Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report

Ariffin, Mohd Hisam Muhamad; Ashfaq, Musannah; Kang, EunKyo

doi:10.5704/moj.1603.009

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…The tubular retractor through the transoral route has been described in only 1 previous report to achieve a microscopic anterior odontoidectomy through a midline pharyngeal incision. 13 Endoscopic endonasal approaches (EEAs) to the midline cervical spine and CVJ are well described and offer the advantage of preventing dysphagia associated with the transoral approach. The latter is believed to be caused by an injury of the neural plexus formed by the primary pharyngeal motor nerves.…”

Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Basma¹,

Rangarajan²,

Michael³

et al. 2021

Operative Surg.

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BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Basma¹,

Rangarajan²,

Michael³

et al. 2021

Operative Surg.

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“…An ossicle located in the position of the normal odontoid is referred to as orthotopic, and considered dystopic if it appears near the occiput in the area of the foramen magnum. The incidence of os odontoideum is unknown because the lesion is usually asymptomatic [8] A review of the literature fails to disclose any solid evidence of aetiology of Os Odontoideum [9]. Kirlew et al [10] published a case of os odontoideum among homozygot twin with fusion of posterior arch of C2 and C3.…”

Section: Discussionmentioning

confidence: 99%

Os Odontoideum: Report of Eight Cases and Review of the Literature

Mahmoud¹,

Hammad²,

Abdrabou³

2020

OJMN

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Background: Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired causes but the aetiology still debated in the literature. It can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk. Methods: Eight cases of os odontoideum were symptomatic at time of presentation, submitted for general and neurological examination, and investigated with different radiological modalities and managed with surgical fixation and stabilization. These patients followed for one year postoperatively. Results: The study includes six male patients and two female patients with median age 18.7 years. All patients presented with myelopathy and showed clinical evidence of atlantoaxial instability. They submitted for complete radiological investigations (plain x ray, CT scan and MRI) craniocervical junction. They underwent cervical surgical stabilization, two cases by atlantoaxial arthrodesis with wiring, two atlantoaxial fixation by lateral mass screw one of them with transoral odontoiectomy, two atlantoaxial fixations by a Rosen's Hooks, and two cases craniocervical fixation by Tie frame. Death postoperatively recorded in two patients. Follow-up one year revealed resolution of symptoms in two patients and four patients remained stationary but without deterioration. Conclusion: Os odontoideum is a rare but sometimes lethal abnormality that requires radiological and clinical judgement to ensure the best choice of management and optimum patient's care.

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“…Jones et al reported oropharyngeal complications in 75% patients who had undergone splitting of soft palate compared to 15.4% of patients who did not undergo splitting of the soft palate 6 . Ariffin et al reported the use of a tubular retractor to provide an “access surgery” for microsurgical transoral excision of os odontoideum by inserting the right length tubular retractor directly into the mouth obviating the need to split the soft palate as the tubular retractor naturally pushes away the soft palate, the uvula and the pillars of the tonsils when its “docks” down on the oropharynx 7 . The surgery was complicated by durotomy managed by tissue sealant.…”

Section: Introductionmentioning

confidence: 99%

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

MH,

SN,

et al. 2023

Malays Orthop J

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Introduction To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ. Materials and methods Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression. Results All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy. Conclusions A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.

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Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report

Cited by 4 publications

References 4 publications

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Os Odontoideum: Report of Eight Cases and Review of the Literature

Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

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