Superior thyroid cornu syndrome: An unusual cause of cervical dysphagia

Objectives: Ossification of a superior thyroid cornu in men may cause pharyngeal airway impingement and result in cervical dysphagia. We report on a clinical case series of this rare condition, called superior thyroid cornu syndrome. This is the first report of a case series of this entity as a possible cause of cervical dysphagia that was successfully treated with an endoscopic procedure. Methods: A clinical case series of 12 patients were identified as having superior thyroid cornu syndrome (years 2001 to 2006). Eleven patients were male and 1 was female; their mean age was 54.6 years. They complained of unresolved throat pain, difficulty swallowing, and/or pain on swallowing. On flexible laryngoscopy, there was an asymmetric indentation of the pharynx due to a prominent superior thyroid cornu. Laryngeal manipulation produced the pain and exposed the prominent cornu in the airway. Computed tomographic evidence of calcification of the superior thyroid horn without other abnormality was noted. Results: After maximal medical treatment with proton pump inhibitors, anti-inflammatory agents, nasal steroids, antihistamines, and/or other allergy treatments, 8 of the patients who had persistent symptoms were treated by transoral pharyngotomy and resection of an approximately 2.0 x 0.5-cm segment of a thyroid cornu. Vast improvement in symptoms occurred in 6 patients, and complete symptom resolution occurred in 3 of those 6. Two of 8 patients reported improvement in swallowing, but persistent pain. The follow-up duration was between 2 and 15 months from the time of surgery. Conclusions: Superior thyroid cornu syndrome may be a rare cause of cervical dysphagia. It may be diagnosed by careful laryngoscopy with laryngeal palpation followed by a computed tomography scan. Surgical resection of the affected superior thyroid cornu by transoral pharyngotomy appears to be effective in relief of symptoms.