ENDOSCOPIC IMAGE‐GUIDED TRANSORAL APPROACH TO THE CRANIOVERTEBRAL JUNCTION: AN ANATOMIC STUDY COMPARING SURGICAL EXPOSURE AND SURGICAL FREEDOM OBTAINED WITH THE ENDOSCOPE AND THE OPERATING MICROSCOPE

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons437-ons444 ◽  
Author(s):  
Promod Pillai ◽  
Mirza N. Baig ◽  
Chris S. Karas ◽  
Mario Ammirati
Keyword(s):  
Soft Palate ◽  
Image Guidance ◽  
Odontoid Process ◽  
Posterior Pharyngeal Wall ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Transoral Approach ◽  
Operating Microscope ◽  
Microscopic Approach ◽  
Pharyngeal Wall

Abstract OBJECTIVE The transoral approach is the most direct and commonly used method to access the ventral craniocervical junction. Recently, an endonasal, endoscopic approach to the craniovertebral junction was proposed. We reasoned that the coupling of the endoscope with the direct transoral approach and image guidance could result in a minimally invasive, simple approach to the ventral craniovertebral junction. We investigated the potential usefulness of such an approach in a cadaver model. METHODS A direct transoral approach to the craniovertebral junction was performed using computed tomography-based image guidance in 9 fresh adult head specimens. Endoscopic odontoidectomy was performed in 5 specimens. In the remaining 4 specimens, the surgical working area and surgical freedom associated with an endoscopic and a microscopic approach to the ventral craniovertebral junction were evaluated and compared. In these 4 specimens, we also measured and compared the exposure of the clivus provided by the endoscope and by the operating microscope without splitting the soft palate. RESULTS With variously angled endoscopic assistance and image guidance, it was possible to tailor the excision of the anterior arch of the atlas and to precisely identify the odontoid process and its related ligaments intraoperatively, resulting in a complete and controlled odontoidectomy. The surgical area exposed over the posterior pharyngeal wall was significantly improved using the endoscope (606.5 ± 127.4 mm3) compared with the operating microscope (425.7 ± 100.8 mm3), without any compromise of surgical freedom (P < 0.05). The extent of the clivus exposed with the endoscope (9.5 ± 0.7 mm) without splitting the soft palate was significantly improved compared with that associated with microscopic approach (2.0 ± 0.4 mm) (P < 0.05). CONCLUSION With the aid of the endoscope and image guidance, it is possible to approach the ventral craniovertebral junction transorally with minimal tissue dissection, no palatal splitting, and no compromise of surgical freedom. In addition, the use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate. An endoscope-assisted transoral approach is a direct and powerful tool for the treatment of surgical pathology at the craniovertebral junction.

Sites in the oropharynx reached by different methods of using mouthwash: clinical implication for oropharyngeal gonorrhoea prevention

2019 ◽  
Vol 96 (5) ◽  
pp. 358-360 ◽  
Author(s):  
Kate Maddaford ◽  
Christopher K Fairley ◽  
Sabrina Trumpour ◽  
Mark Chung ◽  
Eric P F Chow
Keyword(s):  
Soft Palate ◽  
Clinical Implication ◽  
Health Centre ◽  
Posterior Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Oral Rinse ◽  
Food Dye ◽  
The Mean ◽  
Application Methods ◽  
Sex With Men

ObjectivesOropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray).MethodsTwenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged.ResultsThe mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012).ConclusionOverall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.

scholarly journals ODONTOID PROCESS HYPOPLASIA AND BIPARTITE ATLAS ASSOCIATED WITH ATLANTO-AXIAL INSTABILITY

2016 ◽  
Vol 15 (4) ◽  
pp. 330-333 ◽  
Author(s):  
Luis Miguel Sousa Marques ◽  
Clara Romero ◽  
José Gabriel Monteiro de Barros Cabral
Keyword(s):  
Imaging Techniques ◽  
Previous History ◽  
Three Dimensional ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Diagnostic Process ◽  
Fixation Techniques ◽  
Bipartite Atlas

ABSTRACT Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.

Soft palate and oronasal breathing in humans

1984 ◽  
Vol 57 (3) ◽  
pp. 651-657 ◽  
Author(s):  
D. O. Rodenstein ◽  
D. C. Stanescu
Keyword(s):  
Healthy Volunteers ◽  
Soft Palate ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Posterior Pharyngeal Wall ◽  
Nasal Breathing ◽  
Quiet Breathing ◽  
Pharyngeal Wall ◽  
Respiratory Impairment ◽  
Open Mouth

In 20 naive patients without respiratory impairment, we investigated the ability of the soft palate to direct airflow during breathing. Patients were connected to a spirometer, without noseclip. No instructions were given on the breathing route. During quiet respiration, 15 patients breathed solely through the nose, despite an open mouth. During forced vital capacity (FVC) maneuvers, 19 patients expired exclusively through the mouth. When specifically asked to breathe quietly through the mouth, pure nasal breathing was no longer observed. Tidal volume (VT) or FVC were comparable when patients were asked to breathe through the mouth, with or without noseclip: 0.67 +/- 0.46 vs. 0.60 +/- 0.21 liter for VT (mean +/- SD); 4.05 +/- 0.65 vs. 4.18 +/- 0.70 liters for FVC. In eight separate healthy volunteers, the soft palate was shown by fluoroscopy to close the oropharyngeal isthmus during quiet breathing (resulting in pure nasal breathing) and to close the nasopharynx during FVC efforts (resulting in mouth breathing). During oronasal breathing, the soft palate lay in between the tongue and the posterior pharyngeal wall. These data suggest that when both mouth and nose are open, the soft palate is responsible for the partitioning of oronasal flow.

