Anterior cervical plate fixation is a common surgical procedure for cervical spinal disease. However, it sometimes causes serious complications. Pharyngo-esophageal perforation following anterior cervical plate fixation is a rare complication, but associated with severe morbidity. Pharyngo-esophageal perforation often occurs in the acute phase during surgery or within a few months after surgery. However, we encountered 4 cases of delayed perforation developing more than 3 years after the surgery. The chief complaint was dysphagia in two cases, and one case was asymptomatic. There are as yet no clear guidelines for the treatment of pharyngo-esophageal perforation following anterior cervical plate fixation. We performed primary closure in two of the patients and flap reconstruction in the remaining patient. Flap reconstruction was considered in the case with large perforation and anterolateral thigh free flaps were used. In all cases, the perforation was closed and oral intake became possible. Pharyngo-esophageal perforations that occur long after anterior cervical plate fixation may be associated with fewer symptoms, and it is therefore important to bear the possibility in mind, especially in patients who present with dysphagia.
