Transoral and Endoscopic Endonasal Odontoidectomies – Surgical Techniques, Indications, and Complications

Odontoidectomy is indicated for some cases of ventral compression in the upper cervical spine. In this paper, we discuss the indications, surgical steps, and nuances of transoral odondoidectomy (TO) and endoscopic endonasal (EE) odontoidectomy. We compare both approaches and discuss the advantages and disadvantages of each. A broad narrative literature review was performed. We also added tips and surgical pearls of the senior author (KDR) in performing odontoidectomies. Surgical techniques were presented. EE is performed in patients where the dens is located above the nasopalatine line. Although technically more demanding, EE has less soft tissue injury and potentially less risk of dysphonia and dysphagia. The TO approach provides a wider exposure and is not limited by the nasopalatine line. Additionally, the TO approach allows the ability for a more extensive resection of C2; these could include the C2 body and the C2–3 disc space. Ventral reconstructions with cages and plates are also feasible via the TO approach. However, there are additional risks of prolonged intubation and tracheostomy with the TO approach. Surgeons who manage upper cervical spine disease should be comfortable performing both approaches, and selecting the best approach should be determined using patient-specific characteristics.