Surgical treatment of esophago-vertebral fistula and vertebral osteomyelitis after voice prosthesis insertion.

Voice prosthesis (VP) insertion is a common method for post-laryngectomy voice restoration, as it facilitates immediate tracheoesophageal speech acquisition. Although it is a minimally invasive procedure, VP insertion occasionally leads to severe complications. We report a case of esophago-vertebral fistula with vertebral osteomyelitis caused by VP mechanical irritation. A 61-year-old man with multimorbidity developed hypopharyngeal stenosis after chemoradiotherapy for hypopharyngeal and esophageal cancer and underwent total pharyngolaryngectomy with free jejunal transfer. After one year, a VP was placed, which led to the development of an esophago-vertebral fistula with vertebral osteomyelitis. Conservative treatments including antibiotic administration and cessation of oral intake failed, and surgical debridement and pectoralis major myocutaneous (PMMC) flap reconstruction were performed. The esophago-vertebral fistula was repaired using the flap's skin island and the debrided vertebral bone defect was filled with its muscular portion. Following an uneventful postoperative course, the patient resumed oral intake 17 days later. At the 14-month follow-up, no fistula recurrence or osteomyelitis was detected. In patients with multimorbidity and prior chemoradiotherapy, the indication for VP insertion should be carefully evaluated to avoid esophago-vertebral fistula. Simultaneous fistula closure and vertebral bone coverage using a PMMC flap is effective for esophago-vertebral fistula with vertebral osteomyelitis.