Complications Related to Anterior Approaches

  • Luca DenaroEmail author
  • Domenico D'Avella
  • Umile Giuseppe Longo
  • Vincenzo Denaro

Transoral surgery is a procedure performed through the mouth to gain midline access from the sphenoid sinus rostrally to the third cervical vertebral body cau-dally [1], and it is particularly useful for lesions at the anterior aspect of the craniocervical junction [2, 3].

It has been used with varying degrees of success by numerous authors over the past century. The transoral approach, first described by Kanaval in 1919 [4] to remove a bullet locked between atlas and the base of the skull, was successively used by Scoville and Sherman in 1951 [5] for the removal of the odontoid process in basilar impression. Southwick and Robinson [6] and Mosberg and Lippman [7] described the transoral treatment of lesions of the second cervical vertebra.


Vertebral Artery Soft Palate Hyoid Bone Glomus Tumor Odontoid Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Crockard HA (1995) Transoral surgery: some lessons learned. Br J Neurosurg 9:283–293PubMedCrossRefGoogle Scholar
  2. 2.
    Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67:321–325PubMedGoogle Scholar
  3. 3.
    Crockard HA (1991) Ventral approaches to the upper cervical spine. Orthopade 20:140–146PubMedGoogle Scholar
  4. 4.
    Kanavel AB (1919) Bullet locked between atlas and the base of the skull: technique for removal through the mouth. Surg Clin 1:361–366Google Scholar
  5. 5.
    Scoville WB, Sherman IJ (1951) Platybasia, report of. 10 cases with comments on familial tendency, a special diagnostic sign, and the end results of operation. Ann Surg 133:496–502PubMedGoogle Scholar
  6. 6.
    Southwick WO, Robinson RA (1957) Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg Am 39-A:631–644PubMedGoogle Scholar
  7. 7.
    Mosberg WH Jr, Lippman EM (1960) Anterior approach to the cervical vertebral bodies. Bull Sch Med Univ Md 45:10–17PubMedGoogle Scholar
  8. 8.
    Fang HSY, Ong GB (1962) Direct anterior approach to the upper cervical spine. J Bone joint Surg Am 44-A: 1588–1604Google Scholar
  9. 9.
    Greenberg AD, Scoville WB, Davey LM (1968) Transoral decompression of atlanto-axial dislocation due to odontoid hypoplasia. Report of two cases. J Neurosurg 28:266–269PubMedCrossRefGoogle Scholar
  10. 10.
    Menezes AH, VanGilder JC, Graf CJ et al (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53:444–455PubMedCrossRefGoogle Scholar
  11. 11.
    Crockard HA, Pozo JL, Ransford AO et al (1986) Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg Br 68:350–356PubMedGoogle Scholar
  12. 12.
    Di Lorenzo N, Fortuna A, Guidetti B (1982) Craniovertebral junction malformations. Clinicoradiological findings, longterm results, and surgical indications in 63 cases. J Neurosurg 57:603–608PubMedCrossRefGoogle Scholar
  13. 13.
    Hayakawa T, Kamikawa K, Ohnishi T et al (1981) Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. Technical note. J Neurosurg 54:699–703PubMedCrossRefGoogle Scholar
  14. 14.
    Tuite GF, Veres R, Crockard HA et al (1996) Pediatric transoral surgery: indications, complications, and long-term outcome. J Neurosurg 84:573–583PubMedCrossRefGoogle Scholar
  15. 15.
    de Andrade JR, Macnab I (1969) Anterior occipito-cervical fusion using an extra-pharyngeal exposure. J Bone Joint Surg Am 51:1621–1626PubMedGoogle Scholar
  16. 16.
    Southwick WO, Robinson RA (1957) Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg Am 39:631–644PubMedGoogle Scholar
  17. 17.
    Hardy J (1969) Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217PubMedGoogle Scholar
  18. 18.
    Kaibara T, Hurlbert RJ, Sutherland GR (2001) Intraoperative magnetic resonance imaging-augmented transoral resection of axial disease. Neurosurg Focus 10:E4PubMedCrossRefGoogle Scholar
  19. 19.
