{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T03:49:49Z","timestamp":1784692189794,"version":"3.55.0"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Swallowing dysfunction is common following transoral (TO) odontoidectomy. Preliminary experience with newer endoscopic transnasal (TN) approaches suggests that dysphagia may be reduced with this alternative. However, the reasons for this are unclear. The authors hypothesized that the TN approach results in less disruption of the pharyngeal plexus and anatomical structures associated with swallowing. The authors investigate the histological and gross surgical anatomical relationship between pharyngeal plexus innervation of the upper aerodigestive tract and the surgical approaches used (TN and TO). They also review the TN literature to evaluate swallowing outcomes following this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seven cadaveric specimens were used for histological (n = 3) and gross anatomical (n = 4) examination of the pharyngeal plexus with the TO and TN surgical approaches. Particular attention was given to identifying the location of cranial nerves (CNs) IX and X and the sympathetic chain and their contributions to the pharyngeal plexus. S100 staining was performed to assess for the presence of neural tissue in proximity to the midline, and fiber density counts were performed within 1 cm of midline. The relationship between the pharyngeal plexus, clivus, and upper cervical spine (C1-3) was defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Histological analysis revealed the presence of pharyngeal plexus fibers in the midline and a significant reduction in paramedian fiber density from C-2 to the lower clivus (p &lt; 0.001). None of these paramedian fibers, however, could be visualized with gross inspection or layer-by-layer dissection. Laterally based primary pharyngeal plexus nerves were identified by tracing their origins from CNs IX and X and the sympathetic chain at the skull base and following them to the pharyngeal musculature. In addition, the authors found 15 studies presenting 52 patients undergoing TN odontoidectomy. Of these patients, only 48 had been swallowing preoperatively. When looking only at this population, 83% (40 of 48) were swallowing by Day 3 and 92% (44 of 48) were swallowing by Day 7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the midline approach, both TO and TN approaches may injure a portion of the pharyngeal plexus. By limiting the TN incision to above the palatal plane, the surgeon avoids the high-density neural plexus found in the oropharyngeal wall and limits injury to oropharyngeal musculature involved in swallowing. This may explain the decreased incidence of postoperative dysphagia seen in TN approaches. However, further clinical investigation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.7.focus14338","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T04:43:47Z","timestamp":1412138627000},"page":"E16","source":"Crossref","is-referenced-by-count":25,"title":["Transnasal odontoid resection: is there an anatomic explanation for differing swallowing outcomes?"],"prefix":"10.3171","volume":"37","author":[{"given":"Kathryn M.","family":"Van Abel","sequence":"first","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant W.","family":"Mallory","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan L.","family":"Kasperbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"M.D.","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Moore","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel L.","family":"Price","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin K.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry D.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Jentoft","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0370016","series-title":"Anat Cell Biol","first-page":"141","article-title":"Fetal anatomy of the upper pharyngeal muscles with special reference to the nerve supply: is it an enteric plexus or simply an intramuscular nerve?","volume":"46","author":"Abe","year":"2013"},{"key":"b2-0370016","series-title":"Global Spine J","first-page":"273","article-title":"Oropharyngeal dysphagia after anterior cervical spine surgery: a review","volume":"3","author":"Anderson","year":"2013"},{"key":"b3-0370016","series-title":"Spine (Phila Pa 1976)","first-page":"2453","article-title":"Incidence of dysphagia after anterior cervical spine surgery: a prospective study","volume":"27","author":"Bazaz","year":"2002"},{"key":"b4-0370016","series-title":"Ann Otol Rhinol Laryngol","first-page":"919","article-title":"Validity and reliability of the Eating Assessment Tool (EAT-10)","volume":"117","author":"Belafsky","year":"2008"},{"key":"b5-0370016","series-title":"Laryngoscope","first-page":"2900","article-title":"Surgical anatomy of human soft palate","volume":"123","author":"Cho","year":"2013"},{"issue":"3","key":"b6-0370016","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid","volume":"36","author":"Choudhri","year":"2014"},{"key":"b7-0370016","series-title":"Neurosurg Rev","first-page":"115","article-title":"Transnasal endoscopic odontoidectomy after occipito-cervical fusion during the same operative setting\u2014technical note","volume":"34","author":"Cornelius","year":"2011"},{"key":"b8-0370016","series-title":"Anat Rec (Hoboken)","first-page":"1735","article-title":"The sensory innervation of the human pharynx: searching for mechanoreceptors","volume":"296","author":"de Carlos","year":"2013"},{"key":"b9-0370016","series-title":"Eur Spine J","first-page":"661","article-title":"Endoscopic transnasal resection of the odontoid: case series and clinical course","volume":"20","author":"Gempt","year":"2011"},{"issue":"Suppl 1","key":"b10-0370016","series-title":"Eur Spine J","first-page":"S55","article-title":"Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion","volume":"21","author":"Gladi","year":"2012"},{"key":"b11-0370016","series-title":"Head