LABIOMANDIBULAR GLOSSOTOMY APPROACH FOR CRANIOCERVICAL PATHOLOGIES - SPINE RECONSTRUCTION

Jackson Daniel Sousa Silva,Luis Eduardo Carelli Teixeira Da Silva,Alderico Girão Campos De Barros,Felipe Gomes Sousa E Silva,Renato Henrique Tavares

doi:10.1590/s1808-185120212002224171

Jackson Daniel Sousa Silva, Luis Eduardo Carelli Teixeira Da Silva + Show 3 more

Open Access

https://doi.org/10.1590/s1808-185120212002224171

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Abstract

ABSTRACT Objectives: Exposing the clivus and upper cervical spine should, ideally, provide an adequate surgical field in which the surgeon can safely decompress and stabilize the craniovertebral junction (CVJ). We present a series of four cases with a narrative review of the literature in which Median Labiomandibular Glossotomy was used to treat CVJ disorders, in order to highlight the importance and indications of this access. Methods: We performed a retrospective analysis of patients who underwent MLMG for several pathologies. The group comprised four patients (two men and two women). Five approaches were performed (one revision surgery). Results: The approach was suitable for all cases, clivus was achieved when necessary. Distally, C4 was exposed to obtain satisfactory osteosynthesis. Laterally, we had a good view of the tumor borders and control of the vertebral artery. Complications encountered were a superficial wound infection that was easily healed, a later pharyngeal wound dehiscence and pseudoarthrosis, all in the same patient. There are 3 main anterior surgical techniques for managing lesions of the clivus, foramen magnum or upper cervical vertebrae. We chose Median Labiomadibular Glossotomy (MLMG) as a primary option, which provided a direct view of the clivus, C3 – C4 caudally and a wider surgical field. The main advantages of the MLMG technique include direct access to spinal pathology, an avascular plane through the median pharyngeal raphe, and a wider surgical field in both the transverse and sagittal dimensions. Conclusion: This approach provides excellent exposure of the craniocervical junction and upper cervical spine. Level of evidence IV; Series of cases analyzed retrospectively.

Highlights

The exposure of the clivus and upper cervical spine should, ideally, provide and optimal operative field in which the surgeon can decompress and stabilize craniovertebral junction (CVJ)
Various surgical techniques have been described using the transcervical retropharyngeal,[1,2] retrocarotid lateral,[3] and pharyngeal approaches.[4]. These techniques are unsuitable for accessing the upper cervical vertebrae, clivus and CVJ as they afford only limited ventral exposure, posing a risk to critical neurovascular structures.[5]
We performed a retrospective analysis of patients who underwent Median Labiomadibular Glossotomy (MLMG) for several pathologies

Summary

Introduction

The exposure of the clivus and upper cervical spine should, ideally, provide and optimal operative field in which the surgeon can decompress and stabilize craniovertebral junction (CVJ). Various surgical techniques have been described using the transcervical retropharyngeal,[1,2] retrocarotid lateral,[3] and pharyngeal approaches.[4] These techniques are unsuitable for accessing the upper cervical vertebrae, clivus and CVJ as they afford only limited ventral exposure, posing a risk to critical neurovascular structures.[5]. Roux[6] describe splitting the lower lip and mandible in the midline for tumors of the anterior tongue. A mandible and tongue splitting procedure was described by Kocher[7] and Trotter[8] for exposing the base of the tongue, epiglottis and posterior oropharyngeal wall. Wood et all.,[9] used the same approach to access the clivus, operating on two patients, one with chordoma and the other with basilar impression

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