    Menezes AH (2008) Surgical approaches: postoperative care and complications “transoral-transpalatopharyngeal approach to the craniocervical junction”. Childs Nerv Syst 24(10): 1187–1193PubMedCrossRefGoogle Scholar
  20. 20.
    Crockard HA, Johnston F (1993) Development of transoral approaches to lesions of the skull base and craniocervical junction. Neurosurg Q 3:61–82Google Scholar
  21. 21.
    Denaro V (1991) Stenosis of the cervical spine. Springer, BerlinCrossRefGoogle Scholar
  22. 22.
    MenezesAH,VanGilderJC(1988)Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients. J Neurosurg 69:895–903PubMedCrossRefGoogle Scholar
  23. 23.
    Roy-Camille R, Judet TH, Saillant G et al (1981) Tumeurs du rachis. Techniques chirugucales, Orthopedie. Encycl Med Chir Paris 44165:4.06.04Google Scholar
  24. 24.
    Apuzzo ML, Weiss MH, Heiden JS (1978) Transoral exposure of the atlantoaxial region. Neurosurgery 3:201–207PubMedCrossRefGoogle Scholar
  25. 25.
    Ashraf J, Crockard HA (1990) Transoral fusion for high cervical fractures. J Bone Joint Surg Br 72:76–79PubMedGoogle Scholar
  26. 26.
    Ashraf J, Crockard HA, Ransford AO et al (1991) Transoral decompression and posterior stabilisation in Morquio's disease. Arch Dis Child 66:1318–1321PubMedCrossRefGoogle Scholar
  27. 27.
    Bhangoo RS, Crockard HA (1999) Transmaxillary anterior decompressions in patients with severe basilar impression. Clin Orthop Relat Res 359:115–125PubMedCrossRefGoogle Scholar
  28. 28.
    Boni M, Denaro V (1982) The cervical stenosis syndrome with a review of. 83 patients treated by operation. Int Orthop 6:185–195PubMedCrossRefGoogle Scholar
  29. 29.
    Boni M, Denaro V (1982) Surgical treatment of cervical arthrosis. Follow-up review (2–13 years) of the 1st 100 cases operated on by anterior approach. Rev Chir Orthop Reparatrice Appar Mot 68:269–280PubMedGoogle Scholar
  30. 30.
    Crockard HA (1988) Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 34:389–416PubMedGoogle Scholar
  31. 31.
    Crockard HA (1995) Surgical management of cervical rheumatoid problems. Spine 20:2584–2590PubMedCrossRefGoogle Scholar
  32. 32.
    Crockard HA, Essigman WK, Stevens JM et al (1985) Surgical treatment of cervical cord compression in rheumatoid arthritis. Ann Rheum Dis 44:809–816PubMedCrossRefGoogle Scholar
  33. 33.
    Crockard HA, Sen CN (1991) The transoral approach for the management of intradural lesions at the craniovertebral junction: review of. 7 cases. Neurosurgery 28:88–97; discussion 97–88PubMedCrossRefGoogle Scholar
  34. 34.
    D'Alpa F, Scandurra L, Savuto R et al (1989) Pre-, intra- and postoperative somatosensory evoked potentials in cervical vertebral and spinal cord injuries. Minerva Anestesiol 55:115–118PubMedGoogle Scholar
  35. 35.
    Crockard HA, Bradford R (1985) Transoral transclival removal of a schwannoma anterior to the craniocervical junction. Case report. J Neurosurg 62:293–295PubMedCrossRefGoogle Scholar
  36. 36.
    Delgado TE, Garrido E, Harwick RD (1981) Labiomandibular, transoral approach to chordomas in the clivus and upper cervical spine. Neurosurgery 8:675–679PubMedCrossRefGoogle Scholar
  37. 37.
    Di Lorenzo N (1989) Transoral approach to extradural lesions of the lower clivus and upper cervical spine: an experience of. 19 cases. Neurosurgery 24:37–42PubMedCrossRefGoogle Scholar
  38. 38.
    Estridge MN, Smith RA (1967) Transoral fusion of odontoid fracture. Case report. J Neurosurg 27:462–465PubMedCrossRefGoogle Scholar
  39. 39.
    Vougioukas VI, Hubbe U, Schipper J et al (2003) Navigated transoral approach to the cranial base and the craniocervical junction: technical note. Neurosurgery 52:247–250; discussion 251PubMedGoogle Scholar
  40. 40.
    Jones DC, Hayter JP, Vaughan ED et al (1998) Oropharyngeal morbidity following transoral approaches to the upper cervical spine. Int J Oral Maxillofac Surg 27:295–298PubMedCrossRefGoogle Scholar
