Cervical spine osteosynthesis screw: a rare cause of late pharyngeal perforation

Abstract

Late-onset pharyngeal perforation is a rare complication of anterior cervical spine osteosynthesis. Clinical presentation is variable and may led to serious complications. We present a 49-year-old male patient with a six-week history of throat pain and foreign body sensation. He had a previous documented odontoid fracture treated with osteosynthesis with an interf ragmentary screw performed 30 years ago. A screw emerging at the level of the left tonsil was observed in the oropharynx, and it was inserted at the right postero-lateral hypopharyngeal wall. The integrity of the adjacent vessels was confirmed by imaging tests. The patient underwent screw removal by trans-oral approach with endoscopic observation, and was admitted for clinical surveillance, without further complications. The rarity of this condition hampers a consensus regarding the diagnostic and therapeutic approaches, and therefore, they must be individualized. In this clinical case, the patient was managed conservatively, and recovered without significant morbidity.