scholarly journals Craniovertebral Junction Koch spine – an unusual presentation treated with a novel approach: case report and review of literature

2019 ◽  
Vol 5 (3) ◽  
pp. 529
Author(s):  
Bipul Kumar Garg ◽  
Shrikant Pradeep Savant ◽  
Sumit Maheshwari
Keyword(s):  
Spinal Tuberculosis ◽  
Tertiary Care ◽  
Cervical Vertebra ◽  
Posterior Pharyngeal Wall ◽  
Craniovertebral Junction ◽  
Clinical Findings ◽  
Acute Onset ◽  
Retropharyngeal Abscess ◽  
Retropharyngeal Space ◽  
Pharyngeal Wall

<p class="abstract">The retropharyngeal space lies in the posterior pharyngeal wall between the middle and deep layers of the deep cervical fascia. It extends from the base of the skull to the mediastinum and frequently serves as a conduit for spread of disease from the neck into the chest. Spinal tuberculosis is the commonest extra pulmonary manifestation of tuberculosis. Clinical findings of cervical tuberculosis includes neck pain, restricted neck movements, quadriparesis, radicular manifestations, kyphosis, and sensory disturbance. It should be suspected in an adult person who presents with a destructive lesion of the cervical vertebra and retro-pharyngeal mass. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present here a 46 years old female who presented to a tertiary care setup with acute onset dyspnea and quadriplegia with bladder bowel involvement managed with trans oral incision and drainage of retropharyngeal abscess followed by posterior occipitocervical fusion supplemented with Anti Koch Therapy with a good follow up.</p>

scholarly journals Assessment of Upper Airway Anatomy in Awake, Sedated and Anaesthetised Patients Using Magnetic Resonance Imaging

1994 ◽  
Vol 22 (2) ◽  
pp. 165-169 ◽  
Author(s):  
G. D. Shorten ◽  
N. J. Opie ◽  
P. Graziotti ◽  
I. Morris ◽  
M. Khangure
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
General Anaesthesia ◽  
Soft Palate ◽  
Upper Airway ◽  
Posterior Pharyngeal Wall ◽  
Resonance Imaging ◽  
Pharyngeal Wall ◽  
Airway Anatomy ◽  
Clinically Significant

Magnetic Resonance Imaging was used to quantify the effects of 1. sedation and 2. general anaesthesia with a laryngeal mask airway (LMA) in place on the minimum antero-posterior (A-P) diameters of the naso-, oro- and hypopharynx and on the angle of the epiglottis relative to the adjacent posterior pharyngeal wall. Median saggital T1-weighted images of the pharynx were obtained in 46 patients (16 awake, 14 sedated, 16 under general anaesthesia). In sedated patients, the A-P diameters of the pharynx were less than in awake patients, in particular at the levels of the epiglottis and soft palate. General anaesthesia and placement of a LMA was also associated with a reduced A-P diameter at the level of the soft palate, but with increased diameters at the levels of the tongue and epiglottis. Placement of a LMA caused abnormal downfolding of the epiglottis in most cases but this did not cause clinically significant airway obstruction.

Endoscopic Transnasal Odontoidectomy With Anterior C1 Arch Preservation and Anterior Vertebral Column Reconstruction in Patients With Irreducible Bulbomedullary Compression by Complex Craniovertebral Junction Abnormalities: Operative Nuance

2016 ◽  
Vol 12 (3) ◽  
pp. 222-230 ◽  
Author(s):  
Maurizio Iacoangeli ◽  
Alessandro Di Rienzo ◽  
Roberto Colasanti ◽  
Massimo Re ◽  
Davide Nasi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tube Feeding ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Craniocervical Junction ◽  
Safe Alternative ◽  
Transnasal Approach ◽  
Oral Flora ◽  
Neurological Improvement ◽  
Surgical Corridor

Abstract BACKGROUND During the past decades, the transoral transpharyngeal approach has been advocated as the standard route for the removal of odontoid causing an irreducible symptomatic neural compression. However, it may be potentially associated with a significant built-in morbidity because of the splitting of the soft palate for an adequate working angle, tracheostomy, and incision of the oral mucosa, causing exposure to a higher risk of infection by oral flora. OBJECTIVE To describe our experience with the minimally invasive pure endoscopic transnasal odontoidectomy in patients with bulbomedullary compression affected by complex anterior craniovertebral junction abnormalities. METHODS Five patients underwent a pure endoscopic neuronavigation-assisted transnasal odontoidectomy with anterior C1 arch preservation. Moreover, the anterior cervical spine column was reconstructed by filling the gap between the C1 arch and the residual C2 body with autologous/artificial bone. Neither tracheostomy nor enteral tube feeding were needed in any case. RESULTS A postoperative neurological improvement was observed in all patients. Postoperative imaging confirmed a satisfactory spinal cord decompression with cervical anterior column arthrodesis, and without evidence of instability at follow-up, so far. CONCLUSION The endoscopic transnasal approach seems to represent an efficient and safe alternative to the transoral route for the resection of odontoid process causing irreducible bulbomedullary compression. It provides a straightforward and minimally invasive natural surgical corridor to the anterior craniocervical junction, allowing a better working angle with preservation of spine biomechanics, while minimizing potential comorbidities.

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