PHARYNGO-CUTANEOUS FISTULA FOLLOWING ANTERIOR CERVICAL FUSION

A 26-year-old man who underwent anterior cervical fusion for a compres sed fracture of the C5 vertebra developed postoperatively partial extr usion of the bone graft, followed by progressive dysphagia and retroph aryngeal emphysema. Although no definite perforation of the oesophagus or pharynx was detected at reoperation, an extensive pharyngocutaneou s fistula formed subsequently through the operative wound. Open draina ge in association with broad spectrum antibiotics, continuous nasophar yngeal suctioning, stopping of oral intake and gastrostomy feeding res ulted in closure of the fistula. However, the fistula recurred twice s oon after resumption of the oral feeding. The diagnostic difficulties in determining when the healing of a pharyngo-cutaneous fistula is com plete are underlined. In addition, the importance of continued treatme nt for 4-6 weeks after first radiological evidence of closure of the f istula is emphasized.