The management of dysphasia in skeletal hyperostosis

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier's disease, is an ossifying condition frequently encountered in otolaryngology as it affects 12-28 per cent of the adult population. This form of hyperostosis can manifest clinically with dysphagia, food impaction, hoarseness, stridor, myelopathies and other neurological problems. Judicious management of severe dysphagia proves challenging. The failure of conservative care often leaves surgery as the only option. In this report an anterolateral transcervical surgical approach to the confluent osteophytes is discussed and the value of videofluoroscopic swallow highlighted.

Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis

“…Actually, previously reported pathology of dysphasia due to anteriorly protruding deformity of the cervical spine can be classified into OALL [1,5,16] and osteophytosis related to cervical osteoarthritis [5,6,12,13,15,16]. In the present study, large osteophyte at a still mobile intervertebral segment in a patient with OALL and DISH, suggesting that the osteophyte can be potentially an immature form of the OALL, were subjected for analyses.…”

“…Large osteophytes, however, do cause swallowing disorders through a variety of mechanisms, including: (1) direct mechanical compression of the pharynx and esophagus [9], (2) disturbances of normal epiglottis tilt over the laryngeal inlet by the osteophytes at C3-C4 level [5,14], (3) inflammatory reactions in the tissues around the esophagus [1,16], and (4) cricopharyngeal spasm [2].…”

“…Conservative treatment has been indicated for the initial management of these cases [2,16]. Surgical resection of the osteophyte has been reported to be an effective treatment for severe cases and/ or cases with airway obstruction [1,3,4,7,[12][13][14].…”

“…Many surgical reports about DISH-related dysphagia have been described in the literature [1,3,4,7,12,13,16]: however, few of these include postsurgical results for more than 2 years. Except for a few reports in the Japanese literature [3,13], little study has been given to the regrowth of osteophytes after surgical resection.…”

Dysphagia Due to Forestier Disease: Three Cases and Systematic Literature Review

“…Seven cases were reported each from Germany [12][13][14] and the USA [15][16][17]. Five cases were reported each from the UK [18][19][20][21][22] and Chile [23]. Eight cases were reported from eastern Asia, four each from Japan and Korea [24][25][26][27][28][29].…”