Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population.

From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications.

A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision.

A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

牙源性脑干腹侧受压可能是颅颈疾病患者发病率显着的一个来源。齿状突切除术最常见的方法是经口和内窥镜鼻内途径。在这项研究中，作者调查了在儿科人群中使用内窥镜经鼻/经口齿状突切除术的制度方案。

从 2007 年到 2017 年，针对需要齿状突切除术的儿科患者的评估和治疗，制定并完善了多学科机构协议。术前评估包括气道评估、睡眠研究（如果需要）、讨论可能的扁桃体切除术/腺样体切除术，以及神经外科和耳鼻喉科团队的全面影像学检查。对困难气道进行了进一步的术前麻醉咨询。术中，根据耳鼻喉科的判断进行腺样体切除术。齿状突切除术是作为联合手术进行的。由耳鼻喉科医生进行了初级后咽闭合术。术后方案要求立即拔管，24 小时后改为软饮食，术后不使用抗生素。结果变量包括拔管时间、

共有 13 名患者接受了联合内镜经口/经鼻齿状突切除术，并进行了至少 3 年的随访。所有患者术后神经功能稳定或改善。所有患者在手术后立即拔管。平均手术时间为 201 ± 46 分钟，平均估计失血量为 44.6 ± 40.0 毫升。13 名患者中有 9 名同时接受了扁桃体切除术和腺样体切除术。平均住院时间为 6.6 ± 5 天。该系列中的第一位患者需要进行翻修手术以去除残留的小齿状突。一名患者经历了需要修复的咽瓣裂开。

描述了内窥镜经口/经鼻齿状突切除术的协议化、制度化方法。在这个复杂的患者群体中，使用组合的多学科方法可以简化患者管理并获得有利的结果。