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Complications after tonsillectomy: Cervical epidural empyema

Jacek Skladzien, Pawel Strek, Krzysztof Oles, Maciej Wiatr, Jerzy Tomik, Anna Przeklasa-Muszynska

Am J Case Rep 2009; 10:172-175

ID: 878221

Background: Inflammatory complications after routine surgery in the oral and pharyngeal cavities are very rare. Epidural empyema of the cervical vertebrae is a very rare inflammatory process of the epidural spinal area. Symptoms of epidural empyema are not very characteristic, particularly during stages free of neurological symptoms or rises in temperature.
Case Report: A 68-year-old man was admitted to the clinic with complaints of difficulty in swallowing, headaches, vertigo, and pain in the cervical spine. Nine weeks earlier he had had extraction of a protracted styloid process preceded by tonsillectomy. X-ray examinations showed epidural empyema in the cervical part of the medulla oblongata and spinal cord. The patient responded well to nonsurgical treatment. The treatment was successfully completed without any neurological defects, so surgery was not required. The patient has been constantly monitored for 24 months without showing distinctive features of an inflammatory process of the epidural spinal area.
Conclusions: Recurrent infections can be a source of spinal inflammation. Risk factors that raise susceptibility to complications of inflammation of the cervical spine include infections such as those of the upper respiratory or urinary tract, abuse of intravenous medicines, and drug abuse. This part of the spine is especially vulnerable to infections from neighboring tissues due to surgery or diagnostic procedures.

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