- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland,
- Department of Clinical Neurosciences, Spine Unit, Lausanne University Hospital, Lausanne, Switzerland.
DOI:10.25259/SNI_22_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Alberto Vandenbulcke1, Giulia Cossu1, Juan Barges Coll2. Pharyngeal perforation: A rare complication of occipitocervical injury. 28-Jun-2021;12:308
How to cite this URL: Alberto Vandenbulcke1, Giulia Cossu1, Juan Barges Coll2. Pharyngeal perforation: A rare complication of occipitocervical injury. 28-Jun-2021;12:308. Available from: https://surgicalneurologyint.com/surgicalint-articles/10928/
Background: Atlantoaxial dislocation is a rare injury following high-energy trauma. We report an undescribed complication of atlantoaxial dislocation.
Case Description: A 75-year-old man presented with atlantoaxial dislocation and Jefferson C1 fracture after a high-energy trauma. Occipitoaxial stabilizations were performed the day after. A nasopharyngeal fistula was identified at day 5 causing a persistent epistaxis.
Conclusion: Nasopharyngeal fistulization of C1 bony fragment is a rare complication of complex occipitocervical injury. Combined treatment with ENT surgeon should be considered.
Keywords: Atlantoaxial dislocation, Craniocervical junction, Craniocervical stabilization, Jefferson fracture, Rhinopharyngeal fistulizations
A 75-year-old man was the victim of a high-energy road accident. When emergency medical services arrived, he was in cardiac arrest (CA) and presented bilateral nonreactive mydriatic pupils. A rigid cervical collar was applied, and cardiopulmonary resuscitation (CPR) was initiated. CPR was discontinued after 12 min when spontaneous circulation returned. A Glasgow Coma Scale of 3 was described. The patient was intubated, fully sedated on site and airlifted to our emergency room.
When we performed the neurological evaluation, he presented with symmetric miotic nonreactive pupils and a preserved oculocardiac reflex and a polytrauma CT scan showed a Jefferson fracture of C1 with anterior atlantoaxial dislocation [
(a) Sagittal bone CT sequence showing anterior dislocation of C2, with a basion density interval of 16 mm and multifragmented fracture of the anterior C1 arc. (b) Axial bone CT sequence showing a Jefferson fracture of C1: bilateral fracture of the anterior and posterior arcs pointed by the blue arrows. (c) Sagittal T2-weighted MRI sequence showing the anterior dislocation of C2 associated with prevertebral hematoma and suspicion of pharyngeal perforation from the anterior arc fragments.
A prevertebral hematoma from C2 to C5 was also present, with a suspicion of pharyngeal perforation from the anteriorly displaced C1 fragment [
Considering the fracture’s high instability, the absence of major cerebral lesions at cerebral MRI performed 4 h after the trauma and the presence of brainstem reflexes, occipitoaxial stabilization with an occipital plate, and C2 pars screws was performed the day after the trauma. A postoperative CT scan confirmed a correct placement of the pars screws with no major displacement of the C1 bony fragment [
On postoperative day 5, a second ENT evaluation was performed following an episode of massive epistaxis. A nasopharyngeal fistula of the thin mucosal layer identified preoperatively, with exposure of a bony fragment of C1 [
Occipitocervical bony and ligamentous lesions are rare fatal injuries following high-energy trauma.[
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