  41. 41.
    Harkey HL, Crockard HA, Stevens JM et al (1990) The operative management of basilar impression in osteogenesis imperfecta. Neurosurgery 27:782–786; discussion 786PubMedCrossRefGoogle Scholar
  42. 42.
    Ibrahim AG, Crockard HA (2007) Basilar impression and osteogenesis imperfecta: a. 21-year retrospective review of outcomes in 20 patients. J Neurosurg Spine 7:594–600PubMedCrossRefGoogle Scholar
  43. 43.
    Bonney G, Williams JP (1985) Trans-oral approach to the upper cervical spine. A report of 16 cases. J Bone Joint Surg Br 67:691–698PubMedGoogle Scholar
  44. 44.
    Lamas E, Estevez J, Castillo R et al (1977) Os odontoideum removed by a transoral approach. Surg Neurol 7:312–314PubMedGoogle Scholar
  45. 45.
    Pasztor E, Vajda J, Piffko P et al (1980) Transoral surgery for basilar impression. Surg Neurol 14:473–476PubMedGoogle Scholar
  46. 46.
    Gilsbach J, Eggert HR (1983) Transoral operations for cran-iospinal malformations. Neurosurg Rev 6:199–209PubMedCrossRefGoogle Scholar
  47. 47.
    Boni M, Denaro V (1980) Surgical treatment of traumatic lesions of the middle and lower cervical spine (C3–C7). Ital J Orthop Traumatol 6:305–320PubMedGoogle Scholar
  48. 48.
    Spetzler RF, Selman WR, Nash CL Jr et al (1979) Transoral microsurgical odontoid resection and spinal cord monitoring. Spine 4:506–510PubMedCrossRefGoogle Scholar
  49. 49.
    O'Reilly G, Crockard HA, Lightman S et al (1993) Excision of a clival and upper cervical pheochromocytoma by an extended maxillotomy approach: a case report. Skull Base Surg 3:87–90PubMedCrossRefGoogle Scholar
  50. 50.
    Merwin GE, Post JC, Sypert GW (1991) Transoral approach to the upper cervical spine. Laryngoscope 101:780–784PubMedCrossRefGoogle Scholar
  51. 51.
    Denaro V, Denaro L, Gulino G et al (1998) Complicanze nella chirurgia cervicale. Giornale Italiano di Ortopedia e Traumatologia 24:681–688Google Scholar
  52. 52.
    Denaro V, Gulino G, Papapietro N et al (1998) Treatment of metastases of the cervical spine. Chir Organi Mov 83:127–137PubMedGoogle Scholar
  53. 53.
    Windle-Taylor PC (1977) Cervical chordoma: report of a case and the technique of transoral removal. Br J Surg 64:438–441PubMedCrossRefGoogle Scholar
  54. 54.
    Arvin B, Panchmatia JR, Casey AT (2008) Cervical C2 osteoma, unusual presentation and transoral approach for complete excision. Spine J 9(3):e9–e11PubMedCrossRefGoogle Scholar
  55. 55.
    Crockard HA, Calder I, Ransford AO (1990) One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation. J Bone Joint Surg Br 72:682–685PubMedGoogle Scholar
  56. 56.
    Mummaneni PV, Haid RW (2005) Transoral odontoidec-tomy. Neurosurgery 56:1045–1050; discussion 1045–1050PubMedCrossRefGoogle Scholar
  57. 57.
    Di Lorenzo N (1992) Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neurochir (Wien) 118:112–116CrossRefGoogle Scholar
  58. 58.
    Cantarella G, Mazzola RF, Benincasa A (1998) A possible sequela of transoral approach to the upper cervical spine. Velopharyngeal incompetence. J Neurosurg Sci 42:51–55PubMedCrossRefGoogle Scholar
  59. 59.
    Louis R (1992) Anterior surgery of the upper cervical spine. Chir Organi Mov 77:75–80PubMedGoogle Scholar
  60. 60.
    James D, Crockard HA (1991) Surgical access to the base of skull and upper cervical spine by extended maxillotomy. Neurosurgery 29:411–416PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Luca Denaro
    • 1
    Email author
  • Domenico D'Avella
    • 2
  • Umile Giuseppe Longo
    • 3
  • Vincenzo Denaro
    • 4
  1. 1.Department of NeuroscienceUniversity of PaduaPaduaItaly
  2. 2.Department of NeuroscienceUniversity of PaduaPaduaItaly
  3. 3.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityRomeItaly
  4. 4.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityRomeItaly

Personalised recommendations