PMID- 31341480
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 1687-9201 (Print)
IS  - 1687-921X (Electronic)
IS  - 1687-9201 (Linking)
VI  - 2019
DP  - 2019
TI  - Esophageal Perforation due to Anterior Cervical Spine Hardware Placement: Case 
      Series.
PG  - 7682654
LID - 10.1155/2019/7682654 [doi]
LID - 7682654
AB  - Context. This case series discusses surgical management of esophageal 
      perforations that occurred following cervical spine hardware placement. Purpose. 
      (1) Determine presenting symptoms of esophageal perforation after anterior 
      cervical spine hardware placement. (2) Discuss surgical management of these 
      resulting esophageal perforation complications. Design/Setting. Case series of 
      six patients at a tertiary-care, academic medical center. Patient Sample. Six 
      patients with pharyngoesophageal perforations following anterior cervical spine 
      surgery (ACSS). Outcome Measures. Date of ACSS, indication for ACSS, level of 
      hardware, location of esophageal or pharyngeal injury, symptoms at presentation, 
      surgical intervention, type of reconstruction flap, wound culture flora, and 
      antibiotic choice. Methods. A retrospective review of patients with an esophageal 
      or hypopharyngeal injury in the setting of prior ACSS managed by the 
      otolaryngology service at a tertiary, academic center between January 2015 and 
      January 2019. Results. Six patients who experienced pharyngoesophageal 
      perforation following ACSS are included in this study. Range of presentation was 
      two weeks to eight years following initial hardware placement. Five patients 
      presented with an abscess and all had evidence of perforation on initial CT or 
      esophagram. All patients underwent repair with a sternocleidomastoid flap with 
      two patients eventually requiring an additional pectoralis myofascial flap for a 
      persistent esophageal leak. Five patients eventually attained ability to tolerate 
      oral nutrition. An algorithm detailing surgical reconstructive management is 
      proposed. Conclusions. Esophageal perforations in the setting of prior ACSS are 
      challenging clinical problems faced by otolaryngologists. Consideration should be 
      given to early drainage of abscesses and spine surgery evaluation. Spinal 
      hardware removal is recommended whenever possible. Utilization of a pedicled 
      muscle flap reinforces primary closure and allows coverage of the vertebral bony 
      defect. Nutrition, thyroid repletion, and culture-directed IV antibiotics are 
      necessary to optimize esophageal perforation repair.
FAU - Lee, Thomas S
AU  - Lee TS
AUID- ORCID: 0000-0001-7785-6761
AD  - Virginia Commonwealth University, Department of Otolaryngology-Head and Neck 
      Surgery, USA.
FAU - Appelbaum, Eric N
AU  - Appelbaum EN
AD  - Baylor College of Medicine, Department of Otolaryngology-Head and Neck Surgery, 
      USA.
FAU - Sheen, Derek
AU  - Sheen D
AD  - Virginia Commonwealth University, Department of Otolaryngology-Head and Neck 
      Surgery, USA.
FAU - Han, Reintine
AU  - Han R
AD  - Hackensack Meridian Health Mountainside Medical Center, Department of Family 
      Medicine, USA.
FAU - Wie, Benjamin
AU  - Wie B
AD  - Wake Forest University School of Medicine, USA.
LA  - eng
PT  - Journal Article
DEP - 20190625
PL  - United States
TA  - Int J Otolaryngol
JT  - International journal of otolaryngology
JID - 101518366
PMC - PMC6614980
EDAT- 2019/07/26 06:00
MHDA- 2019/07/26 06:01
PMCR- 2019/06/25
CRDT- 2019/07/26 06:00
PHST- 2019/04/11 00:00 [received]
PHST- 2019/05/22 00:00 [accepted]
PHST- 2019/07/26 06:00 [entrez]
PHST- 2019/07/26 06:00 [pubmed]
PHST- 2019/07/26 06:01 [medline]
PHST- 2019/06/25 00:00 [pmc-release]
AID - 10.1155/2019/7682654 [doi]
PST - epublish
SO  - Int J Otolaryngol. 2019 Jun 25;2019:7682654. doi: 10.1155/2019/7682654. 
      eCollection 2019.