and Neck Imaging","first-page":"2085","article-title":"Videofluoroscopic evaluation of oropharyngeal swallowing","volume":"2","author":"Goldsmith","year":"2011"},{"key":"b12-0370016","series-title":"J Neurosurg Pediatr","first-page":"549","article-title":"Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. Report of 2 cases","volume":"5","author":"Hankinson","year":"2010"},{"issue":"2","key":"b13-0370016","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review","volume":"35","author":"Hickman","year":"2013"},{"key":"b14-0370016","series-title":"Anatomy for Surgeons: Volume 1. The Head and Neck","first-page":"389","article-title":"The pharynx and larynx","author":"Hollinshead","year":"1982"},{"key":"b15-0370016","series-title":"Spine J","first-page":"542","article-title":"Endoscopic endonasal odontoidectomy with anterior C1 arch preservation in elderly patients affected by rheumatoid arthritis","volume":"13","author":"Iacoangeli","year":"2013"},{"key":"b16-0370016","series-title":"Op Tech Neurosurg","first-page":"198","article-title":"An endoscopic transnasal odontoidectomy to treat cervicomedullary compression with basilar invagination","volume":"8","author":"Kassam","year":"2005"},{"issue":"1 Suppl","key":"b17-0370016","series-title":"Neurosurgery","first-page":"E213","article-title":"The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report","volume":"57","author":"Kassam","year":"2005"},{"key":"b18-0370016","series-title":"J Neurosurg Spine","first-page":"376","article-title":"Endonasal endoscopic resection of the odontoid process in a nonachondroplastic dwarf with juvenile rheumatoid arthritis: feasibility of the approach and utility of the intraoperative Iso-C three-dimensional navigation. 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Clinical article","volume":"14","author":"Van Gompel","year":"2011"},{"issue":"1 Suppl 1","key":"b27-0370016","series-title":"Neurosurgery","first-page":"ONSE92","article-title":"Endoscopic transnasal transclival odontoidectomy: a new approach to decompression: technical case report","volume":"63","author":"Wu","year":"2008"},{"key":"b28-0370016","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"162","article-title":"Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: our experience of 34 patients","volume":"74","author":"Yadav","year":"2013"},{"key":"b29-0370016","series-title":"Eur Spine J","first-page":"1127","article-title":"Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations","volume":"22","author":"Yu","year":"2013"},{"key":"b30-0370016","series-title":"Arch Orthop Trauma Surg","first-page":"1067","article-title":"Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors","volume":"133","author":"Zeng","year":"2013"},{"key":"b1-0370016","series-title":"Anat Cell Biol","first-page":"141","article-title":"Fetal anatomy of the upper pharyngeal muscles with special reference to the nerve supply: is it an enteric plexus or simply an intramuscular nerve?","volume":"46","author":"Abe","year":"2013"},{"key":"b2-0370016","series-title":"Global Spine J","first-page":"273","article-title":"Oropharyngeal dysphagia after anterior cervical spine surgery: a review","volume":"3","author":"Anderson","year":"2013"},{"key":"b3-0370016","series-title":"Spine (Phila Pa 1976)","first-page":"2453","article-title":"Incidence of dysphagia after anterior cervical spine surgery: a prospective study","volume":"27","author":"Bazaz","year":"2002"},{"key":"b4-0370016","series-title":"Ann Otol Rhinol Laryngol","first-page":"919","article-title":"Validity and reliability of the Eating Assessment Tool (EAT-10)","volume":"117","author":"Belafsky","year":"2008"},{"key":"b5-0370016","series-title":"Laryngoscope","first-page":"2900","article-title":"Surgical anatomy of human soft palate","volume":"123","author":"Cho","year":"2013"},{"issue":"3","key":"b6-0370016","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid","volume":"36","author":"Choudhri","year":"2014"},{"key":"b7-0370016","series-title":"Neurosurg Rev","first-page":"115","article-title":"Transnasal endoscopic odontoidectomy after occipito-cervical fusion during the same operative setting\u2014technical note","volume":"34","author":"Cornelius","year":"2011"},{"key":"b8-0370016","series-title":"Anat Rec (Hoboken)","first-page":"1735","article-title":"The sensory innervation of the human pharynx: searching for mechanoreceptors","volume":"296","author":"de Carlos","year":"2013"},{"key":"b9-0370016","series-title":"Eur Spine J","first-page":"661","article-title":"Endoscopic transnasal resection of the odontoid: case series and clinical course","volume":"20","author":"Gempt","year":"2011"},{"issue":"Suppl 1","key":"b10-0370016","series-title":"Eur Spine J","first-page":"S55","article-title":"Endoscopic transnasal odontoid resection to decompress the bulbo-medullary junction: a reliable anterior minimally invasive technique without posterior fusion","volume":"21","author":"Gladi","year":"2012"},{"key":"b11-0370016","series-title":"Head and Neck Imaging","first-page":"2085","article-title":"Videofluoroscopic evaluation of oropharyngeal swallowing","volume":"2","author":"Goldsmith","year":"2011"},{"key":"b12-0370016","series-title":"J Neurosurg Pediatr","first-page":"549","article-title":"Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation Type I and ventral brainstem compression. Report of 2 cases","volume":"5","author":"Hankinson","year":"2010"},{"issue":"2","key":"b13-0370016","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Transnasal endoscopic approach to the pediatric craniovertebral junction and rostral cervical spine: case series and literature review","volume":"35","author":"Hickman","year":"2013"},{"key":"b14-0370016","series-title":"Anatomy for Surgeons: Volume 1. 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