Mandibular subluxation stabilized by mouthpiece for distal internal carotid artery exposure in carotid endarterectomy Masanori Yoshino, MD, Hiroshi Fukumoto,

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Mandibular subluxation stabilized by mouthpiece for distal internal carotid artery exposure in carotid endarterectomy Masanori Yoshino, MD, Hiroshi Fukumoto, DD, PhD, Tohru Mizutani, MD, PhD, Ryuji Yuyama, MD, Takayuki Hara, MD, PhD Journal of Vascular Surgery Volume 52, Issue 5, Pages 1401-1404 (November 2010) DOI: 10.1016/j.jvs.2010.04.058 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Photographs show the process of making the custom-made mouthpiece. A, The mandible is mobilized anteriorly and laterally to the subluxated position. B, Model of the patient's teeth is made, and from which the final mold is created. C, The mandible has been subluxated and stabilized with the mouthpiece. Journal of Vascular Surgery 2010 52, 1401-1404DOI: (10.1016/j.jvs.2010.04.058) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Photograph shows the intraoperative anatomy after the carotid artery is dissected. The occipital artery (arrowhead) and hypoglossal nerve (arrow) are clearly identified. Journal of Vascular Surgery 2010 52, 1401-1404DOI: (10.1016/j.jvs.2010.04.058) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Illustrations show anterior and lateral views of the operative technique. A, The mandible is mobilized contralaterally and stabilized with the mouthpiece. B, The normal position of the mandible is shown without subluxation. C, The mandible is mobilized anteriorly to the subluxated position. Mandibular subluxation stabilized by the mouthpiece can provide additional exposure. Journal of Vascular Surgery 2010 52, 1401-1404DOI: (10.1016/j.jvs.2010.04.058) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Preoperative three-dimensional computed tomography angiography simulations. A, Normal location of the temporomandibular joint is shown without subluxation. B, Subluxated position of the temporomandibular joint stabilized with the mouthpiece. The mandible is stabilized in the subluxated position, but is not stabilized in the dislocated position. Journal of Vascular Surgery 2010 52, 1401-1404DOI: (10.1016/j.jvs.2010.04.058) Copyright © 2010 Society for Vascular Surgery Terms and Conditions