To increase awareness of cervical osteophytes as an extremely rare cause of recurrent laryngeal nerve palsy; to outline the clinical approach to patients with unilateral vocal fold paralysis and to provide an update on the current management of osteoarthritis and osteophytes.

An elderly man presented with right unilateral vocal fold immobility and a small phonatory gap. By a diagnosis of exclusion, a cervical osteophyte at the level of the sixth and seventh cervical vertebrae was shown to be the cause. The patient responded to speech therapy and no further intervention was required.

A literature review, using Medline, identified only one previously published case of vocal fold paralysis due to osteophytes secondary to osteoarthritis.

The aetiology of unilateral paralysis of the hemilarynx must be fully investigated, as the innervating system has a protracted course, particularly on the left side. Degenerative cervical spine disease, although rare, should be considered as part of the differential diagnosis.

We report two cases in which dysphagia and aspiration, caused by anterior cervical osteophytes, were so severe that surgical resection was performed.

Case reports and a review of the world literature concerning dysphagia caused by anterior cervical osteophytes, in regard to pathogenesis, diagnosis and treatment.

Two patients, aged 71 and 70 years, had long-standing, slowly progressive dysphagia and aspiration; one patient had recurrent episodes of aspiration pneumonia as a result. Both patients were diagnosed on videofluoroscopy with large bony anterior cervical osteophytes. Immediate relief of symptoms was obtained after resection of the osteophytes via an anterolateral, extrapharyngeal approach. Anterior cervical osteophytes are relatively common in the elderly, although not frequently diagnosed, and are mostly seen in cases of diffuse idiopathic skeletal hyperostosis. If therapy is indicated it is mainly conservative; resection is rarely needed.

In patients with anterior cervical osteophytes, surgical treatment is indicated only for selected cases with large, bony osteophytes and severe symptoms.

We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications.

Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3–4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis.

When encountering a patient with an excessive osteophyte formation at the level of C3–4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.