Cirugía y Cirujanos

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirugía y Cirujanos >Year 2005, Issue 6

Oviedo-Montes A, Guinto-Balanzar G, Zamorano-Borquez C, Domínguez-Cortinas F, Valenzuela-Hernández T, Abdo-Toro M
Soft palate transnasal retractor
Cir Cir 2005; 73 (6)

Language: Español
References: 10
Page: 471-474
PDF: 104.08 Kb.

[Full text - PDF]


Introduction: An anterior transoral approach allows the surgeon to access the lower portion of the clivus; to the first, second or third thoracic vertebra. It is indispensable that the teeth, lips, cheeks and tongue be retracted to avoid interposition on the surgical field. This retraction is carried out by means of a Dingman separator. Nevertheless, generally the soft palate is elevated with sutures through the nasal fossa. Because this invasive method could damage soft tissues, we have designed a basket to separate the soft palate from the surgical field, thus allowing the surgeon to maneuver with comfort and without damaging structures.
Technique: A 30-cm segment of 22 gauge wire is passed through each end of a thin sheet of silicon (4 × 3 × 1.5 cm) forming a basket. With the patient under general anesthesia, both free ends of the wire are introduced into the buccal cavity in the same manner nasal packing to control epistaxis. Each end of the wire is slid from the mouth through the nasal fossa to bring them outside the face. Traction is placed on both ends of the wire allow- ing the intraoral band of silicon to elevate and hold the soft palate. The free ends of the wire are affixed to the Dingman separator.
Clinical Case: We present the case of a 64-year-old woman with spastic quadriparesis and hyperreflexia predominantly of the upper extremities, in addition to trophic changes due to arthritis of long duration. Imaging studies demonstrated nonreducible subluxation of the atlantoaxial joint with ventral compression of the bulbomedullar union by the odontoid apophysis. Resection of the anterior arch of the atlas and apophyses was made via the transoral route, where retraction of the soft palate by means of the described basket was employed. The patient did not experience significant sequelae as a result of the technique utilized.

Key words: Transnasal retractor, oropharyngeal access, soft palate, vertebral artropathy.


  1. Harkey HL, Anand VK, Crockard HA, Schenk MP. Open-door maxillotomy approach for lesions of the clivus. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas, vol. 3. Park Ridge, IL: American Association of Neurosurgical Surgeons;1993. pp. 103-112.

  2. 2. Menezes A. Transoral surgery for craniovertebral junction anomalies. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas, vol. 3. Park Ridge, IL: American Association of Neurosurgical Surgeons;1993. pp. 130-135.

  3. 3. Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery 1991;28:88-89.

  4. 4. Menezes A, Van Gilder J. Transoral-transpharyngeal approach to the anterior craniocervical junction. J Neurosurg 1998;69:895-903.

  5. 5. Hardley M, Spetzler R, Sonntag V. The transoral approach to the superior cervical spine. J Neurosurg 1989;71:16-23.

  6. 6. Veres R, Bago A, Fedorcsak I. Early experiences with image-guided transoral surgery for the pathologies of the upper cervical spine. Spine 2001;26(12):1385-1388.

  7. 7. Tyler L, Gregory A, Khalid C, Kenny C, Le Fort I. Osteotomy and skull base tumors: a pediatric experience. Arch Otolaryngol Head Neck Surg 2000;126(8):1004-1008.

  8. 8. Sar C, Eralp L. Transoral resection and reconstruction for primary osteogenic sarcoma of the second cervical vertebra. Spine 2001; 26(17):1936-1941.

  9. 9. Dickman C, Spetzler R, Sonntag V, Apostolides P. Transoral approach to the craniovertebral junction. In: Surgery of the Craniovertebral Junction: Ed. Thieme. pp. 355-369.

  10. 10. Harkey L, Crockard A. Transoral-extended maxillotomy. In: Surgery of the Craniovertebral Junction. Thieme, pp. 371-381.

>Journals >Cirugía y Cirujanos >Year 2005, Issue 6

· Journal Index 
· Links 
Copyright 2010