Anterior cervical deformity extending to the lower retropharyngeal level needs to be explored in a wider fash-ion than conventional transoral approach. This could be obtained with transmandibular incision. This report de-scribes transmandibular approach to mid-cervical region in a patient with basilar invagination.

The patient had a short neck and khyphosis with severe spastic tetraparesis predominant on his left side. Ra-diologic investigations showed basilar invagination, severe cen/icai lordosis with maximum on C5-6 levels and severe cord compression on mid-cervical levels. He was operated on two consecuent sessions; first a C1-C7 poste-rior laminectomy, and after 2 weeks a second operation: anterior decompression, deformity correction, anterior fusion and plating. After tracheostomy, a midmandibular, paralingual svving approach was done. After a C5-6 anterior osteotomy and cord decompression, a wedge bone graft from iliac crest ıvas inserted on the resection space and cervical plate with 4 screvvs from C3-C6 was applicated in the resected anterior spine. During postoper-ative follow-up period for 10 months his tetraparesis improved quite well and he could walk vvithout external sup-ports. He vveared an external support with Halo vest for 6 months.

Transmandibular approach to anterior cervical spinal pathologies with extended deformities not possible to be dealed with conventional anterior cervical or transoral approaches seems to be a reliable method vvithout signifi-cant morbidity.

Keywords: high cervical spine - basilar invagination - transmandibular approach - cervical plates