Transmandible approach for the treatment of upper cervical spine metastatic tumors.

The transmandible tongue-splitting approach is a useful and safe procedure for treating secondary lesions of the upper cervical spine, with only minor cosmetic and functional impairment. This method requires a team approach and has the advantage of enhancing the surgical exposure, thus allowing for resection and stabilization on more levels. Two patients with metastases in the upper cervical spine were treated using this approach. In view of a relatively long life expectancy, a marginal resection was performed. The residual instability required a combined approach and internal fixation. Both patients were ambulant, neurologically intact, and pain free 24 and 26 months postoperatively.