The apical dental ligament is a small midline cord from the dens tip to the anterior foramen magnum margin, representing a notochordal remnant. It provides minimal mechanical contribution to atlantoaxial stability but is an important radiological landmark on MRI. Its disruption in odontoid fractures or severe atlantoaxial injuries adds to the total ligamentous instability burden.
| Origin | Tip (apex) of the dens |
|---|---|
| Insertion | Anterior margin of the foramen magnum |
| Actions | Connects the dens to the skull base; remnant of the notochord |
|---|
The apical dental ligament is identified on sagittal MRI as a small cord at the foramen magnum level. Its disruption combined with alar and transverse ligament injuries indicates complete craniocervical ligamentous instability requiring occipitocervical fusion.
Complete apical, alar, and transverse ligament disruption producing unrestricted craniocervical motion requiring occipitocervical fusion.
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