Mandibular Splitting Approach to the Upper Anterior Vertebral Canal
Adequate exposure of mass lesions behind the vertebral bodies of the second and third cervical vertebrae may be difficult to achieve through the standard anterolateral approach, due to limitations at the superior margins of the exposure. Adequate exposure at the superior end of the anterolateral approach requires division of the superior thyroid and lingual and facial branches of the external carotid artery and places the superior laryngeal nerve in jeopardy. This nerve innervates the vocal cords and is responsible for shouting and singing high notes. The standard exposure through the open mouth transpharyngeal approach is frequently hampered due to the limited range of motion of the temporal mandibular joint and the depth of the wound as one approaches the posterior aspects of the vertebral bodies. It is also difficult to get caudad to the C2–C3 intervertebral disc. On occasion, particularly with patients who have been operated on previously, wider exposure is necessary to adequately remove mass lesions from the anterior vertebral canal which are producing progressive myelopathy.
KeywordsVertebral Body Cervical Vertebra Adequate Exposure Superior Laryngeal Nerve Direct Anterior Approach
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- 1.DeAndrade, McNab (1969) Anterior occipital cervical fusionextrapharyngeal. JBJS 1969Google Scholar
- 2.Fang Ong (1962) Anterior approach to upper cervical vertebrae. JBJSGoogle Scholar
- 3.Hall, Denis, Murray (1977) Exposure of upper cervical spine for decompression by mandible and tongue splitting approach. JBJSGoogle Scholar
- 4.Kocher T (1911) Surgery of the pharynx. Operative Surgery/BlackGoogle Scholar