Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities

Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review

“…7,19,21,28,38 Rates of significant upper respiratory tract edema requiring intervention following transoral approaches have been reported in up to 5% of adults and 4% of children, but this rate may be artificially low due to a more cautious timetable for extubation. 6,9,13,20,26,27,36,39,40 Additionally, an endoscopic transnasal approach may allow for a more prompt return to a normal oral diet. 21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required.…”

“…21,24 The incidence of new-onset dysphagia after a traditional transoral approach ranges from 0%-20% in adults and 0%-4% in the pediatric population, which is not unexpected given the dissection of the posterior pharyngeal tissues that is required. 6,9,13,26,27,34,36,39,40 A final potential advantage of endoscopic transnasal approaches versus transoral approaches is greater access to the structures superior to the soft palate, facilitating a more direct trajectory to the rostral CVJ. This reduces the frequent need to split the palate, which may be required in up to 29% of adult patients undergoing transoral surgery.…”

Mucosal-sparing posterior septectomy for endoscopic endonasal approach to the craniocervical junction

“…Considered the "gold standard" for anterior access to the craniocervical junction (CCJ), the transoral approach has been widely used to gain exposure of diverse pathologies involving the rostral cervical spine and atlantoaxial regions [1][2][3][4][5][6][7][8][9]. However, this approach often entails significant disruption of the tongue or palate, and is associated with a significant risk of velopharyngeal incompetence and prolonged dysphagia necessitating postoperative gastrostomy use [6,7].…”

“…However, this approach often entails significant disruption of the tongue or palate, and is associated with a significant risk of velopharyngeal incompetence and prolonged dysphagia necessitating postoperative gastrostomy use [6,7]. In many cases, tracheotomy is performed routinely [2,4,7,9]. Additional disadvantages of the technique include field contamination, infection, and wound dehiscence [2][3][4]9].…”

“…In many cases, tracheotomy is performed routinely [2,4,7,9]. Additional disadvantages of the technique include field contamination, infection, and wound dehiscence [2][3][4]9]. Extraoral anterolateral transcervical approaches have also been used to access the CCJ without entry into the hypopharynx or oral cavity [10][11][12][13].…”