Radiological and Surgical Anatomy of Ventral C1-C2 Complex

To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex.

This study included six formalin-fixed cadaveric head and neck specimens. Radiological images and anatomical measurements included: C1-C2 distance, bony distance between C1 anterior tubercle-nares and superior incisors, height of C1 anterior arch, and height and width of odontoid articular surface.

The mean distance between C1 anterior tubercle-nares and superior incisors on maxilla were 96.16 ± 8.07 mm and 84.14 ± 9.16 mm, respectively. The mean height of C1 anterior arch was 13.89 mm. The meandistance between medial borders of right-left C1 lateral masses was 19.10 ± 1.80 mm. The mean distance between medial border of lateral midline on mass right and left sides were 9.43 ± 0.88 mm and 9.68 ± 0.97 mm, respectively. The mean height of C1 anterior arch at midline was 13.89 ± 2.48 mm, and the mean distance between ventral surface of anterior arch and ventral joint of odontoid at midline was 6.43 ± 1.29 mm. The anteroposterior, horizontal diameters of odontoid on its base were 12.12 ± 0.38 mm, and 11.12 ± 0.94 mm, respectively. The angles of transoral and transnasal approaches to C1 were 32.67 ± 4.59° and 32.00 ± 2.10°, respectively.

A safe transoral or transnasal odontoidectomy requires accurate measurements and imaging regarding ventral C1-C2 relationships, distances of odontoid, lateral mass and midline.