Journal article
Median labiomandibular glossotomy approach to the craniocervical region
Child's nervous system, Vol.24(10), pp.1195-1201
10/2008
DOI: 10.1007/s00381-008-0609-5
PMID: 18437393
Abstract
In children as well as adults, adequate access to the craniocervical junction and upper cervical vertebra can usually be achieved with a transoral–transpalatopharyngeal route. However, when access is necessary to achieve the C5 level and the upper cervical spine in children, this is very difficult. This is particularly so when the incisor opening is less than 2.5 cm. The median labiomandibular glossotomy provides such an approach.Our experience with five children is presented in a representative case: a 4-year-old male with a family history of spondyloepiphyseal dysplasia presented with mild quadriparesis, 2 years earlier. This had rapid progression with severe upper cervical kyphosis. A standard transoral–transpalatopharyngeal approach or a lateral extrapharyngeal approach would not achieve exposure of the pathology. Hence, a median labiomandibular glossotomy was utilized for ventral decompression with an anterior interbody fusion between C2 and C4. Crown halo cervical traction was placed intraoperatively before a tracheostomy and tonsillectomy. A median labiomandibular glossotomy was then made with resection of the displaced odontoid process and the vertebral bodies of C3 and C4. This was followed by an anterior interbody fusion between the C2 and C4 vertebrae with costal rib grafts.He was successfully decannulated during the second postoperative week upon resolution of lingual edema. A planned staged dorsal occipitocervical fusion was performed 6 months later, at which time the ventral fusion was quite solid. He had full neurological recovery.
Details
- Title: Subtitle
- Median labiomandibular glossotomy approach to the craniocervical region
- Creators
- James Brookes - Department of Otolaryngology Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa IA USARichard Smith - Department of Otolaryngology Head and Neck Surgery 200 Hawkins Drive, 21201 PFP Iowa City IA 52242 USAArnold Menezes - Department of Neurosurgery University of Iowa Hospitals and Clinics 200 Hawkins Drive, 1824 JPP Iowa City IA 52242 USAM C Smith - Department of Otolaryngology Head and Neck Surgery University of Iowa Hospitals and Clinics Iowa IA USA
- Resource Type
- Journal article
- Publication Details
- Child's nervous system, Vol.24(10), pp.1195-1201
- DOI
- 10.1007/s00381-008-0609-5
- PMID
- 18437393
- NLM abbreviation
- Childs Nerv Syst
- ISSN
- 0256-7040
- eISSN
- 1433-0350
- Publisher
- Springer-Verlag; Berlin/Heidelberg
- Language
- English
- Date published
- 10/2008
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Radiation Oncology; Neurosurgery; Otolaryngology; Internal Medicine
- Record Identifier
- 9984006478902771
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