Exposure of the Distal Internal Carotid Artery: A Simplified Approach

Transoral Approach to the Superomedial Parapharyngeal Space

“…The numerous surgical approaches 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] to the PPS discussed in the literature reflect the inherent difficulty of accessing this anatomically complex region in its entirety. The most commonly used approaches include the following: the transcervical approach, the transparotid approach, the transcervical-transparotid approach, the transoral approach, the combined transoral-external approach, and the combined cervical-transpharyngeal approach.…”

Enhancing Access to the Parapharyngeal Space

“…On average, the total condylar translation (forward motion) along the glenoid fossa was 18 -19 mm. With this almost 2-cm anterior movement of the condyle, Coll et al 5…”

“…On average, the total condylar translation (forward motion) along the glenoid fossa was 18–19 mm. With this almost 2‐cm anterior movement of the condyle, Coll et al 5 reasoned that exposure of the distal internal carotid artery at the level of the TMJ could be improved by propping the mouth open. We have also used this technique to augment access to the PPS for open or transcutaneous procedures.…”

Efficacy of Mandibular Subluxation for Carotid Endarterectomy with Combined Fixation Using Interdental Wire and Putty

“…Moreover, use of an intraluminal shunt requires more distal exposure of the ICA. Various techniques used for CEA in cases of cephalic location of the lesions have been reported, including the retrojugular approach [13], dissection and ligation of the adjacent structures (sternocleidomastoid artery, occipital artery and vein [14,15], ansa cervicalis [14], and posterior belly of the digastric muscle [14,16]), nasotracheal intubation [17], mandibular osteotomy [18,19], elevation of the hypoglossal nerve [1,15,16], and MS [3][4][5][6][7][8][9][10][11]20].…”

“…If a higher approach is taken (above the mastoid-mandibular line, which extends from the tip of the mastoid process to the angle of the mandible), an operative space cephalic to the mastoid-mandibular line is required [3]. Mandibular subluxation (MS) for CEA has been proposed to access such a cephalic location of the bifurcation [3][4][5][6][7][8][9][10][11][12]. However, only the subjective effects of MS have been reported, so the objective effects are still unclear.…”