Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation
Vertebral osteomyelitis compromises approximately 1%–7% of all cases of osteomyelitis, whereas the cervical region is affected in 3%–10% of all cases. Not surprisingly, osteomyelitis at the craniocervical junction is a rare occurrence that poses certain challenge to surgeons. With the advancement of...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2021-01-01
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| Series: | Formosan Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2021;volume=54;issue=4;spage=159;epage=163;aulast=Tang |
| _version_ | 1797724841006071808 |
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| author | Chien-Lun Tang Chiung-Chyi Shen |
| author_facet | Chien-Lun Tang Chiung-Chyi Shen |
| author_sort | Chien-Lun Tang |
| collection | DOAJ |
| description | Vertebral osteomyelitis compromises approximately 1%–7% of all cases of osteomyelitis, whereas the cervical region is affected in 3%–10% of all cases. Not surprisingly, osteomyelitis at the craniocervical junction is a rare occurrence that poses certain challenge to surgeons. With the advancement of antibiotics, most patients with vertebral osteomyelitis can be successfully treated by conservative treatment. However, surgical intervention is indicated in cases presented with neurological deficits, spinal deformity, or instability. We present one case of retropharyngeal abscess involving the craniocervical junction that led to irreducible atlantoaxial rotatory dislocation and significant ventral cord compression. Staged procedures with endoscopic endonasal odontoidectomy assisted by nasoseptal flap reconstruction for decompression and posterior occipitocervical fusion were arranged in sequence. Nevertheless, postoperative magnetic resonance imaging revealed incomplete decompression at C2 level of the cervical spine. Prompt revision surgery with nasoseptal flap takedown and reuse performed uneventfully. The patient recovered well and was able to ambulate 5 weeks later. This case illustrated long-term radionecrosis complicated with osteomyelitis and craniocervical instability. An aggressive surgical decompression followed by staged spinal fusion would be beneficial in such complex osteomyelitis cases. |
| first_indexed | 2024-03-12T10:22:36Z |
| format | Article |
| id | doaj.art-6362b0ab7ade41faab86b5434e262364 |
| institution | Directory Open Access Journal |
| issn | 1682-606X |
| language | English |
| last_indexed | 2024-03-12T10:22:36Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Formosan Journal of Surgery |
| spelling | doaj.art-6362b0ab7ade41faab86b5434e2623642023-09-02T09:59:42ZengWolters Kluwer Health/LWWFormosan Journal of Surgery1682-606X2021-01-0154415916310.4103/fjs.fjs_115_20Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxationChien-Lun TangChiung-Chyi ShenVertebral osteomyelitis compromises approximately 1%–7% of all cases of osteomyelitis, whereas the cervical region is affected in 3%–10% of all cases. Not surprisingly, osteomyelitis at the craniocervical junction is a rare occurrence that poses certain challenge to surgeons. With the advancement of antibiotics, most patients with vertebral osteomyelitis can be successfully treated by conservative treatment. However, surgical intervention is indicated in cases presented with neurological deficits, spinal deformity, or instability. We present one case of retropharyngeal abscess involving the craniocervical junction that led to irreducible atlantoaxial rotatory dislocation and significant ventral cord compression. Staged procedures with endoscopic endonasal odontoidectomy assisted by nasoseptal flap reconstruction for decompression and posterior occipitocervical fusion were arranged in sequence. Nevertheless, postoperative magnetic resonance imaging revealed incomplete decompression at C2 level of the cervical spine. Prompt revision surgery with nasoseptal flap takedown and reuse performed uneventfully. The patient recovered well and was able to ambulate 5 weeks later. This case illustrated long-term radionecrosis complicated with osteomyelitis and craniocervical instability. An aggressive surgical decompression followed by staged spinal fusion would be beneficial in such complex osteomyelitis cases.http://www.e-fjs.org/article.asp?issn=1682-606X;year=2021;volume=54;issue=4;spage=159;epage=163;aulast=Tangnasoseptal flapodontoidectomyosteomyelitis |
| spellingShingle | Chien-Lun Tang Chiung-Chyi Shen Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation Formosan Journal of Surgery nasoseptal flap odontoidectomy osteomyelitis |
| title | Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| title_full | Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| title_fullStr | Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| title_full_unstemmed | Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| title_short | Nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| title_sort | nasoseptal flap revision in endoscopic endonasal odontoidectomy for acute atlantoaxial osteomyelitis with atlantoaxial subluxation |
| topic | nasoseptal flap odontoidectomy osteomyelitis |
| url | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2021;volume=54;issue=4;spage=159;epage=163;aulast=Tang |
| work_keys_str_mv | AT chienluntang nasoseptalflaprevisioninendoscopicendonasalodontoidectomyforacuteatlantoaxialosteomyelitiswithatlantoaxialsubluxation AT chiungchyishen nasoseptalflaprevisioninendoscopicendonasalodontoidectomyforacuteatlantoaxialosteomyelitiswithatlantoaxialsubluxation |