Skip to main content
AAO-HNSF 2025 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.

Scientific Oral Presentations

Comprehensive Otolaryngology

Session: Scientific Oral Presentations 3 -Comprehensive Otolaryngology

Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion: Proposed Treatment and Mechanism of Injury

Monday, October 13, 2025
1:42 PM - 1:48 PM EDT
Location: 242
Disclosure(s):
Katelin R. Keenehan, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Delayed esophageal perforation (EP) after anterior cervical discectomy and fusion (ACDF) is a rare but serious complication. The purpose of this study is to analyze patients with delayed EP following ACDF to describe their presentation, treatment and propose a mechanism of injury.

Methods: A retrospective chart review of patients over 18 years of age with EPs presenting to an otolaryngologist from 1998 to 2023 was performed. Inclusion criteria consisted of a delayed EP with a prior history of ACDF. Demographics, comorbidities, length of stay, operative details, and post-operative test results were collected.

Results: Seven patients met inclusion criteria. The mean age was 63.6±10.0 years, and 4 (57%) were female. The mean time between ACDF and EP repair was 2.25 (IQR:7) years. Presenting symptoms included dysphagia, dysphonia, neck abscesses, cutaneous fistula, and neck pain. Fusion levels of the prior ACDF included C5-T1 (N = 2), C5-C7 (N = 1), C4-C5 (N = 1), C3-C6 (N = 1), C4-C7 (N = 1), and C4-C6 (N = 1). Proposed reasons for EP were exposed instrumentation on endoscopy (N = 2), anterior displacement of instrumentation (N = 2), instrumentation malposition (N = 1), failure and infection of instrumentation (N = 1), and adherence of plate to pharyngoesophageal segments causing perforation upon mobilization (N = 1). All patients were successfully treated with hardware removal and primary closure of the esophageal defect. The mean length of follow-up from esophageal repair was 464.4±443.4 days.

Conclusions: Delayed EP is a significant postoperative complication of ACDFs but can be effectively treated through hardware removal and primary closure. Many EPs occur at C5-C6, often mimicking a Zenker diverticulum. Careful observation of symptoms post-ACDF and immediate evaluation upon present symptoms is vital to managing EPs.

    Presenting Author(s)

  • Katelin R. Keenehan, BS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Rochester, NY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Francesca C. Viola, MD

    Resident Physician
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Dept of Otolaryngology
    Niagara Falls, NY, United States

    Disclosure information not submitted.

  • Charles W. Stube, BS MS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences
    Buffalo, NY, United States

    Disclosure information not submitted.

  • CL

    Christopher Lucasti, MD

    University at Buffalo (SUNY), United States

    Disclosure information not submitted.

    • Senior Author(s)

  • JM

    Joseph L. Muscarella, Jr., DO

    Clinical Assistant Professor U Buffalo
    Buffalo ENT Specialists
    Williamsville , NY, United States

    Disclosure information not submitted.