Drainage of a ventral epidural atlantoaxial abscess via the transoral approach

We present a 28-year-old man with neck pain, fevers, elevated acute-phase reactant levels and progressive quadraparesis. He had a history of intravenous drug abuse. Contrast-enhanced cervical spine MRI revealed a heterogeneously enhancing mass in the anterior atlantoaxial region with spinal cord compression. The patient was taken emergently to the operating room for decompression. Although the transoral approach for access to the ventral atlantoaxial complex for resection of compressive inflammatory and neoplastic lesions is well described, reports of evacuation of infectious lesions via this route are limited. Thus, we report drainage of a ventral high cervical abscess via the transoral approach.