A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain
A 42-year-old female patient was referred to the dental department complaining of difficulty in swallowing. She reported pain with every swallow (odynophagia), causing constant discomfort, but no other obvious symptoms or systemic problems. She had been a practicing dentist for the last 12 years, and reported mild pain on swallowing which had worsened within 2-3 days of onset. She was prescribed medication (azithromycin 500, cephalexin 500, and ibuprofen) for throat infection without any relief. Subsequently, she developed intermittent but acute throbbing pain and tenderness in her maxillary molars on the right side, and was referred to the dental department.\nOn examination, pain on percussion was evident with regard to teeth #16 and #17. Intraoral radiography showed proximal caries in tooth #17, while tooth #16 had evidently been satisfactorily root canal treated. As the pain was not relieved by medication (cephalexin 500 and serratiopeptidase-diclofenac potassium), endodontic treatment was administered to tooth #17. Four days after the treatment, the patient resumed with persistent dysphagia, without tooth pain. On examination, previously root canal treated tooth #16 was tender, and was therefore considered for re-endodontic treatment. A complaint of severe piercing pain on instrumentation to the mesio-buccal canal of tooth #16 perplexed endodontists, ultimately they decided to go for mesial root resection expecting that it would resolve the problem, but the dysphagia persisted [].\nA fortnight later the patient returned with worsened dysphagia without dental pain. At the eye/ear-nose-throat (ENT) department, the otorhinolaryngologist diagnosed the case as tonsillitis, and a week later, as sinusitis. The treatment plan was changed with each different diagnosis, without any relief. The patient was then advised to undergo endoscopy, which ultimately proved to be normal. Ultrasonography (USG) of the neck and thyroid function tests also turned normal.\nThe patient was referred to the orthopedic department where they revealed a “stiff neck,” which proved to be the main cause of dysphagia. On palpation and pressure at C3 and C4 levels, the patient experienced pain with restricted spinal movements. Cervical radiographs revealed osteophytic projections impinging upon the posterior pharyngeal wall at the levels of C3, C4, and C5, and cervical hypolordosis []. The osteophyte at the pharyngo-esophageal junction was positioned in such a way that it interfered with the swallowing movement. The patient was ultimately diagnosed with osteophytosis involving C3, C4, and C5.\nThe initial treatment planned was nonsurgical. The patient was referred to the chiropractor/physiotherapist for management of stiff neck. In conjunction with nonsteroidal anti-inflammatory drugs, the nutritional supplements were prescribed for a month.\nThe treatment also included muscle relaxant massages, spinal adjustment with neck exercise, and traction sessions.