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85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

28.05. - 01.06.2014, Dortmund

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Iatrogenic purulent vertebro-pharyngeal fistula and associated necrotic vertebral body

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  • corresponding author Sarah Runge - St. Vincentius-Krankenhaus, HNO-Klinik, Karlsruhe, Germany
  • Peter Joram - St. Vincentius-Krankenhaus, HNO-Klinik, Karlsruhe, Germany
  • Jürgen Mertens - St. Vincentius-Krankenhaus, HNO-Klinik, Karlsruhe, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Dortmund, 28.05.-01.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14hno03

doi: 10.3205/14hno03, urn:nbn:de:0183-14hno035

Published: July 24, 2014

© 2014 Runge et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.