Preliminary Application of Bilateral Submandibular Horizontal Incision in the Treatment of Upper Cervical Tumors

The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior-posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre-customized 3D-printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow-up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post-operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X-ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases.