Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1806857
Case Report

Mandibular Sagittal Split Osteotomy to High Carotid Pathology: Multidisciplinary Management

Vladimir Victorovich Krylov
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Victor Aleksandrovich Luk'ianchikov
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Vadim Aleksandrovich Gorozhanin 
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
,
Roman Nikolaevich Fedotov
4   Maxillofacial Surgery, MGMSU named after A I Evdokimov, Moscow, Russia
,
Taras Andreevich Shatokhin
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Dmitrii Nikolaevich Reshetov
5   Oncology, MGMSU named after A I Evdokimov, Moscow, Moscow, Russia
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Surgical strategies for neck tumors extending to the skull base and high-lying carotid artery pathologies present significant challenges for surgeons, necessitating deviations from traditional neck surgery approaches. These tactics are adopted to expand the surgical approach. Although the mandibular sagittal split osteotomy (MSSO) has been routinely utilized in maxillofacial surgery, its integration into combined surgical approaches for head and neck pathologies has not been widely explored. We present our experience using MSSO in patients with neck pathology. A retrospective analysis was conducted on 12 patients who underwent surgery between 2020 and 2022 for benign neck tumors and vascular pathologies that posed challenges for removal using traditional approaches. All patients underwent surgical treatment utilizing the technique of unilateral MSSO and fragment retraction to enhance the surgical approach for neck pathologies. An evaluation of early postoperative outcomes was performed. Based on the criteria presented, the study group consisted of 12 patients with various histological types of benign tumors (n = 11) and atherosclerotic plaque in the carotid artery (n = 1). Following the osteotomy step, mandibular advancement of an average distance of 17.2 ± 1.6 mm was achieved, allowing for an extended surgical approach on the lateral aspect of the neck measuring 48.7 ± 3.5 mm. This technique facilitated the successful total tumor resection in most of cases. Complications related to the osteotomy were observed in two patients during the early postoperative period, which included malocclusion necessitating plate refixation and hematoma formation in the soft tissues of the neck. The utilization of the unilateral intraoral technique of sagittal split osteotomy with mandibular abduction has demonstrated good outcomes in providing an extended surgical approach for tumors located in the distal neck segment of the internal carotid artery.

Keywords

carotid endarterectomy - mandibular sagittal split osteotomy - mandibular subluxation - neck tumors - split osteotomy - upper neck region

Authors' Contributions

V.V. Krylov contributed to the conceptualization, methodology, resource allocation, writing—review and editing, and supervision. V.A.L. and V.A.G. were involved in the methodology, validation, investigation, resource management, and writing—original draft. T.A.S. contributed to the methodology and visualization, while R.N.F. and D.N.R. were responsible for visualization and investigation.




Publication History

Article published online:
03 April 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Lukyanchikov VA, Khasauov RK, Kordonskaya OO, Dalibaldyan VA, Senko IV. Endoscopy-assisted surgical treatment of carotid artery kinking. Khirurgiia (Mosk) 2020; (02) 13-20
    PubMedSearch in Google Scholar
  • 2 Lukyanchikov VA, Khasauov RK, Kozhaev ZU, Gekkieva ZS, Krylov VV, Vinogradov RA. Minimally invasive surgical treatment of a patient with pathological tortuosity of the carotid artery using endoscopic assistance. Russ J Neurosurg 2018; 20 (04) 80-86
    Search in Google Scholar
  • 3 Farhat-Sabet A, Aicher BO, Tolaymat B. et al. An alternative approach to carotid endarterectomy in the high carotid bifurcation. Ann Vasc Surg 2020; 65: 240-246
    PubMedSearch in Google Scholar
  • 4 Fisher Jr DF, Clagett GP, Parker JI. et al. Mandibular subluxation for high carotid exposure. J Vasc Surg 1984; 1 (06) 727-733
    PubMedSearch in Google Scholar
  • 5 Dalibaldyan VA, Luk'yanchikov VA, Shalumov AZ. et al. The temporary mandible subluxation during surgical treatment of high-level atherosclerotic damages of extracranial part of internal carotid artery. Russian Journal of Neurosurgery. 2016; 1: 60-67
    Search in Google Scholar
  • 6 Simonian GT, Pappas PJ, Padberg Jr FT. et al. Mandibular subluxation for distal internal carotid exposure: technical considerations. J Vasc Surg 1999; 30 (06) 1116-1120
    PubMedSearch in Google Scholar
  • 7 Irace L, Faccenna F, Siani A. et al. Accesso chirurgico all'arteria carotide interna distale medicante osteotomia mandiobolare verticale [Exposure of distal internal carotid artery through mandibular vertical ramus osteotomy]. Minerva Cardioangiol 2003; 51 (03) 337-342
    PubMedSearch in Google Scholar
  • 8 Kumins NH, Tober JC, Larsen PE, Smead WL. Vertical ramus osteotomy allows exposure of the distal internal carotid artery to the base of the skull. Ann Vasc Surg 2001; 15 (01) 25-31
    PubMedSearch in Google Scholar
  • 9 Arakawa Y, Ishii A, Ueno Y. et al. The use of a modified vertical mandibular osteotomy for exposure of a distal cervical internal carotid artery. No Shinkei Geka 2000; 28 (04) 367-371
    PubMedSearch in Google Scholar
  • 10 Vikatmaa P, Mäkitie AA, Railo M, Törnwall J, Albäck A, Lepäntalo M. Midline mandibulotomy and interposition grafting for lesions involving the internal carotid artery below the skull base. J Vasc Surg 2009; 49 (01) 86-92
    PubMedSearch in Google Scholar
  • 11 Capoccia L, Montelione N, Menna D. et al. Mandibular subluxation as an adjunct in very distal carotid arterial reconstruction: incidence of peripheral and cerebral neurologic sequelae in a single-center experience. Ann Vasc Surg 2014; 28 (02) 358-365
    PubMedSearch in Google Scholar
  • 12 Santos RB, Queiroz AB, Fidelis RJ, Lopes CF, Filho JS. Subluxation of the mandible for access to high carotid bifurcation in a patient with iodinated contrast induced parotitis: case report and literature review. J Vasc Bras 2017; 16 (04) 329-334
    PubMedSearch in Google Scholar
  • 13 Vang S, Hans SS. Carotid endarterectomy in patients with high plaque. Surgery 2019; 166 (04) 601-606
    PubMedSearch in Google Scholar
  • 14 McNamara JR, Fulton GJ, Manning BJ. Three-dimensional computed tomographic reconstruction of the carotid artery: identifying high bifurcation. Eur J Vasc Endovasc Surg 2015; 49 (02) 147-153
    PubMedSearch in Google Scholar
  • 15 Nakagawa M, Toyooka T, Takeuchi S. et al. Cadaver investigation of the usefulness of the transstyloid diaphragm approach for high-position plaque carotid endarterectomy. Clin Neurol Neurosurg 2023; 233: 107948
    PubMedSearch in Google Scholar
  • 16 Drobyshev AY, Anastasov G. Orthognathic Surgery Basics. Moscow: Printing Town; 2007: 55
    Search in Google Scholar
  • 17 Kolchin SA, Drobyshev AY, Kurakin KA, Dibirov TM, Miterev AA. The use of 3D technologies in the planning of orthognathic operations in patients with anomalies in the development of the jaws. Endodontics Today. 2022; 20 (02) 183-188
    Search in Google Scholar
  • 18 Yang HM, Kim HJ, Park HW. et al. Revisiting the topographic anatomy of the marginal mandibular branch of facial nerve relating to the surgical approach. Aesthet Surg J 2016; 36 (09) 977-982
    CrossrefPubMedSearch in Google Scholar