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Clinical Outcomes of Double Mandibular Osteotomy for Exposure of Skull Based Carotid Artery Pathology
Michael R Buckley, Michael M McNally, Joshua D Arnold, Oscar H Grandas, Scott L Stevens, Mitchell H Goldman, Eric R Carlson, Michael B Freeman
University of Tennessee Knoxville, Knoxville, TN

OBJECTIVES: Distal exposure of the internal carotid artery stands as a technical challenge and is often inaccessible from a standard lateral neck incision. While the double mandibular osteotomy technique was recently described as an adjunct for vascular surgery exposure, no case series exist in the literature describing technical and functional outcomes. The aim of this study is to report our institutional experience utilizing this exposure for skull based carotid artery pathology.
METHODS: A retrospective review was performed on all patients between 2010 and 2015 who underwent double mandibular osteotomy to treat distal cervical internal carotid artery pathology. Patient demographics, intra-operative variables, functional outcomes, post-operative morbidity, and mortality were analyzed.
RESULTS: A total of fifteen patients underwent double mandibular osteotomy during the study period, nine (n=9) were performed for vascular pathology. Indications for surgery included: carotid body tumor (n=3), symptomatic high grade internal carotid artery stenosis (n=4), and internal carotid artery aneurysm (n=2). The average age was 60 years and the majority were female (66%). Operations included tumor excision (3), patch angioplasty (2), and greater saphenous vein interposition bypass (4). Average operative time was 317 minutes with 150cc mean blood loss. Average length of stay was 3.5 days. Twenty-six percent of patients (4 of 15) had significant procedure related complications including dysphagia (2), mandibular malocclusion (1), and osteomyelitis (1). One patient underwent planned en bloc cranial nerve resection with tumor. The technical success rate was 100% with zero perioperative strokes or mortality.
CONCLUSIONS: Double mandibular osteotomy allows high exposure and treatment of skull based internal carotid artery lesions but is not without hazard. Despite no reported strokes or mortalities, the significant incidence of post-operative functional impairment should be considered. This analysis represents the largest series described in the literature.

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