The apical ligament of the dens (odontoid) runs from the tip of the dens to the anterior margin of the foramen magnum, representing a remnant of the notochord. It is flanked on both sides by the alar ligaments.
Provides a weak axial attachment between the dens and skull base, acting as a vestiga of the chorda dorsalis. Its primary role is as a nominal axial restraint, with the alar ligaments providing the dominant craniovertebral constraint.
The apical dental ligament is assessed in occipital condyle fracture and dens fracture management. Its disruption alone produces minimal instability, but combined alar ligament injury (from high-energy C1-C2 trauma) results in significant craniovertebral instability requiring halo or surgical stabilisation.
Apical ligament tearing accompanying type II dens fracture, with instability determined primarily by alar ligament integrity and overall fracture pattern.
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