Surgical approach to the third area of the internal carotid artery through vertical osteotomy of the mandibular ramus: Case report

Internal carotid artery (ICA) reparative techniques are nowadays widely standardized in traumatic as well as degenerative pathological conditions; therefore, the greatest difficulty encountered in the treatment of lesions at the expense of the most distal segment of the ICA is not a result of the application of these techniques as much as the difficulty in obtaining adequate exposure of the vessel and a sufficiently wide surgical field. In the past, lesions localized more toward the skull were considered to be surgically unreachable. During the last 20 years, however, various techniques have been suggested and attempted for the exposure of this difficult area. This article suggests a type of approach already carried out by the Department of Maxillofacial Surgery of the University of Rome "La Sapienza" in collaboration with the II Department of Vascular Surgery of the same university, which offers the advantage of being of simple and rapid execution with minimum repercussions on the intrasurgical time required and guarantees an excellent exposure of the most distal tract of the ICA with an adequate widening of the surgical field.