Anterior Transoral Approaches to the Upper Cervical Spine in Children

Abstract

In this chapter we describe the anatomy, indications for surgery, surgical approach, and complications of the transoral approach to the cervical spine. The transoral approach provides a direct route to the cervical spine with less morbidity than open approaches through the neck. A multidisciplinary approach (ENT, orthopedic surgery, neurosurgery) serves the patient well in the preoperative planning. Preoperative evaluation with imaging (CT, MRI, or both) is imperative to help identify the underlying cervical spine abnormality. If there are significant cranial nerve deficits, it is our opinion that a tracheostomy is more likely necessary prior to the procedure due to the combined insult with surgery. If there is significant glossopharyngeal, vagal, or hypoglossal nerve deficits, there is a need for tracheostomy, as these individuals will not be able to adequately protect their airway postoperatively. Emergent tracheostomy due to inability to secure an airway postoperatively has also been observed and is the reason the patients at risk need to be identified preoperatively.