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Clip1:

The patient is positioned supine with skull tongs; mouth retractor is applied; the soft palate is retracted with stay stitches.  The post. pharyngeal wall is opened with cutting diathermy, surgeon standing on the head end of the patient.. The pharyngeal muscles are stripped away from the underlying axis and arch of atlas.

Clip2:

 The anterior arch of the atlas is drilled.  The soft tissue behind the arch is  cleared off.  

Clip3:

Drilling of odontoid and the body of the C2 is carried out.

Clip4:

An attempt is made to remove the residual peg of the odontoid with dissector; but it requires further drilling; surgeon is standing on the right side of the patient. Transverse ligament is exposed following odontoidectomy; the ligament may be cut for further decompression. Corpectomy of C2 (abt 2cms width) is being completed (surgeon is back to head end of the patient).

Pharyngeal wall may be closed in a single layer with absorbable sutures.