On May 8, the Department of Orthopedics successfully performed two cases of atlantoaxial surgery via the oropharyngeal approach, filling the gap in the field of anterior surgery for atlantoaxial dislocation in our hospital. Atlantoaxial spine is the abbreviation of atlantoaxial and pivotal spine, also known as the first and second cervical spine, which is located in the junction area between the skull and the lower cervical spine, also known as the upper cervical spine. Untreated fractures of the dentate (a bony protrusion located in the second cervical vertebra) due to trauma, congenital dentate dysplasia, and rheumatoid arthritis can cause slippage and dislocation between the atlantoaxial vertebrae and eventually compress the medulla oblongata and spinal cord in this region, causing paralysis of the extremities to varying degrees in mild cases, or even death in severe cases. Because of the complex etiology and pathogenesis of atlantoaxial subluxation and its proximity to the respiratory and heartbeat centers, surgery has been considered clinically intimidating. In China, due to the lack of awareness of this disease, misdiagnosis and mistreatment are more common, and those who are referred to large hospitals usually have a history of about 10-20 years, with heavy neurological symptoms, poor general condition, and high treatment difficulty being the common problems of these patients. In the past, for old atlantoaxial dislocations, cranial traction repositioning and posterior occipitocervical fusion or atlantoaxial fusion were generally used. However, nearly half of the old dislocations cannot be completely reset by traction alone, and the treatment period is long. Therefore, some scholars have also used anterior release to obtain adequate repositioning, followed by posterior fusion surgery. Although this procedure is able to achieve good repositioning and fusion, it requires two surgeries, which greatly increases the pain and risk for the patient. In contrast, a single anterior transoral pharyngeal approach for release and special repositioning plates for repositioning and fixation is currently the most advanced and effective method for treating atlantoaxial subluxation. Due to the special anatomical position of the atlantoaxial spine, the release surgery must be performed in the oral cavity, which is very difficult to reveal and operate, and often only one eye of the operator and one eye of the assistant can see the surgical field, which makes the surgery much more difficult and risky, not to mention the reset and plate fixation in the narrow oral cavity. The deputy director of our orthopedic department, Chang Weinbing, had gone to the Royal National Hospital for Neurosurgery in the United Kingdom for training in upper cervical surgery, and had accumulated many years of experience in transoral anterior atlantoaxial surgery in his former workplace. This time, with the strong support of the department leadership and all colleagues in the department, including the director of the Department of Orthopaedics, Dr. Zheng Qiujian and Dr. Wang Yisheng, after thorough preparation, and with the premise of minimizing risk factors as much as possible, this surgery was actively carried out, filling the gap in this field in the Department of Orthopaedics of our hospital. The surgery was performed last Friday on a total of 2 patients. The first case was a patient who came all the way from Jiangxi province and moved around to many hospitals before finally being referred to the provincial hospital by his peers. This patient had a large oral cavity, so a preoperative decision was made to perform a one-stage procedure of release, repositioning and plate fixation. The excellent anesthesia technique of Deputy Director Zhou Guobin of the Department of Anesthesiology made the oral cavity fully relaxed and the surgery went smoothly as expected. The second case was a patient with rheumatoid arthritis, whose long-term hormone use and secondary osteoporosis increased the risk of surgery, while the patient’s small cherry mouth greatly increased the difficulty of surgical operation. Preoperatively, the patient was originally intended to undergo only a release surgery, but after intraoperative exploration, Chang Weibing thought that a one-stage repositioning and plate fixation could be attempted. Finally, with the soft palate incised and enlarged, the repositioning and plate fixation were successfully performed after hard work. At present, two patients are out of the dangerous period after 5 days of recovery, and the strength of their limbs is in the process of obvious increase after the operation, one of them has already left the bed to move around, and the operation has been a success.