2026 Poster Presentations
P524: THE SUBMANDIBULAR RETROPHARYNGEAL APPROACH AS A SAFE ROUTE TO THE UPPER ANTERIOR CERVICAL SPINE - AN ANATOMICAL STEP BY STEP DISSECTION AND SURGICAL CASE PRESENTATION
Alexander F Kuffer, MD, DMD, PhD1; Manuel A Molina-Vega, MD1; Mohammad A Nour El Dine, MD2; Harry Van Loveren, MD2; Siviero Agazzi, MD2; Davide M Croci, MD2; 1Lakeland Regional Health; 2University of South Florida
Background: Surgical access to the anterior upper cervical spine and craniovertebral junction is technically demanding due to limited space and the presence of critical neurovascular and visceral structures. Traditional anterior routes, such as the transoral, transnasal or anterolateral approaches, are associated with limitations in exposure and increased morbidity. The submandibular retropharyngeal approach (SRA) has been proposed as an alternative to access the upper anterior cervical spine and the cranio-cervical junction, but detailed anatomical documentation and clinical validation remain limited.
Methods: A cadaveric head specimen was prepared with colored vascular injections to enhance anatomical delineation. Stepwise dissection was performed to document the surgical corridor of the SRA, complemented by high-resolution photography and illustrations. Endoscopic assistance was employed to extend cranial visualization to the anterior arch of C1. The approach was compared with transoral, transnasal, and anterolateral techniques in terms of exposure, safety, and surgical accessibility. A clinical case of a patient undergoing anterior C2 corpectomy for metastatic destruction of the C2 vertebral body was presented to illustrate practical application.
Results: The SRA provided a safe, direct, and oblique surgical trajectory to the anterior C2 vertebral body and craniovertebral junction, with reduced need for pharyngeal retraction and preservation of the pharyngeal plexus. Endoscopic assistance further enhanced cranial exposure. The illustrative case demonstrated successful anterior reconstruction with a bone strut graft and plate fixation, achieving spinal stability without significant postoperative dysphagia or speech deficits.
Conclusion: The submandibular retropharyngeal approach represents a viable alternative to traditional anterior routes for upper cervical spine surgery, combining effective exposure with reduced risk to critical structures. Its integration into neurosurgical practice may broaden surgical options for complex anterior cervical pathologies.