Transoral approach to the lower clivus and upper cervical spine

5 cases were operated via a transoral approach for basilar impression (2 cases), tumor (2), or traumatic dislocation of the odontoid process (1). In all except 1 there was compression of the lower medulla and/or upper cervical cord. Posterior cervical fusion was also performed in 2 patients. There was significant improvement in all the patients who presented with neurological deficits. Surgical morbidity was low and there was no mortality. The use of the operating microscope, microdrill, self-retaining mouth retractor, flexible oral endotracheal tube, and intraoperative fluoroscopy permit a safe, direct approach to the lower clivus and upper cervical region.