Cervical spine osteomyelitis post tracheo-esophageal puncture with voice prosthesis: Two case reports and literature review

Tracheo-esophageal puncture (TEP) with a voice prosthesis (VP) is the most widely used modality for vocal rehabilitation after total laryngectomy (TL). The most common asso­ciated complications are less serious peri- and intra-prosthetic leakages, inflammation, and strictures. Serious complications are rare and can be associated with significant morbidity and even mortality. In this article, we aim to shed light on a rare complication in 2 cases with delayed erosion of the VP through the posterior pharyngeal wall, leading to osteomyelitis with irreversible neurological morbidity. One case was treated surgically with spinal decompression, whereas the second case had a rapid clinical deterioration that led to abstention of treatment and mortality. Both cases had irreversible tetraplegia. Such rare, serious complications require a prompt diagnosis followed by a multi-disciplinary management due to the fact that they carry significant neurological morbidity.