PMC8326140_01
(a) Sagittal bone CT sequence showing anterior dislocation of C2, with a basion density interval of 16 mm and multifragmented fracture of the anterior C1 arc. (b) Axial bone CT sequence showing a Jefferson fracture of C1: bilateral fracture of the anterior and posterior arcs pointed by the blue arrows. (c) Sagittal T2-weighted MRI sequence showing the anterior dislocation of C2 associated with prevertebral hematoma and suspicion of pharyngeal perforation from the anterior arc fragments.
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F1
CT scan showed a Jefferson fracture of C1 with anterior atlantoaxial dislocation [Figure 1a and b]. Cerebrocervical magnetic resonance imaging (MRI) confirmed the atlantoaxial dislocation with a complete bilateral lesion of the alar ligaments and articular capsule. A prevertebral hematoma from C2 to C5 was also present, with a suspicion of pharyngeal perforation from the anteriorly displaced C1 fragment [Figure 1c].
Sagittal bone CT sequence showing postoperative craniocervical junction.
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F2
A postoperative CT scan confirmed a correct placement of the pars screws with no major displacement of the C1 bony fragment [Figure 2].
Pharyngeal inspection with a curved laryngoscope showing a perforation in the posterior wall of the pharynx caused by the anteriorly displaced fragment of the C1 fracture.
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F3
A nasopharyngeal fistula of the thin mucosal layer identified preoperatively, with exposure of a bony fragment of C1 [Figure 3].