Transoral approach to the upper cervical spine

The transoral approach to pathology of the upper cervical spine is logical, but it is seldom used due to concerns about exposure and infection. The authors report on 16 consecutive patients requiring exposure from clivus through C3 for pathology, including spinal cord compression by rheumatoid pannus, craniovertebral anomalies, and tumor. Exposure was obtained using a Dingman mouth gag and soft palate retraction with silicone rubber sheeting. A horizontal "H" incision was made in the posterior pharyngeal wall creating three layers, closed separately, with attention to a watertight closure of the final mucosal layer. In no case was it necessary to divide the mandible, tongue, soft palate, or uvula. There were no deaths, wound breakdowns, infections, or persistent cerebrospinal fluid leakage. Patients with neurological indications improved postoperatively, and all tumors were grossly resected. Combined otolaryngology/neurosurgical exposure and treatment of pathology involving the upper cervical spine via the transoral approach is safe and effective. Functional results have been excellent, and no major complications were encountered.