Hypertrophic Anterior Cervical Osteophytes Causing Dysphagia and Airway Obstruction

Abstract

Hyperostosis of anterior cervical vertebral osteophytes can produce otolaryngological symptoms ranging from mild dysphagia, dysphonia, and foreign body sensation to severe food impaction and stridulous dyspnea. Airway compromise necessitating a tracheostomy is very rare. We discuss the case of an elderly man who presented with progressive dysphagia and a large hypopharyngeal mass as his initial manifestations of hypertrophic anterior cervical osteophytes. After a biopsy of the mass, the patient went into airway distress due to bilateral vocal fold fixation by the enlarging mass and consequently required a surgical airway. A combined team approach to the removal of the osteophytes successfully resolved his symptoms. The clinical, diagnostic, radiologic, and therapeutic principles involved in this case are presented and discussed. The recognition of hypertrophic osteophytes as a potential cause of common otolaryngological symptoms in the elderly population is paramount, as these symptoms can rapidly progress and lead to life-threatening airway obstruction. Medical and surgical interventions can be employed for the treatment of hypertrophic anterior cervical osteophytes, and they often result in favorable outcomes.

Bilateral vocal fold paralysis and dysphagia secondary to diffuse idiopathic skeletal hyperostosis

“…Of these mechanisms, only immobilization because of edema has been reported and was addressed with laryngoscopic laser debulking of edematous mucosa . Arytenoid fixation by osteophytes has been described, although not in patients meeting the criteria for DISH . In contrast, no edema or arytenoid fixation was found in the case presented, supporting true paralysis secondary to nerve compression by osteophytes.…”

Unusual presentation of cervical spine metastases to the ENT surgeon

“…8 In another case, hypertrophic anterior cervical osteophytes resulted in airway compromise following a diagnostic biopsy. 9 In our experience, stridor due to cervical spine dislocation is extremely problematic. Attempts to intubate or perform a tracheostomy, especially in an emergency, could result in irreversible spinal cord damage associated with neck mobilisation.…”

Laryngeal Manifestation of Forestier's Disease

“…Most patients with DISH can be managed conservatively, as we decided. Surgical excision is appropriate in patients with severe and progressive symptoms such as airway obstruction and progressive weight loss caused by dysphagia problems [ 5 , 12 , 13 ].…”