Irace L, Faccenna F, Siani A, Gabrielli R, Pascucci M, Marino M, Benedetti-Valentini M, Valentini V, Fabiani F, Nicolai G, Torroni A, Iannetti G
II Cattedra di Chirurgia Vascolare, Policlinico Umberto I, Università degli Studi di Roma, La Sapienza, Rome, Italy.
Minerva Cardioangiol. 2003 Jun;51(3):337-42.
Exposure of the distal internal carotid artery at the level of the second cervical vertebra required manoeuvers such as division of digastric muscle or mandibular subluxation. These increase the exposure but may not provide adequate access and are associated with significant cranial nerves or temporal mandibular joint complications. Vertical Ramus Osteotomy (VRO) provided access of the internal carotid artery (ICA) up to the base of the skull, with low incidence of cranial nerve injury temporo-mandibular joint (TMJ) pain and no preincision preparation. We report two cases in which vertical division of the mandibular ramus provided access of the ICA up to the base of the skull. Preoperative Duplex Scan examination and in the second case the arteriography revealed ICA preocclusive stenosis within 1.5 cm of the skull base. VRO was performed trouhgh a standard neck incision and miniature titanium plates were used to reapproximate the mandible after vascular procedure. There were no death, cranial nerve injury, mandibular nonunion, malocclusion or TMJ pain. We found that VRO is useful when carotid artery pathology extends beyond the usual field of exposure, avoiding nerve injury or TMJ lesion and requires no additional pre-incision preparation.
在第二颈椎水平暴露颈内动脉远端需要采取诸如切断二腹肌或下颌半脱位等操作。这些操作增加了暴露范围，但可能无法提供足够的手术入路，并且会伴有严重的颅神经或颞下颌关节并发症。垂直下颌支截骨术（VRO）可提供至颅底的颈内动脉（ICA）手术入路，颅神经损伤和颞下颌关节（TMJ）疼痛的发生率低，且无需术前准备。我们报告两例通过垂直切断下颌支获得至颅底的ICA手术入路的病例。术前双功超声扫描检查，第二例行动脉造影显示在颅底1.5厘米范围内ICA存在闭塞前狭窄。通过标准颈部切口进行VRO，血管手术后使用微型钛板重新对合下颌骨。无死亡、颅神经损伤、下颌骨不愈合、错牙合或TMJ疼痛。我们发现当颈动脉病变超出通常的暴露范围时，VRO很有用，可避免神经损伤或TMJ病变，且无需额外的术前准备。
