Vocal cord paralysis following approaches to the anterior cervical spine

The charts of 85 patients who had undergone an approach to the anterior cervical spine between 1966 to 1970 were reviewed. Nine of them (11 percent) showed postoperative voice changes, three of those had permanent vocal cord paralysis. The possible causes of recurrent nerve damage are discussed.     

Transoral approach to the upper cervical spine

The transoral approach to pathology of the upper cervical spine is logical, but it is seldom used due to concerns about exposure and infection. The authors report on 16 consecutive patients requiring exposure from clivus through C3 for pathology, including spinal cord compression by rheumatoid pan-nus, craniovertebral anomalies, and tumor. Exposure was obtained using a Dingman mouth gag and soft palate retraction with silicone rubber sheeting. A horizontal “H” incision was made in the posterior pharyngeal wall creating three layers, closed separately, with attention to a watertight closure of the final mucosal layer. In no case was it necessary to divide the mandible, tongue, soft palate, or uvula. There were no deaths, wound breakdowns, infections, or persistent cerebrospinal fluid leakage. Patients with neurological indications improved postopera-tively, and all tumors were grossly resected. Combined otolaryngology/neurosurgical exposure and treatment of pathology involving the upper cervical spine via the transoral approach is safe and effective. Functional results have been excellent, and no major complications were encountered.     

Critical analysis of the evaluation of postoperative dysphagia following an anterior cervical discectomy and fusion

Background and purposePostoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF.MethodsInternational classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015–2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma.ResultsOne hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word “dysphagia” documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations.ConclusionPostoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.     

Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery

Delayed pharyngoesophageal perforation is a rare complication following anterior cervical spine surgery. Patients usually present weeks to years after surgery with vague symptoms, such as dysphagia and neck pain. We report five cases of delayed pharyngoesophageal perforation following anterior cervical spine surgery with hardware fixation. Successful surgical management of these patients required removal of hardware and closure of the defect supported with a vascularized flap. Laryngoscope, 2010     

Surgery of the clivus and anterior cervical spine

Traumatic, degenerative, benign, and malignant lesions of the clivus and cervical spine were treated by three basic surgical procedures. Midline skull base lesions in the nasopharynx, clivus, and C-1 were approached via the transmandibular and transcervical route. Lesions of C-2 and C-3 were operated on through a high transcervical route (above the hypoglossal nerve). A low transcervical route was used for lesions at the level of C-4 to C-7.     

Posttraumatic synostosis between the thyroid cartilage and the cervical spine causing dysphagia

A 64-year-old man, 7 years after cervical trauma, presented with severe dysphagia of 3-month duration. Computed tomography showed an unusual synostosis between the thyroid cartilage and the cervical spine at C5-6-7 on the right side. A barium swallow study revealed no laryngeal elevation during swallowing. Surgical resection of the bony fusion was performed, and the patient's dysphagia immediately improved without any complications. We report a case of delayed synostosis between the thyroid cartilage and the cervical spine causing severe dysphagia 7 years after cervical trauma. Surgical resection of the bony fusion resulted in immediate improvement of the dysphagia.     

Traction diverticulum of the hypopharynx following anterior cervical spine surgery. Case report and review

Pharyngeal complications due to anterior cervical spine surgery (ACSS) are not rare. We describe the case of a traction diverticulum of the hypopharynx after ACSS, a complication that has not yet been reported. We discuss the possible mechanism. A review of the complications of ACSS that are of interest to the otolaryngologist is included.     

Repair of esophageal perforation due to anterior cervical spine instrumentation

The complication of esophageal perforation after anterior cervical spine fusion for cervical spine disease is rare but potentially fatal. We describe two cases of esophageal perforation found by esophagoscopic visualization. In one patient, primary closure could not be achieved, and a submental island flap was used to repair the defect. In the second patient, primary closure was achieved and a pectoralis major flap was interposed between the closure and the residual instrumentation. Postoperatively, both patients had no evidence of persistent perforation and had resolution of preoperative symptoms. Laryngoscope, 2010     

Osteochondrosis of the cervical spine as a cause of globus sensation and dysphagia

Dysphagia and globus hystericus can be caused by disorders of the cervical spine. Functional disorders of the upper cervical spine are the most common cause of dysphagia and globus hystericus due to vertebral disease. Prominent osteophytes of the ventral spine occasionally cause these complaints. In these cases the operative ablation of the osteophytes is effective. This is demonstrated in the following report, and the indication for operation is discussed.     

Osteomyelitis of the cervical spine following laryngectomy.

