Efficacy of Mandibular Subluxation for Carotid Endarterectomy with Combined Fixation Using Interdental Wire and Putty

Bifurcation of the carotid artery at a cephalic location greatly increases the risk associated with carotid endarterectomy (CEA). Mandibular subluxation (MS) can improve access to the cephalic location; however, the benefits of MS remain unclear. The present study objectively assessed the efficacy of MS. MS was performed with only wire fixation of healthy teeth in four patients (Group A), with wire fixation reinforced by inserting Coltoflax® putty between healthy teeth in 17 patients (Group B), and with wiring between maxillary and mandibular screws reinforced by inserting Coltoflax® putty between the wires in five edentulous patients (Group C). Preand postoperative axial computed tomography angiography images at the level of the tip of the mastoid process were used to compare the following measurements: mastoid-mandible distance between the anterior margin of the mastoid process and posterior margin of the mandible; and mastoid-internal carotid artery-mandible (MIM) angle between the line connecting the anterior margin of the mastoid process and the center of the internal carotid artery, and the line connecting the posterior margin of the mandible and the center of the internal carotid artery. MS increased the overall mastoid–mandible distance by 5.7 ± 3.1 mm. The increase was significantly greater in Group B (6.7 ± 2.0 mm) than in Group A or C (4.0 ± 4.1 mm) (P=0.032). MS increased the overall MIM angle by 13.3 ± 7.9o. MS with the combination of wire with Coltoflax® putty offered the widest surgical corridor for CEA.