title: Vertical ramus osteotomy combined with a parasymphyseal mandibulotomy for improved access to the parapharyngeal space.
abstract: BACKGROUND
  A number of procedures have been described that facilitate access to the parapharyngeal space. Their use may be limited because of restricted access or postoperative morbidity.
  
  
  METHODS
  We describe the use of two mandibular osteotomies to greatly enhance the exposure of the parapharyngeal space, with possible access up to the skull base.
  
  
  RESULTS
  We have performed this procedure in three cases with minimal postoperative morbidity and no neurologic deficit or occlusal disturbances.
  
  
  CONCLUSIONS
  We have found that the osteotomies described provide far better exposure to this area than a single mandibular osteotomy alone. Furthermore, it avoids a facial scar.
authors.affiliation: Department of Maxillofacial Surgery/Head and Neck Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
authors.forename: Graham I
authors.initials: GI
authors.lastname: Smith
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brennan
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Webb
authors.forename: Vellupilai
authors.initials: V
authors.lastname: Ilankovan
mesh_terms: D006801:Humans; D008334:Mandible / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010614:Pharynx / Q000601:surgery*