Transoral Transmandibular Approach for Multilevel Anterior Cervical Fusion: Technical Note

The transoral transmandibular approach is indicated for pathologies affecting C1-3 that require an anterior or combined anteroposterior approach to address. This approach has been described previously for cervical tumors requiring en bloc resection, deformity, and pathologic fractures secondary to rheumatological disease. Here, we to illustrate the transoral transmandibular approach for cervical osteomyelitis. A 29-year-old male presented with neck pain and was found to have osteomyelitis of unclear etiology at C1-4 complicated by pathological fractures at C2-3. He initially underwent a C1-5 posterior spinal fusion and empiric antibiotic therapy but represented 3 months later with pseudoarthrosis. Due to posterior element erosion, the patient underwent an anterior transoral transmandibular approach for C2-4 corpectomies and C1-5 anterior fusion, followed by posterior occiput-C6 fusion. Postoperatively stable neurological exam and improved neck pain. This case demonstrates how the anterior transoral transmandibular approach enables access and robust multilevel anterior column reconstruction for pathologies affecting C1-3.