Giant Cervical Osteophytes Their Significance in ENT Practice

Abstract

Case IA thirty year old male presented with complaints of simple snoring for the past 3 years. He had crescendo decrescendo type of breathing during this period. He did not complain of dysphagia, neck pain or limitation of neck movements. Examination revealed a hemispherical mass in the midline of the posterior pharyngeal wall measuring 2 cms x 2 cms in diameter extending from the level of the soft palate to the tip of the epiglottis, and laterally to the level of the posterior tonsillar pillar on either side. Mucous membrane over the swelling appeared healthy and on palpation revealed a bony hard, non tender smooth immobile mass. There was no cervical lymphadenopathy. On indirect laryngoscopy the mass was seen partially occluding the view of the laryngeal air way and both the vocal cords moved normally. Skiagrams of the cervical spine revealed a bridging osteophyte over the anterior aspect of C1 and C2 vertebrae (fig 1) with no evidence of sclerosis or erosion. The intervertebral space appeared normal. Ossification of the ligamentum nuchae was noted ( fig.l). Skiagrams of the lumbosacral spine and the dorsal spine were normal. Haematological investigations viz. Serum calcium, Phosphorous, Alkaline Phosphatase and proteins were not contributory. A mini sleep study (ECG monitoring, X-ray chest and. pulse oximetry) was done during sleep, were not contributory, Polysomonography

Anterior cervical osteophytes causing dysphagia: Choice of the approach and surgical problems

“…We have reviewed 67 studies reported in the literature of the past 25 years, which include patients with symptomatic ACOs treated by this approach. [ 11 12 13 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 ] Nineteen studies[ 29 30 34 38 39 49 50 51 54 56 62 …”

“…The transoral approach to the high cervical osteophytes is reported only in five studies. [ 20 24 69 81 83 ] On the other hand, even a large series of patients treated by transoral approach to the cervical spine for different pathologies do not include cases of osteophytes or diffuse skeletal hyperostosis. [ 84 85 ] The large study of 533 transoral operations by Choi and Crockard[ 86 ] does not focus on anterior osteophytes.…”

“…The data of the 12 reviewed patients with anterior osteophytes of the high cervical region treated by transoral approach are summarized in Table 4 . [ 20 24 69 81 83 ] Differently from those located below C3, a female prevalence (8 among 12 cases) is evidenced. Dysphagia was referred to in 9 cases, odynophagia in 3, and dysphonia in 3.…”

Timing for surgical intervention in DISHphagia

“…Differential diagnosis of dysphagia in this age group includes esophageal tumors, esophageal stricture, motility disorders, Plummer–Vincent syndrome, and other mediastinal mass lesions. [14] Hence, a thorough oropharyngeal examination with the help of esophagoscopy and barium swallow is mandatory to exclude other causes of dysphagia,[15] as conducted in all included patient in this study [Figure 3].…”