title: Mandibular subluxation stabilized by mouthpiece for distal internal carotid artery exposure in carotid endarterectomy.
abstract: The standard approach for carotid endarterectomy cannot provide adequate exposure of the distal internal carotid artery in the presence of high cervical carotid bifurcation or high plaque. Limited accessibility of the distal internal carotid artery has resulted in the development of various operative techniques. Mandibular subluxation is the most simple and least invasive technique, but it does require invasive maneuvers, such as wiring, to stabilize the mandible. We use a mouthpiece made by the dentist to stabilize the mandible in the physiologic subluxated position. This technique provides an adequate exposure of the distal internal carotid artery as with the other methods, and the risk of morbidity is very low.
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. ymasa-tky@umin.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Yoshino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukumoto
authors.forename: Tohru
authors.initials: T
authors.lastname: Mizutani
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yuyama
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hara
mesh_terms: D002343:Carotid Artery, Internal / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology*; D007593:Joint Instability / Q000517:prevention & control*; D008334:Mandible / Q000503:physiopathology*; D009064:Mouth Protectors; D013704:Temporomandibular Joint / Q000503:physiopathology*; D016896:Treatment Outcome