Symptomatic irreducible [[basilar invagination]] has traditionally been approached through a [[transoral]]-[[transpharyngeal]] route with resection of the anterior portion of [[C1]] and the [[odontoid]]. Modification of this exposure with either a Le Fort [[osteotomy]] or a [[transmandibular]] osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications.