Abstract

Purpose: Treatment of vascular lesions of the high cervical internal carotid artery (zone III) resulting from penetrating trauma, blunt trauma, aneurysms, and atherosclerosis pose a challenge for vascular surgeons due to bony interference's of the mandibular ramus and mastoid process. Although many techniques have been described, two methods, have been identified as effective and associated with low morbidity. The purpose of this study is to compare these two methods, mandibular distraction and vertical ramus osteotomy, for their effectiveness at increasing access to the cranial base and distal internal carotid artery.

Materials and Methods: Five fresh frozen cadavers were utilized for a total of ten cranial base exposures. The following two techniques were evaluated on each of the twelve exposures: 1) Anterior distraction of the mandible without violation of the TMJ capsule, 2) Vertical ramus osteotomy of the mandible with distraction of the proximal and distal segment. The neutrally positioned mandible with the condyle seated in the glenoid fossa served as the control. The area of surgical access defined by bony and cartilaginous landmarks was determined for each technique using the nondistracted control as a baseline.

Results: Of the two techniques studied, the vertical ramus osteotomy group provided the greatest increase in surgical access with an approximately 99.64% increase over the control and a mean area of exposure of 14.653 cm2. Mandibular distraction provided only a 28.32% increase with a mean area of 9.252cm2. The control or non-distracted baseline mean area of exposure was 7.214cm2.

Conclusion: Vertical ramus osteotomy significantly increases access to cranial base vascular lesions with minimal morbidity. The procedure can be completed rapidly with no additional skin incisions. The access is greater and more reliable than that achieved by mandibular distraction techniques.

Department

Dentistry

School

Graduate School

First Advisor

Keith Hoffmann

Second Advisor

Philip Boyne

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1998

Date (Title Page)

3-1998

Language

English

Library of Congress/MESH Subject Headings

Vertical Dimension; Oral Surgical Procedures; Osteotomy

Type

Thesis

Page Count

vi; 33

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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