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DISH of the cervical spine causing epiglottis impingement
Tommaso Bartalena1, Francesco Buia, Alberto Borgonovi
1Department of Radiology, S. Orsola University Hospital - via Massarenti 9, 40138, Bologna, Italy.
The Indian Journal of Radiology & Imaging
|November 3, 2009
Summary
Diffuse idiopathic skeletal hyperostosis (DISH) can cause swallowing difficulties. Cervical spine DISH can alter the epiglottic tilt mechanism, leading to dysphagia and aspiration.
Area of Science:
- Rheumatology
- Gastroenterology
- Otolaryngology
Background:
- Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory skeletal disorder.
- It primarily affects the vertebral column with characteristic calcification and ossification of ligaments and entheses.
- While commonly associated with spinal symptoms, extraspinal manifestations are also recognized.
Observation:
- A case report detailing a patient experiencing pharyngeal dysphagia and episodic aspiration.
- The patient's symptoms were directly linked to DISH affecting the cervical spine.
- Imaging and clinical evaluation revealed structural changes impacting the swallowing mechanism.
Findings:
- Cervical spine involvement in DISH can lead to significant alterations in the epiglottic tilt mechanism during deglutition.
- This mechanical disruption is a direct cause of oropharyngeal dysphagia and aspiration.
- The study highlights a previously under-recognized complication of DISH.
Implications:
- This case underscores the importance of considering DISH in patients presenting with unexplained swallowing disorders.
- Early recognition and management of cervical spine DISH may prevent severe complications like aspiration pneumonia.
- Further research into the biomechanics of swallowing in DISH patients is warranted.
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