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He has a history as a smoker and moderate drinker, COPD, hiatus hernia with gastroesophageal reflux and ankylosing spondulitis. Physical exploration showed no changes to the larynx, with protrusion of the posterior wall of the hypopharynx. Nasofibroscopy revealed no suspicious lesions or signs which could attribute the odinophagia to other diseases or concomitant conditions. A cervical CT found degenerative lesions with prominent osteophytes on the anterior face of vertebral bodies C3 and C4, and of less intensity on C2 and C5, which were distorting and compressing the hypopharynx (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). The lack of involvement of the intervertebral discs and the absence of ankylosis were key to a diagnosis of Forestier's disease. As the airway was not compromised, the condition was managed using hygiene and dietetic measures and anti-inflammatories. The hygiene and dietetic measures consisted of preferably following an easy-to-chew diet, avoiding foods with a heterogeneous consistency which could cause choking and making eating easier by using postural measures. The drugs used were oral ibuprofen 600<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h, preferably administered 30<span class="elsevierStyleHsp" style=""></span>min to 1<span class="elsevierStyleHsp" style=""></span>h before meals, only on the days when the patient felt the most severe discomfort. On the days that the odinophagia was most marked, he was also recommended to take 1<span class="elsevierStyleHsp" style=""></span>g of paracetamol or 575<span class="elsevierStyleHsp" style=""></span>mg metamizol, between doses of ibuprofen. He was also advised to stop smoking and drinking.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 2</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 74-year-old male diagnosed with Forestier-Rotes-Querol's disease or diffuse idiopathic skeletal hyperostosis (DISH), undergoing outpatient monitoring of dysphonia and dyspnoea due to hypertrophy of the arytenoid mucosa caused by chronic irritation of the cervical osteophytes. He has a history of COPD and is an ex-smoker. The patient underwent endolaryngeal microsurgery, with partial resection of the arytenoid mucosa by CO<span class="elsevierStyleInf">2</span> laser. Anatomopathological analysis showed epithelial hyperplasia with no dysplasia, with superficial keratosis and submucosal oedema with marked vasodilation. After surgery, the symptoms improved, and were controlled thereafter with the same hygiene and dietetic measures and anti-inflammatories mentioned in case 1.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">DISH was described in 1950<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>; it was found that cervical involvement affected 76% of patients. It is principally diagnosed in males and people of advanced age, characterised by an increase in bone in certain anatomical locations. The spinal column is frequently affected, most commonly the cervical and dorsal regions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main difference from other rheumatic diseases is the absence of cervical ankylosis or involvement of the intervertebral discs.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In order to diagnose the condition, it is very important to observe the hard protrusion in the posterior wall of the oro- and hyperpharynx. Lateral radiography of the neck is helpful, easy and fast. However, CT scanning enables differential diagnosis from other conditions. Oesophagogram and high digestive endoscopy are reserved for cases where there is doubt.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The radiographic criteria laid down by Resnick help to establish a diagnosis: (1) ossification of the antero-lateral side of four contiguous vertebrae; (2) absence of ankylosis of the apophyseal joints or of the sacroiliac joint; and (3) preservation of intervertebral discs.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although a very varied clinical history has been described in these patients, it is more usual for them to present with symptoms such as a sensation of a foreign body, choking, dysphagia, cough and dysphonia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This is due to the involvement of the anterior ligament at dorsocervical level, osteophytes cause a mechanical problem which provokes pharyngeal symptoms; a perilesional inflammatory component adds to this problem, which justifies the partial improvement achieved with anti-inflammatories. Cricopharingeal muscle spasm and changes to the mobility of the epiglottis can also be a cause of dysphagia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In terms of treatment, the great majority of authors propose conservative measures, using hygiene and dietetic measures in association with anti-inflammatories. A surgical approach is reserved for patients with incapacitating symptoms or when the airway and digestive tract are compromised.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, there are authors who defend surgery as the treatment of choice,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> using a transoral approach route for high cervical exostosis and anterolateral cervicotomy for low.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Published work suggests that existing osteophytes should be removed together with an anterior cervical fusion, as ossification of the ligament progresses to rigidity, so that recurrence is likely if a cervical fusion is not performed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our work, the first patient presented with problems with swallowing and was managed conservatively (easy-to-chew diet and anti-inflammatories); the second patient presented with problems not only with swallowing, but also had an arytenoid oedema which could not be explained by other comorbidities; the problem was managed by resection of the excess mucous membrane by laser. The symptoms of both patients were relieved using this strategy and they are currently well-controlled.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Clinical Cases" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] ] ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-02" "fechaAceptado" => "2012-05-03" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Torres A, Ceballo Pedraja JM, Abrante Jiménez A, Esteban Ortega F. Tratamiento de dos casos de enfermedad de Forestier-Rotes Querol. Acta Otorrinolaringol Esp. 2014;65:56–58.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 612 "Ancho" => 950 "Tamanyo" => 84734 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial CT imaging of the first patient at glottic level.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 819 "Ancho" => 950 "Tamanyo" => 84071 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial CT imaging of the first patient at supraglottic level.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 738 "Ancho" => 950 "Tamanyo" => 58428 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral radiography of the neck of the first patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Senile ankylosing hiperostosis of the spine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. 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Journal Information
Vol. 65. Issue 1.
Pages 56-58 (January - February 2014)
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Vol. 65. Issue 1.
Pages 56-58 (January - February 2014)
Case Study
Treatment of Two Cases of Forestier-Rotes-Querol's Disease
Tratamiento de dos casos de enfermedad de Forestier-Rotes Querol
Visits
1967
Antonio Gómez-Torres
, José Mario Ceballo Pedraja, Antonio Abrante Jiménez, Francisco Esteban Ortega
Corresponding author
Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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