Double Mandibular Osteotomy for Access to High-Carotid Pathology

Buckley, Michael R.; Carlson, Eric R.; Heidel, R. Eric; McNally, Michael M.; Hodge, Andrew; Fahmy, Mina D.; Arnold, Joshua D.; Grandas, Oscar H.; Freeman, Michael B.

doi:10.1016/j.avsg.2020.08.093

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…Invasive therapy for atherosclerotic carotid stenoses includes open surgery, stenting, or a combination of both [ 2 , 3 ]. Distal ICA lesions can only be approached with great difficulty by open surgery, either from the retromandibular fossa or by other means (e.g., the mobilization of the parotid gland, double mandibular osteotomy, or mandibular subluxation with styloidectomy) [ 4 , 5 , 6 , 7 ]. For this reason, stenting rather than open surgery is the invasive option for these patients, even for those who are symptomatic [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Nguyen

Bérczi

Nyárády

et al. 2022

JCM

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The aim was to evaluate the outcome of stenting in patients with isolated distal internal carotid artery (ICA) stenosis or post-surgical restenosis, as no data are currently available in the literature. Sixty-six patients (men, N = 53; median age: 66 [IQR, 61–73] years) with ≥ 50% distal ICA (re)stenosis were included in this single-center retrospective study. The narrowest part of the (re)stenosis was at least 20 mm from the bifurcation in all patients. Patients were divided into two etiological groups, atherosclerotic (AS, N = 40) and post-surgical restenotic (RES, N = 26). Postprocedural neurological events were observed in two patients (5%) in the AS group and in two patients (7.7%) in the RES group. The median follow-up time was 40 (IQR, 18–86) months. Three patients (7.5%) in the AS group had an in-stent restenosis (ISR) ≥ 50%, but none in the RES group. Three patients (7.5%) in the AS group and seven patients (26.9%) in the RES group died. None of the deaths in the RES group were directly related to stenting itself. The early neurological complication rate of stenting due to distal ICA (re)stenoses is acceptable. However, the mid-term mortality rate of stenting for distal ICA post-surgical restenoses is high, indicating the vulnerability of this subgroup.

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Section: Introductionmentioning

confidence: 99%

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Nguyen

Bérczi

Nyárády

et al. 2022

JCM

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“…When mandibular osteotomies (MDO) are planned, incisions can be extended along the submandibular and submental regions and the lower lip. 12 , 14 , 30 , 34 , 37 , 39 , 43 …”

Section: Discussionmentioning

confidence: 99%

“…Por outro lado, extensões pré-auriculares também foram descritas 4 , 9 , 37 , com a vantagem de facilitar a identificação do nervo facial. Quando há o planejamento de osteotomias mandibulares (OMD), as extensões podem ser realizadas ao longo das regiões submandibular, submentual e lábio inferior 12 , 14 , 30 , 34 , 37 , 39 , 43 .…”

Section: Discussionunclassified

“…Por outro lado, extensões préauriculares também foram descritas4,9,37 , com a vantagem de facilitar a identificação do nervo facial. Quando há o planejamento de osteotomias mandibulares (OMD), as extensões podem ser realizadas ao longo das regiões submandibular, submentual e lábio inferior12,14,30,34,37,39,43 .Além dessas estruturas, ramos cutâneos do plexo cervical, como o nervo auricular magno e o nervo cervical transverso, que cursam profundamente até a fáscia do músculo ECM, também podem ser lesados durante esse acesso, resultando em parestesia do lóbulo da orelha e da face anterior do pescoço5 .Em seguida, a maior parte dos autores orienta a dissecção ao longo da borda anterior (medial) do ECM para retração lateral3,[5][6][7][8][9][10][11][12][13][14][15][16][17]21,23,[25][26][27][28][32][33][34][35][36][37][38]40,[44][45][46][47][48][49]…”

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Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta – revisão integrativa da literatura e proposta de protocolo

et al. 2022

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Resumo Diversas manobras já foram descritas para o acesso ao segmento distal cervical da artéria carótida interna ou à bifurcação carotídea alta; entretanto, há divergências na sistematização dessas técnicas. O objetivo deste estudo é revisar as técnicas descritas e propor um protocolo prático que auxilie na seleção da técnica mais adequada para cada caso. Para isso, foi realizada uma busca nas bases de dados PubMed Central, Biblioteca Virtual em Saúde e SciELO por artigos sobre o tema, em língua inglesa ou portuguesa, publicados entre os anos de 1980 e 2021. Entre as manobras descritas, parece razoável que as duas etapas iniciais sejam a abordagem ao músculo esternocleidomastóideo, seguida pela secção/retração do ventre posterior do músculo digástrico. Caso necessário, a subluxação mandibular temporária unilateral é um recurso adicional e preferível à divisão do aparato estiloide, devido ao menor potencial de morbidade. Exposições ainda mais amplas podem ser obtidas com as osteotomias mandibulares.

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“…When mandibular osteotomies (MDO) are planned, incisions can be extended along the submandibular and submental regions and the lower lip. 12,14,30,34,37,39,43 In addition to these structures, cutaneous branches of the cervical plexus, such as the great auricular nerve and the transverse cervical nerve, which run deep until the fascia of the SCM muscle, may also be injured during this access, causing paresthesia of the earlobe and the anterior aspect of the neck. 5 Next, the majority of authors recommend dissection along the anterior (medial) margin of the SCM muscle for lateral retraction.…”

Section: First Stage (Conventional Access): Retraction Of the Scm Mus...mentioning

confidence: 99%

Surgical access to the distal cervical segment of the internal carotid artery and to a high carotid bifurcation – integrative literature review and protocol proposal

et al. 2022

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Several different maneuvers have been described for obtaining access to the distal cervical segment of the internal carotid artery or to a high carotid bifurcation. However there are different approaches to systematization of these techniques. The objective of this study is to review the techniques described and propose a practical protocol to support selection of the most appropriate technique for each case. The review is based on the results of database searches on PubMed Central, the Virtual Health Library (BVSalud), and SciELO for articles on the subject published in English or Portuguese from 1980 to 2021. Among the different maneuvers described, it appears reasonable that the first two steps should be to obtain access at the sternocleidomastoid muscle, followed by section or retraction of the digastric muscle posterior belly. If needed, temporary unilateral mandibular subluxation is an additional resource that is preferable to division of the styloid apparatus process, because of its lesser potential for morbidity. Even wider exposure can be obtained using mandibular osteotomies.

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Double Mandibular Osteotomy for Access to High-Carotid Pathology

Cited by 4 publications

References 11 publications

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Acesso cirúrgico ao segmento cervical distal da artéria carótida interna e à bifurcação carotídea alta – revisão integrativa da literatura e proposta de protocolo

Surgical access to the distal cervical segment of the internal carotid artery and to a high carotid bifurcation – integrative literature review and protocol proposal

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