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. 2020 Jan 29;4(2):178-183.
doi: 10.22603/ssrr.2019-0090. eCollection 2020.

Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature

Takaomi Kobayashi  1 , Tadatsugu Morimoto  1 , Kazumasa Maeda  1 , Yu Toda  1 , Hirohito Hirata  1 , Tomohito Yoshihara  1 , Masaaki Mawatari  1
Affiliations

Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature

Takaomi Kobayashi et al. Spine Surg Relat Res. .

Abstract

Introduction: The transoral mandibular tongue-splitting approach is typically performed for the treatment of upper cervical tumor and instability but has not been performed for the treatment of upper cervical epidural abscess (UCEA). We report the first case of UCEA successfully treated with a transoral mandibular tongue-splitting approach.

Technical note: A 62-year-old man who had medical histories of tracheotomy with intubation and dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma presented with neck pain and limb weakness. The imaging examination revealed bone erosion of C2-C4 vertebrae and abscess at the level of C2-C4, supporting a diagnosis of UCEA. The transcervical approach could not be used for treatment; therefore, the transoral mandibular tongue-splitting approach was used successfully to perform decompression, debridement, and iliac bone grafting. Subsequently, we reviewed the literature pertaining to the use of the transoral mandibular tongue-splitting approach. The approach can be invasive and cause some complications. However, no fatal complications have been reported, and all patients demonstrated a favorable neurological outcome with reduced neurological deficits.

Conclusions: This case and subsequent literature review suggest that the transoral mandibular tongue-splitting approach may be effective for the improvement of neurological outcomes without fatal complications in patients with UCEA. There may be an increasing number of patients with UCEA requiring the transoral mandibular tongue-splitting approach due to the increasing prevalence of immunocompromized status and the aging population.

Keywords: complication; mandibular tongue-splitting; neurological outcome; transcervical approach; transoral approach; upper cervical epidural abscess (UCEA).

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Post-tracheotomy, post-intubation, and post-dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma.
Figure 2.
Figure 2.
Sagittal plane of CT scan before treatment (A). Sagittal T2-weighted MRI before treatment (B). These images show bone erosion of C2-C3 vertebrae (A) and cervical epidural abscess at the C2-C3 levels (B).
Figure 3.
Figure 3.
Transoral mandibular tongue-splitting approach. Median mandibular splitting, median longitudinal incision of the tongue, partial resection of eroded lesion of C2-C3 vertebrae, debridement of the abscess, suturing tongue, and titanium plate fixation of the mandible were performed.
Figure 4.
Figure 4.
Postoperative images. (A) Sagittal plane of CT scan. (B) Lateral radiograph.
See this image and copyright information in PMC

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