title: Retropharyngeal abscess with secondary osteomyelitis and epidural abscess: proposed pathophysiological mechanism of an underrecognized complication of unstable craniocervical injuries: case report.
abstract: Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the authors describe the case of a previously healthy and immunocompetent patient who developed a large retropharyngeal abscess with spinal osteomyelitis after a high-energy craniocervical injury. This unusual report of osteomyelitis with a delayed presentation after a high-energy traumatic injury of the craniocervical junction highlights the possibility of direct injury to a specific area in the oropharyngeal mucosa adjacent to the osteoligamentous structures of the craniocervical junction, an overall underrecognized complication of unstable craniocervical injuries.
authors.affiliation: Department of Neurological Surgery, The Ohio State University Wexner Medical Center and The James Cancer Hospital, Columbus, Ohio; and.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Goulart
authors.affiliation: Department of Neurosurgery, InvisionHealth Brain & Spine Center, Buffalo, New York.
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Mattei
authors.affiliation: Department of Neurological Surgery, The Ohio State University Wexner Medical Center and The James Cancer Hospital, Columbus, Ohio; and.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Fiore
authors.affiliation: Department of Neurological Surgery, The Ohio State University Wexner Medical Center and The James Cancer Hospital, Columbus, Ohio; and.
authors.forename: William J
authors.initials: WJ
authors.lastname: Thoman
authors.affiliation: Department of Neurological Surgery, The Ohio State University Wexner Medical Center and The James Cancer Hospital, Columbus, Ohio; and.
authors.forename: Ehud
authors.initials: E
authors.lastname: Mendel
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D020802:Epidural Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017703:Retropharyngeal Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020196:Trauma, Nervous System / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: ALL = anterior longitudinal ligament; MSSA = methicillin-sensitive Staphylococcus aureus; OSU = The Ohio State University; RPS = retropharyngeal space; SEA = spinal epidural abscess; TLIF = transforaminal lumbar interbody fusion; epidural abscess; infection; osteomyelitis; retropharyngeal abscess; trauma; traumatic craniocervical injuries; traumatic spinal injuries; whiplash