Odontoid fractures are potentially serious injuries due to their proximity to the medulla oblongata of the brainstem. Their management can be medical or surgical, depending on their stability or instability. Irreducible cases are difficult to treat. The objective is to show the course of a case managed by nasal endoscopy and occipito-C2 fixation. This involves a 22-year-old patient who fell from a tree, resulting in a type II Anderson and D’Alonzo fracture that became irreducible due to the family’s refusal of surgery and later led to deficits. He underwent nasal endoscopic odontoidectomy followed by occipito-C2 fixation without the use of brainstem evoked potentials, with good progress.
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