Transoral Translabial Transmandibular Approach to the Clivus and High Cervical Region: Indications and Surgical Technique

Introduction: Tumors involving the clivus and high cervical region may be challenging to treat. We describe in detail our technique to access these lesions by a multidisciplinary approach, emphasizing surgical steps to allow maximal surgical exposure, to achieve satisfactory cosmetic results, and to prevent complications.

Material and Methods: A 38-year-old man presenting with a recurrent clivus chordoma extending inferiorly into the high cervical spine was admitted to hospital. Neurological and radiological investigation demonstrated a craniocervical instability as well. The patient underwent multidisciplinary surgical treatment by a transoral translabial transmandibular approach without glossotomy. The approach provided proper surgical exposure allowing anterior tumor removal.

Results: The patient's postoperative period was uneventful. In a second procedure the posterior extension of the tumor was resected through a posterior cervical approach. A stabilization of the craniocervical junction was performed during this second procedure. A video demonstrating the surgical steps is presented.

Conclusions: The transoral translabial transmandibular approach with lateral tongue retraction provides wide surgical exposure allowing tumor resection of the craniocervical junction. A glossotomy can be avoided. Excellent cosmetic results may be achieved by performing the described surgical technique.