A 19 year-old boy presented with Type II odontoid fracture and subsequently underwent anterior odontoid screw fixation. Odontoid process fractures account for 10%-15% of all cervical fractures. Two thirds of all odontoid process fractures are type II according to the Anderson-D’Alonso classification. Anterior odontoid screw fixation provides osteosynthesis and hence best functional and anatomical outcome. In surgical approach skin incision is usually placed at the level of C5-C6, working pathway created to reach the C2 level. During entire surgical procedure simultaneous AP and lateral image intensifiers are required to facilitate the operating surgeon. High expertise and skill is required to prevent damage to the vital structures along with good theater set up. During this procedure there is high chance of iatrogenic injury to the vital structures like carotid artery, trachea and oesophagus.