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At the January 1987 Southern Section Meeting of the Triological Society in Santa Fe, NM, Nathan E. Nachlas, MD, and colleagues described their technique and reported the results using an anterior extraoral approach to the atlas and axis in five patients. The work was performed in the Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore. In comparison with transoral approaches, this technique allows adequate exposure for bone grafting of the cervical spine but avoids salivary contamination. The technique involves excision of the submaxillary gland, division of the digastric tendon, identification and tracing of the hypoglossal nerve from the skull base to the tongue, identification of the superior laryngeal nerve, and retropharyngeal dissection. Also, this approach can be used in biopsies of tumors that invade the atlas or axis and are of unknown origin. Postoperatively, none of the patients had wound infections or cranial nerve palsies, and
STIERNBERG CM. Approach to the Atlas and Axis. Arch Otolaryngol Head Neck Surg. 1987;113(4):355. doi:10.1001/archotol.1987.01860040015003