Cervical ankylosing hyperostosis and airway obstruction.

Forestier's disease, or ankylosing hyperostosis of the cervical spine, has been described to cause dysphagia, foreign body sensation, and aspiration. We report two patients with ankylosing hyperostosis producing ulceration of the posterior plate of the cricoid cartilage, inflammatory edema, and secondary bilateral vocal cord paralysis with airway obstruction. This disease initially produces minimal dysphagia when the primary location of the osteophyte is just above and posterior to the cricoid, then, progressive airway obstruction. The pathogenesis is infection superimposed on ulceration of the cricoid produced by laryngeal movement over a large, sharp osteophyte. Management included tracheostomy for airway management, endoscopy to rule out malignancy, intravenous antibiotic therapy, and surgical excision of the osteophyte.