[Atloido-axoid surgery by a transoral approach]

The author has approached 18 atlanto-axial joints in 15 years by a transoral approach. Fourteen of the lesions were post traumatic, two congenital, one rheumatoid and one a tumour. It is concluded that the approach is a valuable one provided that there is adequate surgical technique, good antiseptic preparation, antibiotic therapy, provisional peroperative tracheostomy and special retractors. Use of adequate suture is also important. In some cases, magnification was needed. Medullary monitoring may also be helpful. The author estimates that the approach is more effective than extrabuccal techniques since it allows a direct exposure of the lesion. Large excisions are possible followed by reconstruction and grafting. It also allows screw fixation of the odontoid process. Two patients among earlier cases became infected but without serious long-term complications. Remaining cases have uncomplicated follow-up.