologies.