title: The Double Mandibular Osteotomy for Vascular and Tumor Surgery of the Parapharyngeal Space.
abstract: OBJECTIVE
  The purposes of this study are to describe our experience using a double mandibular osteotomy for access to the parapharyngeal space in vascular and tumor surgery and to report on the outcomes and complications of this procedure.
  
  
  METHODS
  We designed and implemented a case series to review the medical records of all patients treated with a double mandibular osteotomy for parapharyngeal space access from 1994 to 2016. Patient demographic characteristics, indications for the procedure, outcomes, and complications were recorded.
  
  
  RESULTS
  A total of 17 patients underwent a double mandibular osteotomy procedure for access to the parapharyngeal space during the study period. There were 7 men (41%) and 10 women (59%) comprising the cohort. The average age was 57 years (range, 29 to 75 years). The follow-up period ranged from 6 to 98 months (mean, 40 months), and 7 patients (41%) were tobacco users at the time of surgery. The most common indication was high internal carotid artery stenosis (n = 6) followed by carotid body paraganglioma (n = 3). Average blood loss was 186 mL, and there were no deaths during the study period. Eight postoperative complications were noted in 7 patients (41%). No procedures were aborted or compromised because of inadequate parapharyngeal space access. All patients showed clinical and radiographic signs of healing of the osteotomy sites.
  
  
  CONCLUSIONS
  The double mandibular osteotomy provides adequate access to the parapharyngeal space for effective tumor removal and high carotid surgical intervention with acceptable patient morbidity and complications.
authors.affiliation: Formerly, Oral/Head & Neck Oncologic Surgery Fellow, University of Tennessee Medical Center, Knoxville, TN; Currently, Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlieve
authors.affiliation: Professor, Kelly L. Krahwinkel Chairman, and Residency Program Director, Department of Oral and Maxillofacial Surgery, and Director, Oral/Head and Neck Oncologic Surgery Fellowship Program, University of Tennessee Medical Center and University of Tennessee Cancer Institute, Knoxville, TN. Electronic address: ECarlson@mc.utmck.edu.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Carlson
authors.affiliation: Professor and Chief, Division of Vascular Surgery, Department of Surgery, University of Tennessee Medical Center, Knoxville, TN.
authors.forename: Michael
authors.initials: M
authors.lastname: Freeman
authors.affiliation: Assistant Professor, Division of Vascular Surgery, University of Tennessee Medical Center, Knoxville, TN.
authors.forename: Ryan
authors.initials: R
authors.lastname: Buckley
authors.affiliation: Assistant Professor, Division of Vascular Surgery, University of Tennessee Medical Center, Knoxville, TN.
authors.forename: Josh
authors.initials: J
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D002345:Carotid Body Tumor / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000379:methods*; D008875:Middle Aged; D010614:Pharynx; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods*