Zenker’s Diverticulum in Forestier Disease: Chance or Causality?

Document Type : Original

Authors

Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Palermo, Italy.

Abstract

Introduction:
Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker’s diverticulum.
 
Materials and Methods:
A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords.
 
Results:
The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years.
 
Conclusions:
We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’s diverticulum in a patient with Forestier disease, especially for the life-threatening complications of Zenker’s diverticulum.

Keywords

References

  1. Henry MACA, Lerco MM, Tagliarini JV, Castilho EC, Novaes FT, Lamonica VC. Pharyngoesophageal diverticulum: evaluation of treatment results. Rev Col Bras Cir.2013;40(2): 104-9.
  2. Ludlow A. A case of obstructed deglutition, from a preternatural dilatation of, and bag formed in, the pharynx. Med Obs Inq 1767;3:85
  3. Zenker FA, von Ziemssen H. Krankheiten des Oesophagus. In: Von Ziemssen H, editor. Handbuch der special Pathologie und Therapie. Leipzig, Germany: FC Vogel; 1877:1-87
  4. Sen P, Lowe DA, Farnan T. Surgical interventions for pharyngeal pouch. Cochrane Database Syst Rev. 2005;(3):CD004459.
  5. Cook IJ, Gabb M, Panagopoulos V, Jamieson JJ, Dodds WD, Dent J et al. Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992; 103(4): 1229-35.doi:10.1016/0016-5085(92) 91508-2
  6. Venturi M, Bonavina L, Colombo L, Antoniazzi L, Bruno A, Mussini E, et al. Biochemical markers of upper esophageal sphincter compliance in patients with Zenker's diverticulum. J Surg Res. 1997;70(1):46-8. doi:10.1006/jsre.1997.5049
  7. Bizzotto A, Iacopini F, Landi R, Costamagna G. Zenker's diverticulum: exploring treatment options. Acta Otorhinolaryngol Ital. 2013;33(4):219-229.
  8. Albers DV, Kondo A, Bernardo WM, Sakai P, Moura RN, Silva GL et al. Endoscopic versus surgical approach in the treatment of Zenker's diverticulum: systematic review and meta-analysis. Endosc Int Open. 2016;4(6):E678-E686. doi: 10.1055/s-0042-106203
  9. Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013;9(12):741-750.doi:10.1038/nrrheum.2013.165
  10. Pulcherio JO, Velasco CM, Machado RS, Souza WN, Menezes DR. Forestier's disease and its implications in otolaryngology: literature review. Braz J Otorhinolaryngol. 2014;80(2):161-166. doi:10.5935/1808-8694.20140033
  11. Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol. 2008;35(8):1635-1638.
  12. Castellano DM, Sinacori JT, Karakla DW. Stridor and dysphagia in diffuse idiopathic skeletal hyperostosis (DISH). Laryngoscope. 2006;116(2): 341-344. doi:10.1097/01.mlg.0000197936.48414.fa
  13. van Overbeek JJ. Pathogenesis and methods of treatment of Zenker's diverticulum. Ann Otol Rhinol Laryngol. 2003; 112(7):583-593.doi:10.1177/ 000348940311200703
  14. Salam MA, Cable HR. Acquired pharyngeal diverticulum following anterior cervical fusion operation. Br J Clin Pract. 1994;48(2):109-110.
  15. Sood S, Henein RR, Girgis B. Pharyngeal pouch following anterior cervical fusion. J Laryngol Otol. 1998;112(11):1085-1086.doi:10.1017/s0022215100 142525
  16. Goffart Y, Moreau P, Lenelle J, Boverie J. Traction diverticulum of the hypopharynx following anterior cervical spine surgery. Case report and review. Ann Otol Rhinol Laryngol. 1991; 100(10): 852-855.doi:10.1177/000348949110001012
  17. Ba AM, LoTempio MM, Wang MB. Pharyngeal diverticulum as a sequela of anterior cervical fusion. Am J Otolaryngol. 2006;27(4):295-297. doi:10. 1016/j.amjoto.2005.11.009
  18. Dobran M, Gladi M, Mancini F, Nasi D. Rare case of anterior cervical discectomy and fusion complication in a patient with Zenker's diverticulum. BMJ Case Rep. 2018;11(1):e226022. doi:10.1136/bcr-2018-226022
  19. Mader R, Lavi I. Diabetes mellitus and hypertension as risk factors for early diffuse idiopathic skeletal hyperostosis (DISH). Osteoarthritis Cartilage. 2009;17(6):825-828. doi:10.1016/j.joca.2008.12.004
  20. Kuperus JS, Mohamed Hoesein FAA, de Jong PA, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis: Etiology and clinical relevance. Best Pract Res Clin Rheumatol. 2020;34(3):101527. doi:10.1016/j.berh.2020.101527
  21. Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559-568. doi:10.1148/119.3.559



 

Iranian Journal of Otorhinolaryngology
Volume 34, Issue 2
March and April 2022
Pages 107-112

Files

Share

How to cite

Statistics