Abstract Introduction Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory disorder of the entheses characterized by flowing ossification of the anterior longitudinal ligament with preservation of intervertebral disc height. Although often asymptomatic, extensive cervical involvement can narrow the airway and impair swallowing. These manifestations may be mistaken for tumor-related symptoms in patients undergoing head and neck cancer evaluation, making clinical awareness crucial. Case Presentation An 80-year-old male, nonsmoker and nondrinker, presented with right-sided tongue pain and a gradually enlarging lesion first noticed in December 2020. He also reported right ear fullness, mucus retention, throat tightness, and odynophagia. Physical examination revealed a right lateral tongue lesion, while flexible laryngoscopy showed no laryngeal mass. Contrast-enhanced CT of the neck demonstrated a 2 cm tongue lesion along with severe multilevel anterior bridging osteophytes consistent with DISH. A large C4-C5 osteophyte caused anterior airway narrowing, and another at C6-C7 displaced the pyriform sinus and laryngeal structures. Preservation of disc height confirmed the diagnosis radiographically. Biopsy revealed a well-differentiated keratinizing squamous cell carcinoma of the tongue. The patient underwent right hemiglossectomy and selective neck dissection (levels I-III) without complications. Postoperatively, he continued experiencing thick saliva and difficulty swallowing solids, consistent with persistent pharyngeal impingement from DISH. Discussion This case emphasizes the importance of recognizing DISH as an anatomic comorbidity that can mimic or worsen aerodigestive symptoms in elderly patients with head and neck cancer. Cervical DISH affects up to 20% of men over 70 years 1-3 and has been linked to metabolic syndrome, diabetes, and obesity 4. Radiographically, it presents as contiguous ossification of the anterior longitudinal ligament across four or more vertebrae, with maintained disc spaces and absence of sacroiliac erosion 2. Prominent cervical osteophytes may compress the pharynx or larynx, leading to dysphagia, odynophagia, or airway obstruction 5-7. In the perioperative or ICU setting, unrecognized DISH can complicate intubation, extubation, and swallowing rehabilitation 6,8. Awareness of its imaging features allows early airway planning and distinction between mechanical and malignant dysphagia. Conclusion Diffuse idiopathic skeletal hyperostosis should be actively identified in elderly patients undergoing head and neck cancer workup. Although often incidental, significant cervical ossification can contribute to dysphagia and airway compromise, influencing surgical and anesthetic decisions. Early recognition helps prevent airway-related complications and improves multidisciplinary management in oncologic care. This abstract is funded by: None
Etukudoh et al. (Fri,) studied this question.