Obstructive sleep apnea in a patient with orofacial pain secondary to cervical fixation

Dyspnea in the Supine Position after Anterior Cervical Discectomy and Fusion

“…The metal plate caused anterior displacement of the posterior pharyngeal wall, affecting the airflow by narrowing the middle pharyngeal space of the upper airway. 2 4 In our case, however, the airway obstruction improved when the thickening of the posterior pharyngeal wall and prevertebral soft tissues from C2 to C5 disappeared. It strongly supports the effect of the anterior cervical soft tissue swelling on the patient's dyspnea.…”

“… 7 Some studies have investigated the association between the metal plate used in anterior cervical fusion surgery and postoperative sleep apnea. 2 4 To our knowledge, however, there are no reports on an association between anterior cervical soft-tissue swelling and postoperative dyspnea. However, a significant increase in anterior cervical soft-tissue swelling after ACDF has been reported.…”

“…In the two reports on upper airway obstruction after anterior cervical fusion in English, the metal plate used for the cervical fusion was the cause of the upper airway obstruction. 2 4 We were not sure that this was applicable to lower cervical fusions because the thyroid cartilage and cricoid cartilage support the upper airway below the C5 level. The metal plate caused anterior displacement of the posterior pharyngeal wall, affecting the airflow by narrowing the middle pharyngeal space of the upper airway.…”

“…Kanti and Aparna 4 reported a case of difficulty breathing during sleep after cervical fixation with a plate and screws from C3 to C5. A lateral cephalogram showed that the upper top of the fixation device impinged on the patient's middle pharyngeal space, resulting in obstruction of the upper airway.…”

Sleep and Orofacial Pain: Physiological Interactions and Clinical Management

“…Often medication, commonly prescribed for pain management, affects breathing during sleep and can even interfere with other common sleeprelated disturbances. For instance, mechanical management for pain control may affect normal respiration predisposing to sleep related breathing disorders [60].…”