Management of Pharyngeal Perforation with Cervical Spine Injury Following Blunt Trauma on Electric Vehicle Accident

BACKGROUND Cases of pharyngeal perforation (PP) associated with cervical spine injury following blunt trauma are extremely rare. CASE REPORT A 58-year-old woman was hit by a car while riding an electric bicycle. She presented with neck pain and dyspnea on admission to the hospital. The CT scan showed suspected fractures of the 5th and 6th cervical vertebrae without evidence of cervical emphysema. Serial blood tests revealed a rapidly decreasing hemoglobin level. An urgent surgical exploration of the neck was performed. Intraoperative findings included complete tears of the anterior and posterior longitudinal ligaments of the cervical spine, rupture of the 5th and 6th cervical intervertebral discs, and a longitudinal laceration of the posterior pharyngeal wall. The patient underwent surgical management, which included PP repair and cervical spine infusion via an anterior cervical approach. The buccopharyngeal fascia was sutured to the prevertebral fascia to seal the connection between the PP and the prevertebral space. The patient recovered well after surgery. The 3-month postoperative follow-up showed a stable cervical spine and good healing of the PP. CONCLUSIONS We present the first case of PP associated with severe cervical spine injury following blunt trauma. Direct laryngoscopy is essential to establish the presence of PP and to assess the size and location of the injury. In this rare case, suturing the buccopharyngeal fascia and prevertebral fascia to isolate the PP and spinal implant was effective in preventing implant infection and surgical failure potentially caused by salivary leakage.