Surgical exposure of the high cervical carotid artery: experimental study and review

Difficulty in gaining access to the high cervical internal carotid artery (ICA) has thus far prevented effective operation for intimal repair and treatment of aneurysms at this level. Mobilization of the angle of the mandible by means of mandibular osteotomies considerably improves exposure to the high cervical ICA. This procedure has been performed in rhesus monkeys and in human cadavers. In monkeys, retromandibular external carotid artery-ICA anastomoses were carried out with no problems (neurological, wound healing, or other). This new technique should be considered for the management of some high cervical ICA lesions, particularly those occurring after closed cervical trauma.