Transoral missile removal from the anterior C1 region following transpharyngeal missile wound

We present a successful treatment result in a rare case of low velocity mis sile transpharyngeal wound to the upper cervical area in a 33-year-old man. There are very few reports concerning related cases, with some disagreemen t regarding their treatment. The retained missile was successfully removed from the anterior region of the C1 vertebra through a transoral-transpharyn geal approach using the explosive transpharyngeal wound sustained. Neurolog ical status and spine stability were not affected due to the missile's low velocity. The early soft-tissue debridement, missile removal, pharyngeal cl osure without wound drainage and broad-spectrum antibiotic coverage resulte d in an uneventful postoperative course and good long-term outcome. Early s urgery is important to prevent complications in such cases. However, the pr ophylactic tracheostomy, wound drainage and applying of a nasogastric tube could be left to the surgeon's judgment based on the individual patient's r espiratory status, intraoperative findings and wound contamination/coloniza tion.