Anatomical and surgical insights into double mandibular osteotomy with segmental rotation for parapharyngeal space and infratemporal fossa access.

PURPOSE: The primary objective was to quantify the additional exposure of the distal cervical internal carotid artery achieved by double mandibular osteotomy. The secondary objective was to assess the technical feasibility by identifying key anatomical landmarks and defining the optimal operative steps. METHODS: Twenty dissections were performed on formalin-embalmed cadavers. The internal carotid artery exposure was measured before and after double mandibular osteotomy, in conjunction with sectioning of the stylohyoid, styloglossus, and stylopharyngeus muscles, as well as resection of the styloid process. Mean values between the two groups were compared using an independent two-sample Student’s t-test. RESULTS: The transcervical approach exposed 33.85 mm (± 5.8 mm) of the internal carotid artery. After double osteotomy, a mean exposure of 67.75 mm (± 5.1 mm) was achieved, representing an increase of 33.9 mm. A statistically significant difference between group means was observed (t = –19.43, p < 0.05; 2.45 × 10⁻21), supporting rejection of the null hypothesis. CONCLUSION: Double mandibular osteotomy offers an effective alternative for accessing the parapharyngeal space and infratemporal fossa, facilitating tumor resection and carotid interventions. This technique balances surgical accessibility with preservation of surrounding structures, resulting in an acceptable level of morbidity.