Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.001117
Jornal Vascular Brasileiro
Case Report

Subluxação da mandíbula para abordagem de bifurcação carotídea alta em paciente com parotidite por contraste iodado: relato de caso e revisão de literatura

Subluxation of the mandible for access to high carotid bifurcation in a patient with iodinated contrast induced parotitis: case report and literature review

Reinaldo Benevides dos Santos, André Brito Queiroz, Ronald José Ribeiro Fidelis, Cicero Fidelis Lopes, José Siqueira de Araújo Filho

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Resumo

A doença aterosclerótica das carótidas extracranianas pode resultar em complicações com alta morbidade e mortalidade. A avaliação pré-operatória com exames contrastados de imagem é associada a complicações como a parotidite, além das já bem conhecidas reações alérgicas e da disfunção renal. A bifurcação carotídea alta e a doença aterosclerótica de extensão cranial costumam ser fatores limitantes para o tratamento cirúrgico convencional. Entretanto, quando há contraindicação ao uso de contraste iodado ou impossibilidade do tratamento endovascular, há a necessidade do conhecimento de técnicas cirúrgicas que permitam a realização da endarterectomia com segurança. A subluxação da mandíbula se mostrou uma técnica adjuvante segura e efetiva, de fácil execução e reprodutibilidade, possibilitando o acesso a bifurcações carotídeas altas com boa exposição do campo cirúrgico e permitindo a realização da endarterectomia conforme a técnica padrão. Apresentamos o caso de uma paciente com bifurcação carotídea alta e com limitações para uso do contraste iodado que foi submetida a endarterectomia carotídea após subluxação de mandíbula.

Palavras-chave

doença das artérias carótidas; parotidite; endarterectomia; angioplastia; fixação maxilomandibular; mandíbula.

Abstract

Atherosclerotic disease of the extracranial carotid arteries can cause complications with high morbidity and mortality rates. The contrast imaging examinations used in preoperative evaluation are associated with complications such as parotitis, in addition to well-known allergic reactions and renal dysfunction. A high carotid bifurcation or atherosclerotic disease that extends distally are often limiting factors for conventional surgical treatment. However, when iodinated contrast is contraindicated or endovascular treatment is not feasible, knowledge of surgical techniques that allow safe endarterectomy is required. Subluxation of the mandible has proven to be a safe and effective adjuvant technique that is easy to perform and reproducible, providing access to high carotid bifurcations with good exposure of the surgical field and allowing endarterectomy to be performed with a standard technique. We present the case of a patient with a high carotid bifurcation and limitations for use of iodinated contrast who underwent carotid endarterectomy after subluxation of the mandible.

Keywords

arotid artery diseases; parotitis; endarterectomy; angioplasty; jaw fixation techniques; mandible

References

1. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation. 2011;124(4):489-532. PMid:21282505. http://dx.doi.org/10.1161/CIR.0b013e31820d8d78.

2. Ristow A von, Leal D, Vescovi A, Massiere B. Doença oclusiva carotídea e do tronco braquiocefálico. In: Lobato AC. Cirurgia endovascular. 3. ed. São Paulo: Instituto de Cirurgia Vascular e Endovascular de São Paulo; 2015. p. 987-1040.

3. Silva JL. Anatomia cirúrgica dos vasos do pescoço. In: Maffei FHA. Doenças vasculares periféricas. 5. ed. Rio de Janeiro: Guanabara Koogan; 2016. p. 61-80.

4. Capoccia L, Montelione N, Menna D, et al. Mandibular subluxation as an adjunct in very distal carotid arterial reconstruction: Incidence of peripheral and cerebral neurologic sequelae in a single-center experience. Ann Vasc Surg. 2014;28(2):358-65. PMid:24090828. http://dx.doi.org/10.1016/j.avsg.2013.01.024.

5. Dossa C, Shepard AD, Wolford DG, Reddy DJ, Ernst CB. Distal internal carotid exposure: a simplified technique for temporary mandibular subluxation. J Vasc Surg. 1990;12(3):319-25. PMid:2398590. http://dx.doi.org/10.1016/0741-5214(90)90155-4.

6. Jaspers GW, Witjes MJ, Van den Dungen JJ, Reintsema H, Zeebregts CJ. Mandibular subluxation for distal internal carotid artery exposure in edentulous patients. J Vasc Surg. 2009;50(6):1519-22. PMid:19782520. http://dx.doi.org/10.1016/j.jvs.2009.07.068.

7. Fry RE, Fry WJ. Extracranial carotid artery injuries. Surgery. 1980;88(4):581-7. PMid:7423378.

8. Simonian GT, Pappas PJ, Padberg FT Jr, et al. Mandibular subluxation for distal internal carotid exposure: technical considerations. J Vasc Surg. 1999;30(6):1116-20. PMid:10587398. http://dx.doi.org/10.1016/S0741-5214(99)70052-2.

9. Zhang G, Li Y, Zhang R, et al. Acute submandibular swelling complicating arteriography with iodide contrast: a case report and literature review. Medicine. 2015;94(33):e1380. PMid:26287428. http://dx.doi.org/10.1097/MD.0000000000001380.

10. Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media. Radiology. 1990;175(3):621-8. PMid:2343107. http://dx.doi.org/10.1148/radiology.175.3.2343107.

11. Sussman RM, Miller J. Iodide mumps after intravenous urography. N Engl J Med. 1956;255(9):433-4. PMid:13358860. http://dx.doi.org/10.1056/NEJM195608302550907.

12. Panasoff J, Nusem D. Iodide mumps. World Allergy Organ J. 2008;1(5):85-6. PMid:23282324. http://dx.doi.org/10.1097/WOX.0b013e318172fcd4.

13. Cansel M, Yagmur J, Cuglan B, et al. Iodide-induced parotitis after coronary angiography. Hong Kong J Emerg Med. 2011;18:421-3.

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