Anatomy Atlas and Interpretation of Spine Surgery

12
J.-g. Shi et al.
Median mandibulotomy with glossotomy:
The tongue, sublingual muscles, and mandible are split
through along the midline.
This approach allows the full exposure of the posterior
pharyngeal wall up to the inferior border of C5 and
is suitable for dealing with patients with ventral lesions
on the upper and lower cervical spine.
This approach is convenient for the treatment of
vertebral lesions involving many segments of the upper
and lower cervical spine.
Fig. 1.15 Position of lateral atlantoaxial exposure and incision by
suprahyoid approach
3 Lateral Atlantoaxial Exposure
and Odontoidectomy by Suprahyoid
Approach
3.1 Overview
The anteromedial retropharyngeal approach to the upper cervical
spine was improved by Southwick and Robinson (1975)
to expose the middle and the inferior cervical spine. This
approach can be applied to anterior tumor resection, debridement
and atlantoaxial fixation of the upper cervical spine, as
well as odontoid fixation. It can directly expose the clivus to
C3 and can even be expanded to expose the middle to lower
cervical spine. This approach accesses the retropharyngeal
space from the medial side of the carotid sheath, which can
avoid injuries to the carotid artery and basicranial nerves.
However, it also has a greater chance of damaging the superior
laryngeal nerve, glossopharyngeal nerve, and vertebral
artery compared to lateral carotid sheath approach. The
advantage of this technique is that it is completely an extramucosal
approach and thereby can effectively reduce the chance
of infection. The disadvantage is that it is not a direct approach
and it results in long exposure and the need of tracheotomy.
3.2 Position
Patient is placed in a supine position, with the head
slightly extended backward and turned to the opposite
side at a 30°. A moderate head elevation provides better
surgical vision and venous drainage (Figs. 1.15,
1.16, and 1.17).
General anesthesia with fiberoptic nasotracheal
intubation can prevent excessive neck movement and
avoid the low position mandible obstructing the surgical
field in orotracheal intubation case.
Fig. 1.16 Position of lateral atlantoaxial exposure and incision by
suprahyoid approach
Fig. 1.17 Submandibular incision on the skin
Mentum
cephalad
platysma