Mandibular Subluxation for Distal Cervical Exposure of the Internal Carotid Artery

Abstract

Surgical access to the distal segment of the cervical internal carotid artery (ICA) is a challenge because of the limited exposure imposed by bony structures and concern regarding cranial nerve and major vasculature injury. Our objective is to quantify the additional exposure of the distal cervical ICA obtained with mandibular subluxation (MS) compared with maneuvers that do not mobilize the mandible. Thirty dissections of the cervical ICA and common carotid artery bifurcation were performed on fresh cadavers. The length of the ICA exposure was measured from the carotid bifurcation to the most distally exposed ICA after sectioning the posterior belly of the digastric and stylohyoid muscles, removal of the styloid process, and MS. After MS, a 5.52 +/- 1.00 cm mean exposure of the cervical ICA was obtained. Comparison between the second and third measures revealed an average additional exposure of the ICA of 0.77 cm, corresponding to an additional 16.2% (P < .001). Neck length, sex, and age showed no correlation with the ICA exposure. MS provided an additional exposure of the distal segment of the cervical ICA and may be useful in selected cases to improve access. However, staged maneuvers should be used, and the need for MS depends on the level and extension of the lesion.