Pharyngo-cutaneous fistula following anterior cervical fusion

A 26-year-old man who underwent anterior cervical fusion for a compressed fracture of the C5 vertebra developed postoperatively partial extrusion of the bone graft, followed by progressive dysphagia and retropharyngeal emphysema. Although no definite perforation of the oesophagus or pharynx was detected at reoperation, an extensive pharyngocutaneous fistula formed subsequently through the operative wound. Open drainage in association with broad spectrum antibiotics, continuous nasopharyngeal suctioning, stopping of oral intake and gastrostomy feeding resulted in closure of the fistula. However, the fistula recurred twice soon after resumption of the oral feeding. The diagnostic difficulties in determining when the healing of a pharyngo-cutaneous fistula is complete are underlined. In addition, the importance of continued treatment for 4-6 weeks after first radiological evidence of closure of the fistula is emphasized.