Delayed pharyngeal extrusion of an anterior odontoid screw

A 27-year-old woman with a type II odontoid fracture was treated by anterior odontoid screw fixation. Radiographic union at the fracture site was obtained 3 months after surgery. Nearly 3 years after surgery, she presented at a local Ear, Nose, and Throat (ENT) clinic with a 2-month history of dysphagia. Laryngoscopy identified the head of the odontoid lag screw. Plain radiography showed that the head of the screw had migrated into the pharyngeal soft tissue. The atlantoaxial joint was stable, and computed tomography (CT) scans confirmed odontoid fracture fusion. The screw was found to be movable during endoscopy. The screw could be removed by using a transpharyngeal endoscopic approach under general anesthesia. The failure of the screw was considered to be due in part to malpositioning of the screw and in part to local infection. A transoropharyngeal endoscopic approach to remove the loose anterior odontoid screw was feasible.