The internal branch of the superior laryngeal nerve supplies innervation to the mucosa of the larynx and has an important sensory reflex that serves to protect the lungs from aspiration. Injury to this nerve can predispose the patient to life-threatening pneumonia. It is therefore imperative for the surgeon to recognize the location and course of this nerve to avoid injuring it. Injury most commonly occurs either by excessive retraction in different planes or by accidental ligation of the nerve.
Understanding the dimensions of the craniovertebral junction has clear implications for surgery in this area. If a lesion may be approached through a perpendicular exposure, the suboccipital craniectomy alone may be sufficient. Additional exposure of the ventrolateral clivus without brainstem retraction requires condylar removal. A more limited condylar removal than the 17 mm described in this report may be adequate if the entire 47-degree angle is not needed.
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