Only one case of osteomyelitis of the cervical spine following laryngectomy for carcinoma of the larynx has been reported in the literature to date. We report an unusual case of osteomyelitis of the cervical spine following treatment of laryngeal carcinoma by radiotherapy (RT) and subsequent laryngectomy and discuss the relevant literature.     

Delayed neck infection following anterior spine surgery

Pharyngoesophageal perforation and neck abscess formation is a rare complication of anterior cervical spine surgery. This complication usually manifests itself within the early postoperative period and is associated with soft tissue trauma at the time of surgery. We describe two cases of retropharyngeal abscesses and persistent pharyngocutaneous fistulae which occurred in a delayed fashion several months after cervical spine surgery. The etiology, diagnosis, and treatment of this problem is discussed with a review of the current literature.     

Dysphonia and dysphagia as early manifestations of autoimmune inflammatory myopathy

PurposeWhile dysphagia is a recognized manifestation of autoimmune inflammatory myopathy, a relationship between myositis and dysphonia or laryngeal pathology is not well-documented. We therefore sought to describe the spectrum of laryngeal disorders present in myositis patients, evaluate whether any specific conditions are overrepresented among these patients compared to a large treatment-seeking population, and examine the clinical course and outcomes of these symptoms.Materials and methodsThis was a retrospective chart review, including all patients seen at the Johns Hopkins Voice Center between January 2016 and December 2017. Demographic data, comorbidities, and laryngeal diagnoses were extracted from the electronic medical record. The charts of patients with myositis were reviewed further to ascertain details of their laryngeal symptoms and myositis disease course. Associations between myositis and dysphonia/dysphagia were evaluated using binary regression and multinomial logistic regression models to adjust for age, sex, race, and smoking status.ResultsOf 4252 patients, sixteen had myositis. Compared to 4236 controls, these patients had significantly higher odds of presenting with muscular voice disorders (adjusted odds ratio (OR*) = 4.503, p* = 0.005) and dysphagia (OR* = 6.823, p* < 0.001). A majority (64.3%, CI:35.6–93.0%) of myositis patients had laryngeal pathology among the presenting symptoms of their myositis. Across all diagnostic categories, there was a non-significant trend towards better outcomes in patients receiving specific interventions for their laryngeal symptoms.ConclusionsMuscular voice disorders and dysphagia are significantly overrepresented in myositis patients presenting to a laryngology clinic, and in these patients, both are frequently among the presenting symptoms of myositis.     

Functional dysphonia following cervical spine injuries]

After a head or a cervical injury dysphonia and its accompanying globus syndrome are often ignored, even if the existence of these traumatic sequelae are repeatedly reported. Till now there is no coherent idea about their pathogenesis, wherefore in the individual case wide differences exist in the diagnosis, treatment and in the expert opinion. It could be shown in this paper, that a posttraumatic dysphonia, due to a minor trauma, is a well defined disease with an uniform pathogenesis. The diagnosis results from the typical anamnesis of the accident, from the prove of the functional dysphonia and last not least from the prove of a functional deficit of the cervical spine, especially in the height of C 2/3. The right diagnosis allows a causal treatment and enables a just expert opinion.     

Pharyngeal pouch following anterior cervical fusion

A case of an acquired pharyngeal pouch which formed as a consequence of previous anterior cervical fusion is reported. This is a rare cause of pharyngeal pouch formation with only one such case previously reported in the English language literature. In our case adhesions had formed between the posterior pharyngeal wall and the area around the screw used to hold the Senegas plate on the anterior aspect of the fifth to seventh cervical spinal vertebrae.     

Complications of tracheostomy after anterior cervical spine fixation surgery

Purpose

Cervical traumatic spinal cord-injured patients often way require both anterior cervical spine stabilization and tracheostomy in the first few days after the injury. The infectious complication of tracheostomy can interfere with the evolution of the fixation surgery. The aim of our study was to evaluate the safety of tracheostomy performed early after anterior cervical spine stabilization.

Materials and methods

We reviewed the clinical records of 28 patients admitted to our hospital intensive care unit. In all cases, percutaneous tracheostomy was performed using the percutaneous dilation technique.

Results

The average time interval between the fixation surgery and tracheostomy was 8.25 ± 5.57 days. We had complications in tracheostomy in only 3 cases: minor bleeding occurred in 1 patient and stomal infection, not propagated to the fixation surgery wound, was observed in 2 patients. Two patients died without causal relation to these interventions.

Conclusions

The early performance of tracheostomy after cervical spinal fixation surgery is safe, still realized early and nearly this, at least if the tracheostomy is performed by percutaneous method.