Transoral Percutaneous Access for Upper Cervical Spine and Oropharyngeal Ablation

Monday, March 31, 2025

5:30 PM – 5:35 PM CT

Location: Music City Center, 204

Abstract Presenter(s)

Nancy Ann Little, MD

Resident
UAB, United States

Author/Co-author(s)

JJ

Jesse Jones, MD

Assistant Professor
University of Alabama at Birmingham, United States
Junjian Huang, MD

Assistant Professor
Emory University School of Medicine, United States

Learning Objectives: Upper cervical and oral lesions present a treatment challenge due to complex anatomy with numerous critical structures demanding intricate and often high-risk surgeries and procedures. Herein we present our transoral approach technique through two cases: a maxillary ameloblastoma and a C1 lateral mass.

Background: Transoral routes are utilized by surgical colleagues for open and robotic surgical intervention in the upper spine and skull base. Although daunting, transoral access can be the safest and most cosmetically appealing approach for maxillofacial and high cervical masses.

Clinical Findings/Procedure Details: Case 1: A 47 year old male patient with a history of leukemia status post bone marrow transplant was referred for management of a painful lytic lesion of the left C1 lateral mass. Given prior malignancy, diagnostic sampling in addition to treatment was desired. The posterior approach was not favored given surrounding vasculature. Using CT guidance, sequential core biopsy, cryoablation, and vertebroplasty were performed via a transoral approach.

Case 2: A 73 year old female patient with a history of ameloblastoma with numerous surgical resections and recurrences was referred for management of enlarging and symptomatic mass. A transoral approach was favored in order to preserve the facial nerve and honor the patients cosmetic concerns with trans facial percutaneous approaches.

In both cases, precise positioning of the cryoablation probe was necessary to preserve integrity of adjacent structures for stability and function, respectively. In order to both control the depth of the probe, after planning the route trajectory and distance, the protective cover of the probe was trimmed and placed around the needle to precisely limit the length of needle which could enter the submucosal tissues. This offered the additional benefit of protecting the distal aspect of the probe in the oral cavity prior to percutaneous access.

Conclusion and/or Teaching Points: The transoral approach is feasible and safe. The described technique is a reproducible method that prioritizes safety, minimizing contact with oral mucosa, and precision.