Modified trans-oral approach with an inferiorly based flap

• Published in: Journal of clinical neuroscience Vol. 17; no. 4; pp. 464 - 468
• Main Authors: Al-Holou, Wajd N, Park, Paul, Wang, Anthony C, Than, Khoi D, Marentette, Lawrence J
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.04.2010
• Subjects: Atlanto-Axial Joint - surgery; Chordoma; Clivus; Craniocervical junction; Humans; Neurology; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Pharyngeal flap; Postoperative Complications - epidemiology; Surgical Flaps; Trans-oral approach; Chordoma; Craniocervical junction; Pharyngeal flap; Clivus; Trans-oral approach
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2009.08.015

Abstract The trans-oral approach allows direct access to pathologies of the anterior craniocervical junction. However, the classic midline incision of the posterior pharyngeal wall can be surgically burdensome and limits lateral exposure. We reviewed the medical records of nine patients undergoing the trans-oral approach. The sites of the pathology ranged from the clivus to C2, and surgical exposure ranged from the clivus to C3. Each operation utilized an inferiorly based flap. None of the patients experienced vascular or neurologic complications, and no patient had a cerebrospinal fluid fistula, pseudomeningocele, or meningitis postoperatively. The trans-oral approach with an inferiorly based flap can therefore be safely and effectively performed with minimal oropharyngeal and neurologic morbidity. Not only does a U-shaped flap allow adequate exposure from the lower half of the clivus to C3, a flap improves lateral exposure, provides a clear operating field, and allows superficial mucosal closure not directly overlying the operative field.