Mandibular subluxation for high carotid exposure

Mandibular subluxation for distal internal carotid artery exposure in edentulous patients

“…Previous reports on exposing techniques to gain such additional exposure range from dental wiring and the use of Steinmann pins for subluxation of the mandible at the temporomandibular joint, to more invasive and time-consuming methods such as a mandibular osteotomy or the recently redescribed parotid gland mobilization (Table). [2][3][4][5][6][7][8][9][10] During these approaches, transecting or tying the sternal mastoid or occipital artery, separating the hypoglossal and vagus nerves higher up, transecting the digastric muscle, and transecting the styloid process may all be used to gain further exposure. These methods are either planned in advance or can be extended during operation when encountering complications such as more distal disease than expected, distal ICA bleeding, and distal ICA dissection.…”

Contemporary presentation and evolution of management of neck paragangliomas

“…2,5,8 Because the mortality and neurological morbidity of tumor resection with internal carotid artery ligation was worse than the natural history of these slowly growing tumors, [10][11][12] expectant management was the standard treatment before the era of carotid artery reconstruction. 13 Currently, however, uncomplicated resection of these tumors is usually feasible as a result of careful preoperative planning and the use of several adjuncts, including crosssectional imaging, 14,15 selective preoperative embolization, 16 and mandibular subluxation, 17,18 use of bipolar cautery, 19,20 selective carotid shunting based on intraoperative cerebral monitoring, 21 and carotid artery reconstruction when deemed necessary. 2,5,22 The aim of the present study was to review the contemporary presentation and the evolution of management strategies for these complex tumors over the last five decades.…”

Mandibular subluxation stabilized by mouthpiece for distal internal carotid artery exposure in carotid endarterectomy

“…5 More recently, the unilateral subluxation technique accomplished by circummandibular and transnasal wiring has required only 10 minutes. 4 In addition, the intradental wiring or circummandibular and anterior nasal spine wiring technique has been described. 2 However, wiring introduces potential complications, such as bleeding, infection, and dental injury; therefore, we developed the mouthpiece technique to eliminate such complications.…”