Transoral approach to C1-2

  • fiberoptic nasotracheal intubation & NG tube
  • Mayfield head rest with head slightly extended
  • cleanse oral cavity with clorhexidine
  • preop ABx = IV Ancef & Flagyl

Landmarks

  • anterior tubercle on atlas (ALL & longus colli muscles attached)

Superficial Dissection

  • inject posterior oropharynx with 1:200,000 epinephrine
  • midline 3 cm vertical incision centered on anterior tubercle
  • expose anterior arch subperiosteally