Our objective is to propose a novel surgical technique, the microscope-assisted odontoid
resection via submandibular retropharyngeal "key-hole" approach. The patient suffered
a traumatic cervical spine injury due to a motorcycle accident. We removed the upper
two-thirds of the CII vertebra's odontoid process along with the cortical fragment
causing the medullar compression. With this surgical technique the velopharyngeal
insufficiency, occurring at the traditional transoral surgery, is avoidable while
the access to the odontoid process is insured. The MRI confirmed ventral injury to
the meninges, which increases the risk of wound healing complications and sepsis so
along with the high risk of velopharyngeal insufficiency occurring at the transoral
surgery, stood in favour of the new method. During the submandibular "key-hole" technique
besides the use of tissue-glue, tamponing the meninges damage with multiple layers
of viable soft tissue could be performed. The postoperative CT and MR imaging confirmed
the complete decompression of the medulla oblongata. The patient's tetraplegic state
entirely regressed, and eight months after the surgery he became self-sufficient.
From now on, the surgical method we used could be a considerable alternative to the
classic transoral transpharyngeal or endoscopic endonasal odontoid resection.
