Unorthodox technique of simultaneous reposition of an odontoid process fracture from a posterior pharyngeal wall approach and direct screw fixation from a submandibular approach.

This paper presents a case of an unorthodox technique of screw fixation of an odontoid process fracture which consisted in simultaneous reposition of an odontoid process fracture from a posterior pharyngeal wall approach and direct screw fixation from a submandibular approach. A 53-year-old patient sustained an injury to the cervical spine. Radiographs and CT scans revealed an Anderson and D'Alonzo type II fracture of the odontoid process. No neurological deficits were found. Due to a significant degree of dislocation of the fractured fragment towards the spinal cord it was initially decided that the fragment should be removed and the spinal cord decompressed from a posterior pharyngeal wall approach. Such treatment would later require another surgery: craniocervical stabilization from a posterior approach, which would impair the mobility of the cervical spine. The initial choice of surgical technique was additionally influenced by a radiological assessment performed following anesthesia, which revealed that the dislocation of the fractured fragment could not be reduced through traction and maneuvering the bone head even despite drug-induced muscle relaxation. In the course of the surgery, however, it turned out that fracture reposition could be attempted from a posterior pharyngeal approach. Therefore it was decided that a simultaneous screw fixation of the odontoid fracture would be performed from a submandibular approach following reposition. Direct screw fixation of the odontoid process fracture resulted in a complete recovery and did not impair the mobility range of the cervical spine.