Page 99 - Portuguese Journal - SPORL - Vol 61. Nº2

Cervical spine osteosynthesis screw:

a rare cause of late pharyngeal

perforation

Clinical Case

Authors Abstract

Late-onset pharyngeal perforation is a
Patrícia Silva Sousa rare complication of anterior cervical spine
Serviço de Otorrinolaringologia, Centro Hospitalar osteosynthesis. Clinical presentation is variable
de Trás-os-Montes e Alto Douro, Portugal and may led to serious complications. We present
a 49-year-old male patient with a six-week history
Clara Magalhães of throat pain and foreign body sensation. He had
Serviço de Otorrinolaringologia, Centro Hospitalar a previous documented odontoid fracture treated
de Trás-os-Montes e Alto Douro, Portugal
with osteosynthesis with an interfragmentary
Diogo Sousa screw performed 30 years ago. A screw emerging
Serviço de Ortopedia, Centro Hospitalar de Trás-os- at the level of the left tonsil was observed in
Montes e Alto Douro, Portugal the oropharynx, and it was inserted at the right
postero-lateral hypopharyngeal wall. The integrity
António Lemos Lopes of the adjacent vessels was confirmed by imaging
Serviço de Ortopedia, Centro Hospitalar de Trás-os- tests. The patient underwent screw removal by
Montes e Alto Douro, Portugal trans-oral approach with endoscopic observation,
and was admitted for clinical surveillance, without
Anita Cunha further complications. The rarity of this condition
Serviço de Otorrinolaringologia, Centro Hospitalar
de Trás-os-Montes e Alto Douro, Portugal; Serviço hampers a consensus regarding the diagnostic and
de Otorrinolaringologia, Hospital das Forças therapeutic approaches, and therefore, they must
Armadas, Porto, Portugal be individualized. In this clinical case, the patient
was managed conservatively, and recovered
António Castanheira without significant morbidity.
Serviço de Otorrinolaringologia, Centro Hospitalar Keywords: late pharyngeal perforation; anterior
de Trás-os-Montes e Alto Douro, Portugal cervical spine osteosynthesis; screw.

Introduction
Anterior osteosynthesis of a cervical spine
fracture using screws, plates, and other metal
devices for fragment fixation is a widely used
and usually well-tolerated surgical procedure.
1
Although rare, pharyngoesophageal perforation
may occur as a complication in the peri-
Correspondence: and immediate postoperative period of this
Patrícia Silva Sousa, procedure. Late perforation occurs years after
Serviço de Otorrinolaringologia, Centro Hospitalar de
Trás-os-Montes e Alto Douro, the surgical intervention and is a less frequent
Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal complication ; few such cases of perforation
2–5
+351 259300500
prssousa@chtmad.min-saude.pt in the pharynx have been described.
The clinical presentation of perforation varies
from mild symptoms such as odynophagia
Article received on February 28, 2023. and pharyngeal foreign body sensation to
Accepted for publication on April 9, 2023. severe or even fatal complications such as

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