PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(03): 597-604
DOI: 10.1055/s-0045-1806857
Case Report

Mandibular Sagittal Split Osteotomy to High Carotid Pathology: Multidisciplinary Management

Vladimir Victorovich Krylov
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Victor Aleksandrovich Luk'ianchikov
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Vadim Aleksandrovich Gorozhanin 
2   Neurosurgery, FGBU NMICO FMBA Rossii, Moscow, Russia
,
Roman Nikolaevich Fedotov
4   Maxillofacial Surgery, MGMSU named after A I Evdokimov, Moscow, Russia
,
Taras Andreevich Shatokhin
1   Fundamental Neurosurgery, Pirogov Russian National Research Medical University, Moscow, Russia
3   Neurosurgery, FSBSI Neurology Research Center, Moscow, Russia
,
Dmitrii Nikolaevich Reshetov
5   Oncology, MGMSU named after A I Evdokimov, Moscow, Russia
› Author Affiliations
Funding None.
› Further Information
Also available ateRef
  Permissions and Reprints
Preview

Abstract

Surgical strategies for neck tumors extending to the skull base and high-lying carotid artery pathologies present significant challenges for surgeons, necessitating deviations from traditional neck surgery approaches. These tactics are adopted to expand the surgical approach. Although the mandibular sagittal split osteotomy (MSSO) has been routinely utilized in maxillofacial surgery, its integration into combined surgical approaches for head and neck pathologies has not been widely explored. We present our experience using MSSO in patients with neck pathology. A retrospective analysis was conducted on 12 patients who underwent surgery between 2020 and 2022 for benign neck tumors and vascular pathologies that posed challenges for removal using traditional approaches. All patients underwent surgical treatment utilizing the technique of unilateral MSSO and fragment retraction to enhance the surgical approach for neck pathologies. An evaluation of early postoperative outcomes was performed. Based on the criteria presented, the study group consisted of 12 patients with various histological types of benign tumors (n = 11) and atherosclerotic plaque in the carotid artery (n = 1). Following the osteotomy step, mandibular advancement of an average distance of 17.2 ± 1.6 mm was achieved, allowing for an extended surgical approach on the lateral aspect of the neck measuring 48.7 ± 3.5 mm. This technique facilitated the successful total tumor resection in most of cases. Complications related to the osteotomy were observed in two patients during the early postoperative period, which included malocclusion necessitating plate refixation and hematoma formation in the soft tissues of the neck. The utilization of the unilateral intraoral technique of sagittal split osteotomy with mandibular abduction has demonstrated good outcomes in providing an extended surgical approach for tumors located in the distal neck segment of the internal carotid artery.

Keywords

carotid endarterectomy - mandibular sagittal split osteotomy - mandibular subluxation - neck tumors - split osteotomy - upper neck region

Authors' Contributions

V.V. Krylov contributed to the conceptualization, methodology, resource allocation, writing—review and editing, and supervision. V.A.L. and V.A.G. were involved in the methodology, validation, investigation, resource management, and writing—original draft. T.A.S. contributed to the methodology and visualization, while R.N.F. and D.N.R. were responsible for visualization and investigation.




Publication History

Article published online:
03 April 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India