Mandible splitting approach to the C1 C2 area requires an incision in the oral pharyngeal space and then osteotomy through the mandible. The tongue is incised along the midline to preserve hypoglossal enervation on each side. The retropharyngeal wall mucosa and muscle is split longitudinally to gain access to the anterior portion of the basion, C1, and C2. A variation of the mandible splitting approach involves a submandibular incision with access through the submandibular incision and caudal retraction of the tongue without incision within the tongue.