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THE CERVICOTHORACIC JUNCTION (C7-T4) is difficult to approach anteriorly. We have recently described a unilateral or bilateral inverted-T MANUBRIOTOMY. Midline longitudinal incision from the manubrial notch to 3cm caudad to the manubriosternal angle. The internal thoracic artery is then identified by blunt dissection in the second intercostal space, carefully isolated and divided between ligatures. The posterior surface of the manubrium is freed by blunt dissection. The manubrium is osteotomized, and the transverse limb should exit at the second intercostal space. Exposure to the spine is in between the major blood vessels. The right recurrent laryngeal nerve, which loops around the subclavian artery, should be isolated and protected. An 8 cm wide exposure to the spine is possible with a bilateral manubriotomy. Exposure of the 7th cervical to the 4th thoracic vertebrae is possible, and by retracting the left innominate vein, down to the 5th thoracic vertebra.