Hypopharyngeal and Esophageal Injury after ACDF

Abstract

Objective: To evaluate presenting symptoms, workup, and management of hypopharyngeal and esophageal injury associated with ACDF.

Method: We performed a retrospective review of consecutive cases in an academic institution. Inclusion criteria included patients with esophageal injury and dysphagia after ACDF who presented to otolaryngology clinics from January 2006 to July 2011 (N = 10). Outcomes reviewed include time to presentation, presenting symptoms, repair method, and oral intake status.

Results: Four of 10 patients presented with dysphagia, hoarseness, neck pain, or abscess within a week after ACDF. Three of 10 presented >1 year after ACDF with abscess, aspiration pneumonia, or stridor. Three of 10 had delay in diagnosis (>1 year between presentation and final diagnosis). Fusion plate removal occurred in 9 out of 10 patients. Conservative treatment was successful in 3 out of 10 who had no esophageal injury or only small perforation on endoscopy. One of 10 underwent successful repair with SCM flap. Six of 10 underwent free tissue transfer (1 required salvage SCM flap, 2 had persistent fistula). On posttreatment MBS, 4 out of 10 had asymptomatic diverticulums. Seven of 10 patients were taking PO at 1 week-9 months posttreatment.

Conclusion: In patients with a history of ACDF and dysphagia, clinicians should maintain a high index of suspicion for morbid complications such as esophageal perforation. Greater than 3 months of mild-moderate dysphagia should prompt evaluation with MBS whereas severe symptoms may indicate MBS/CT/endoscopy. Majority of patients will need fusion plate removed and will resume oral intake.