頸部内頸動脈高位病変に対する下顎骨垂直骨切り術の有用性

The Use of a Modified Vertical Mandibular Osteotomy for Exposure of a Distal Cervical Internal Carotid Artery

I．はじめに

　頸部内頸動脈の高位病変は，下顎骨，下位脳神経，咀嚼筋群などが障害となり外科治療が困難であり，幾つかのアプローチが工夫されている．今回われわれは，一過性脳虚血発作（TIA）を反復した後，minor strokeを生じ，その原因として頸部内頸動脈高位病変（第1頸椎下縁から第2頸椎椎体レベル）が疑われた1例を経験した．内頸動脈（ICA）が分岐後内側へ走行し，動脈瘤も疑われたため，下顎骨垂直骨切り術を行い，広い術野で満足すべき手術を行うことが出来た．本法の詳細を述べ適応について考察を加えたので報告する．

We report herein the case of a 56-year-old woman who presented with repeated transient ischemic attacks (TIAs). Cerebral angiography revealed that the left redundant internal carotid artery (ICA) un-characteristically curved medially. These findings were highly suggestive of an internal carotid artery aneurysm at the level between the first and second cervical vertebral bodies. The lesion was presumed to be difficult to access by the surgical procedure usually adopted in carotid endarterectomy. Thus, we de-cided to employ a modified vertical mandibular osteotomy. The operative view revealed that the lesion was atherosclerotic stenosis with ulceration, so carotid endarterectomy was indicated. This mandibular osteo-tomy not only provided us with wide, satisfactory exposure of the distal cervical internal carotid artery but also afforded good mandibular stability during the postoperative period.