Oropharyngeal odontoidectomy

Transsphenoidal approach for odontoid surgery for odontoid malformation. A odontoid deformity is a rare congenital malformation, including odontogenic dysplasia, odontoid distal bone, odontoid separation, and odontoid absence. The odontoid deformity is fixed only to the atlantoaxial joint by local ligamentous tissue, which makes the local instability, and it is easy to cause spinal cord injury due to dislocation caused by trauma. Clinically, it can be asymptomatic, but when it is slightly traumatized, symptoms of medullary or upper cervical spinal cord compression may occur. Curing disease: Indication Oropharyngeal odontectomy is available for: 1. C1 ~ C2 semi-dislocation or dislocation can not be reset after traction, the symptoms of ventral brain pressure of the brain stem are not relieved. 2. There are neurological symptoms in the skull base depression. After the traction, the odontoid process can not be reset. The posterior stenosis is performed after the posterior fixation. Preoperative preparation 1. 3 to 5 days before surgery, oral disinfection 3 times / d. 2. According to the bacterial culture of the nasopharynx before surgery, antibiotics were administered intravenously 1 day before surgery. 3. Install the skull ring-vest holder 1d before surgery. Surgical procedure Incision The upper and lower jaws are retracted by the opener, and then the vertebral body is distinguished by touch. The first cervical vertebra, that is, the midline of the front of the atlas, has a nodule, and the intervertebral disc between the second and third cervical vertebrae protrudes, which can be used as another positioning marker. Make a vertical incision in the middle of the posterior pharyngeal wall 2. Reveal The soft palate is cut along the midline, and then separated from the midline to the vertebral body, and retracted to the outer edge of the lateral side block. The vertebral artery is located on the outside of the outer edge of the side block, so be careful not to damage the vertebral artery. The soft tissue flap can be retracted with a long line. 3. Dentate resection Using a high-speed micro-running drill, the former nodule is the center, the anterior arch of the atlas is cut about 1cm, then the odontoid is sharpened, and the remaining odontoids are carefully bitten with a rongeur. 4. Bone graft For those who have not undergone posterior fusion, depending on the situation, ankle joint bone graft fusion can also be used. Fang and Ong introduced the use of a rectangular autologous iliac bone block to insert a similarly shaped bone graft bed between the lateral side of the atlas, the lateral mass of the vertebral body and the vertebral body to achieve C1 to C2 anterior fusion. If only the anterior decompression is performed, then the posterior fusion should be done. 5. Close the incision Rinse the wound with saline, and close the ligament and periosteum to the middle, and suture the muscle, anterior fascia and mucosa intermittently.