gms | German Medical Science

We report on a 78-year-old patient, who came to our ENT-clinic with a severe dysphagia. Three weeks ago the patient was subjected to neurosurgery treating a cervical spinal stenosis by insertion of a Dynamic Cervical Implant (DCITM) by an anterior cervical approach. During surgery the lateral pharyngeal wall was injured. But a related opening was immediately sutured and then the defect was considered as closed.

The ENT examination only revealed a bland bulging of the posterior pharyngeal wall. A monocontrast examination of the esophagus showed an injury with dorsal dilatation at the level of the hypopharynx. Subsequent panendoscopy revealed a slit-like defect with an extensive purulent inflammation including necrotic vertebral body due to a vertebro-pharyngeal fistula.

Concerning therapeutical options conservative versus surgical treatment was discussed. Especially possibilities for antiinfectious therapy and how spine stability could be ensured were evaluated. Furthermore surgical options for fistula-closure were assessed. We decided to perform a revision surgery comprising the removal of the DCI™ and closure of the fistula using a vascular pediculed infrahyoid muscle flap according to Remmert.

Conservative therapies followed. Additional dysphagia tests were performed and after having carried out functional dysphagia therapy successfully total oral nutrition could be achieved for the patient finally.

The case presentation will provide the detailed approach and related discussions.