Horner's Syndrome: An Unusual Complication of Transcervical Zenker's Diverticulectomy

Horner's syndrome is a clinical entity encountered by head and neck surgeons in patients with penetrating neck injury, post-neck dissections, and cervical sympathetic chain schwannomas. However, Horner's syndrome after transcervical resection of Zenker's diverticulum has not been previously described in the published literature. A patient who had failed two previous attempts at endoscopic repair of a large Zenker's diverticulum underwent transcervical diverticulectomy with cricopharyngeal myotomy. A previous history of anterior cervical fusion at C5 and C6 was also present. Postoperatively, he developed pupillary asymmetry, left upper eyelid ptosis, and ipsilateral anhydrosis. Ophthalmology consultation was initiated, and cocaine 10% solution drops applied to both eyes confirmed the diagnosis. His symptoms persisted at 2 years postsurgery. Horner's syndrome is a potential complication of Zenker's diverticulectomy due to the close proximity of the pouch base to the sympathetic chain. The likelihood of injury to the cervical sympathetic chain is also increased in the setting of previous neck surgery.