PMC5482169_01
Preoperative fiber optic endoscopy showed protrusion of the posterior pharyngeal wall causing partial occlusion of the oesophageal inlet (arrow)
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F1
He initially underwent fiber optic endoscopy that revealed an anterior mass in the midline projecting into the middle pharynx [Figure 1].
The preoperative lateral plain radiograph reveals beak like ossified anterior longitudinal ligament (OALL) projecting anteriorly at C4-5 (a), which is confirmed on mid-sagittal computed tomography (CT) image (b). The magnetic resonance T2 weighted image (c) shows minimal compression of the thecal sac at C3-4 disc level
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F2
Plain cervical radiography revealed OALL extending from the C4 to C7 levels with beak-like OALL maximal at C4-5 [Figure 2a]. There was minimal cervical cord compression at the C3-4 disc level due to OPLL [Figures 2b and 2c].
Preoperative lateral video fluoroscopy (LVF) revealed a filling defect in the pharynx anterior to the projected OALL at the C4-5 level
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F3
The maxillofacial surgeons performed lateral video fluoroscopy (LVF) documenting a disturbance in the oesophageal phase, and reflux at the level of the beak-like projection [Figure 3].
The OALL was protruding into the operative field (a), which was smoothened by a combination of high-speed drill (b), and an ultrasonic bone curette (c)
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F4
It was largely removed with a bone rongeur and then smoothed using a high-speed drill [Figure 4a and b] and ultrasonic bone curette (SONOPET, Stryker, USA, Figure 4c).
The postoperative plain lateral radiograph (a) and CT mid-sagittal image (b) and axial image at C4 level (c) showing adequate smoothening of the OALL. The postoperative LVF study revealed improvement in the swallowing function (d)
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F5
Adequate decompression of the OALL was confirmed on the lateral plain radiograph [Figure 5a] and CT [Figures 5b and 5c] studies. Additionally, the LVF study one-month later confirmed improved swallowing [Figure 5d].