case_images: PMC10198215_01
case_images: (a) Preoperative lateral radiograph demonstrating a defect of the anterior arch of the atlas, (b and c) CT images showing anterior arch disruption, (d) the right C0-C1 facet is auto-fused (white arrow), (e and f) images taken 5 years preoperatively (intact anterior arch and C0-C1 facet), (g) fractured posterior arch of the atlas (white arrow), and (h) sagittal T1-weighted MR image showing low intensity in the clivus and C2 body, indicating osteonecrosis. CT: Computed tomography, MR: Magnetic resonance
case_images: JCVJS-14-93-g001.jpg
case_images: PMC10198215_01_JCVJS-14-93-g001.jpg
case_images: F1
case_images: Plain radiography and computed tomography (CT) revealed complete disruption of the anterior AAA [Figure 1a-c]. The ipsilateral C0-C1 facet spontaneously fused, likely due to osteoarthrosis after facet involvement in ORN [Figure 1d]. These findings were not observed in the images taken 5 years preoperatively [Figure 1e and f]. The posterior AAA was simultaneously fractured [Figure 1g]. Magnetic resonance imaging (MRI) showed relatively low intensity in the C2 dens and clivus, indicating possible osteonecrosis, while the posterior structures were intact [Figure 1h].
case_images: (a) Bone fragment in the epipharynx observed through nasal endoscope, (b) the fragment that was disrupted from the posterior pharyngeal wall (white arrow), (c) the bone fragment that the patient kept after they spat it out, and (d) a micro-CT image of the fragment. CT: Computed tomography
case_images: JCVJS-14-93-g002.jpg
case_images: PMC10198215_01_JCVJS-14-93-g002.jpg
case_images: F2
case_images: Figure 2a and b show the nasal endoscopic findings before the episode. We performed a micro-CT scan of the fragment that the patient brought to us and confirmed that it was the anterior AAA [Figure 2c and d].
case_images: One-year postoperative images. (a) Lateral radiograph, (b) endoscopic image of the posterior pharyngeal wall showing resolution of soft-tissue defect at the area of disruption of the anterior arch of the atlas, (c) sagittal CT, and (d) MR images showing no progression of the necrotic area in the clivus and C2 body but rather a slight improvement of T1-low intensity. CT: Computed tomography, MR: Magnetic resonance
case_images: JCVJS-14-93-g003.jpg
case_images: PMC10198215_01_JCVJS-14-93-g003.jpg
case_images: F3
case_images: The patient achieved successful pain relief immediately postoperatively [Figure 3a]. One-year postoperative nasal endoscopy demonstrated the resolution of the soft-tissue defect in the posterior pharyngeal wall [Figure 3b]. T1-low intensity, which may indicate spontaneous bone healing [Figure 3c and d]. The patient was completely free of pain medication use.