Lateral mandibulotomy: a technique of exposure for penetrating injuries of the internal carotid artery at the base of the skull.

Injuries to the internal carotid artery are rare but are frequently fatal or associated with significant neurologic sequelae. Exposure for surgical repair of penetrating injuries to the internal carotid artery at the base of the skull is difficult because of the overlying ramus of the mandible and the facial nerve. In the past, these injuries have been treated by techniques such as occlusion of the artery with a Fogarty balloon catheter, or subluxation of the temporomandibular joint to gain access to the arterial injury. Based on techniques previously reported for extirpation of parapharyngeal space tumors, we describe lateral mandibulotomy for exposure of penetrating carotid artery injuries at the base of the skull. The technique affords relatively rapid and adequate exposure of these injuries allowing ligation, or in selected cases, arterial repair.