title: Direct transoral reduction of anteriorly displaced type II odontoid fracture during anterior odontoid screw fixation: Review of literature.
abstract: BACKGROUND
  The anteriorly displaced type II odontoid fracture is treated either conservatively by halo-vest brace immobilization or surgically by posterior atlantoaxial fusion. Anterior odontoid screw fixation is not advised for this pattern of odontoid fracture because of the difficult trajectory for screw insertion despite its advantage of salvaging the upper cervical spine rotatory range of movement. This article presents a new transoral manipulation technique for reduction of anteriorly displaced type II odontoid fracture and review of the literature.
  
  
  METHODS
  A 24-year-old man presented 2 weeks after a motor vehicle accident with anteriorly displaced type II odontoid fracture. Intraoperatively, after unsuccessful attempts to reduce the anteriorly displaced type II odontoid fracture, complete reduction of the odontoid process and proper screw placement were achieved by direct transoral manipulation with an army-navy hand retractor. Additional manual pressure on the spinous process of the cervical spine at the same time has resulted in better reduction. The patient was followed up neurologically and radiologically to assess the reduction and healing of the odontoid fracture.
  
  
  RESULTS
  Postoperatively, the patient was neurologically intact, and his computed tomography cervical spine scan showed proper placement of the odontoid screw with adequate reduction of the odontoid process. At the 3-month follow-up, the patient was neurologically intact and had painless full range of cervical spine movement, and his computed tomography cervical spine scan showed a well-healed odontoid fracture.
  
  
  CONCLUSIONS
  Direct transoral manipulation with an army-navy hand retractor can be used to assist in reducing the anteriorly displaced type II odontoid fracture during anterior odontoid screw fixation.
authors.affiliation: Department of Spine Surgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Tamer
authors.initials: T
authors.lastname: Orief
authors.affiliation: Department of Spine Surgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Khaled
authors.initials: K
authors.lastname: Almusrea
authors.affiliation: Department of Spine Surgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Assiri
keywords: Displaced; Fixation; Fracture; Manipulation; Odontoid; Transoral