Abordaje transmandibular para resección de aneurisma carótideo

Abstract

Introduction and objective: Transmandibular approaches are part of the surgical arsenal of our Specialty and, although their main indication is malignant tumors of the oral cavity and oropharynx, they are also occasionally used for tumors of the parapharyngeal space. We present the case of a patient with a carotid aneurysm of very high localization, who presented a differential diagnosis with a vagal paraganglioma, not accessible to a conventional cervicotomy and who was resected by a transmandibular approach. Method: A lateral step manibulotomy was performed to access the carotid space and once the diagnosis was verified, a double section in the cranial segment of the left internal carotid artery, excluding the section where the aneurysm was, and then a vascular by-pass with internal saphenous vein. Once the viability of the graft was verified, the mandibulotomy was reconstructed with titanium miniplates and a nasogastric tube was left for feeding for 3 weeks. Subsequently, the correct alignment of the osteotomies was checked with an orthopantomography. Results: The swallowing had to be progressive because after the first days a pain manifested at the first bite that disappeared a few weeks later. The patient did not have any other complications. Functional studies conducted to date confirm graft patency and swallowing is completely normal without limitation or pain to the mouth opening. Discussion: This case is exposed to the consideration of the growing role of the ENT surgeon in cervicofacial and skull base surgery, and the suitability of the joint action of different Specialties in the resolution of complex problems of these locations. Conclusions: Synergistic action with other specialists who also perform surgery in the head and neck area offers optimal results in the surgical treatment of complex problems of this location.