S112 – Fibula C-Spine Reconstruction Following Retropharynx Abscess

Objectives 1) Understand the pathogenesis and epidemiology of retropharyngeal abscess. 2) Appreciate the diagnostic dillema and rapid progression of untreated deep neck space infections. 3) Recognize the significance of free vascularized tissue grafting in the acute post-infection setting of cervical osteomyelitis. Methods A 42-year-old man presented with rapidly progressive odynophagia, respiratory distress, and lower extremity muscle weakness. A large odontogenic retropharyngeal abc-scess had rapidly progressed to cervical osteomyelitis. Diagnostic imaging revealed C2-C6 level involvement. A review of the literature reveals the unusual progression of this case. Results Following drainage, debridement, and anterior as well as posterior stabilization, the patient underwent reconstruction. An early successful second-stage reconstruction was performed with vascularized free fibula graft. The patient did well postoperatively with resolution of paresis, pain, and airway compromise. Conclusions We present the first reported use of vascularized free fibula graft for anterior cervical spine reconstruction from a complicated odontogenic retropharyngeal abscess leading to cervical osteomyelitis. A review of the literature highlights the dangers of untreated deep neck space infections and the role of the reconstructive surgeon in their management.