Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary.In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2–C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed.Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea,

Progressive dysphagia and dysphonia secondary to DISH-related anterior cervical osteophytes: A case report

“…Isolated dysphagia is present in nearly 75% of the cases, along with less frequent; dyspnea (14%), symptoms/signs of aspiration (9%), stridor (3%), cervical pain (3%), cough (3%), and dysphonia (2%). [4]…”

“…Rarely, DISH leads to aspiration pneumonia, stridor, dyspnea, or airway obstruction requiring emergency tracheotomy. [4] Obstruction, when it occurs, most often involves the C5-C6, followed by C4-C5, C2-C3, and C3-C4 levels; it is least common at C1-C2. [7] a narrowed esophageal lumen at the C4-C5 level [ Figure 1].…”

Oropharyngeal dysphagia as an uncommon manifestation of an osteoarticular disease

“…The patients are frequently asymptomatic, reason why some authors advocate that this is not a disease but a radiological finding. Nevertheless, symptoms attributed to the growth of anterior cervical osteophytes, such as musculoskeletal symptoms, neurological manifestations, airway compromise, dysphonia and dysphagia have been reported 10–13…”

Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature

“…A laryngeal mask airway was used in one patient [10], a facemask airway was used in one patient [12], and thyrocricoid puncture and retrograde intubation were attempted in one patient [16]. We also identified nine cases of emergency tracheotomies due to sudden upper airway obstruction induced by OALL of the cervical spine [18,[28][29][30][31][32][33][34][35].…”