Case of lingual osseous choristoma

Abstract

Introduction: Cervical hyperostosis associated with Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a rare cause of dysphagia. Ossification of ligaments, tendons and joint capsule insertions which can lead to dysphagia, hoarseness, laryngeal stenosis and dyspnoea in cervical hyperostosis. Pharmacological and surgical management have been reported. We present a case of recurrent postoperative pyogenic granuloma requiring laser excision and steroid injection after surgical reduction of oropharyngeal cervical hyperostosis. Case report: A 59-year-old male with dysphagia and foreign body sensation showed clinical and radiological oropharyngeal indentation caused by cervical hyperostosis. He underwent intraoral surgical reduction of upper cervical hyperostosis. Although his oropharyngeal symptoms resolved for 3 weeks, he presented with right posterior pharyngeal haematoma secondary to postoperative infection of pharyngeal mucosa. Histology confirmed reactive vascular response indicative of pyogenic granuloma. Despite surgical removal, intravenous antibiotic and nasogastric feeding for 2 days, he developed recurrent posterior pharyngeal pyogenic granuloma within 6 weeks and required Nd-Yag Laser excision and intramuscular steroid injection. Discussion: Postoperative complications after posterior pharyngeal surgery include infection, haematoma, neck pain, dysphagia and dysphonia. Recurrent pyogenic granuloma after removal of postoperative haematoma secondary to mucosal infection is rare and has not been reported. Immediate surgery may not be necessary as some pyogenic granuloma resolves spontaneously. Conclusion: Recurrent pyogenic granuloma of posterior pharyngeal wall after surgical reduction of cervical hyperostosis is rare. Laser excision with intramucosal steroid injection should be considered in the management of this rare complication.