Forestier's disease and its implications in otolaryngology: literature review

Abstract

Introduction: Forestier's disease affects the spinal column of primarily elderly men. It is not rare, but it is often undiagnosed and can lead to significant morbidity and mortality. When it affects the cervical spine, it can result in important otorhinolaryngological manifestations.

Objective: To analyze the pharyngeal and laryngeal symptoms of the Forestier's disease.

Methods: Literature review of the Web of Knowledge, PubMed, and SciELO databases and of the ten most frequently cited journals in the field of otorhinolaryngology. Additionally, a manual search was performed for publications in the reference lists of selected articles, mostly those of a historical nature.

Results: The etiology of the disease is still unclear. Symptoms of complications are more significant than the disease itself. Dysphagia is the most common cervical symptom and has several involved mechanisms. Other symptoms are sleep apnea, pharyngeal globus, coughing, dysphonia, dyspnea, otalgia, and medullary compression. The diagnosis is verified by appropriate radiological study. Treatment is based on a conservative strategy. Patients with refractory dysphagia and respiratory impairment can be surgically treated.

Conclusion: Forestier's disease should be suspected in elderly patients with the major symptoms of complications, which are common in otorhinolaryngology practice and when identified, a multidisciplinary approach should be instituted as soon as possible.

Figure 1

Video laryngoscopy image of a patient with Forestier’s disease, showing submucosal bulging in hypopharynx, corresponding to prominent cervical osteophytes.

Figure 2

Plain profile X-ray of the cervical spine showing diffuse calcification in the anterior longitudinal ligament and calcification areas in the posterior longitudinal ligament.

Figure 3

Profile chest X-ray showing diffuse calcification of the anterior longitudinal ligament with prominent formation of osteophytes in the thoracic spine.

Figure 4

Magnetic resonance images of the cervical spine in T1 showing calcification of the anterior longitudinal ligament, with no involvement of nervous structures.