Item response theory has its origins in educational measurement and is now commonly applied in health-related measurement of latent traits, such as function and symptoms. This application is due, in large part, to gains in the precision of measurement attributable to item response theory and corresponding decreases in response burden, study costs, and study duration. The purpose of this paper is twofold: introduce basic concepts of item response theory and demonstrate this analytic approach in a worked example, a Rasch model (1PL) analysis of the Eating Assessment Tool (EAT-10), a commonly used measure for oropharyngeal dysphagia. The results of the analysis were largely concordant with previous studies of the EAT-10 and illustrate for brain impairment clinicians and researchers how IRT analysis can yield greater precision of measurement.

Anterior cervical spine fusion and stabilization is a well-recognized procedure for a number of cervical spine disorders. Unfortunately, the complex anatomy of the cervical spine means that these procedures are not without complications. Pharyngo-oesophageal perforation is a rare but potentially life-threatening complication of cervical spine surgery and may present intra-operatively, in the immediate post-operative period or many years later. We present the case of a gentleman with ankylosing spondylitis who presented with a pharyngeal perforation and fistula five years after cervical spine surgery.

We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.

In this report a new enlarged approach to the anterior cervical spine is presented. A 66-year-old female, having a large C3-C4-C5 chordoma, recurrent after surgery and following radiotherapy, underwent a surgical resection.

The approach allows a wide retraction of the nasopharynx, oropharynx and larynx from the midline, only sacrificing the superior laryngeal nerve on one side.

Its continuty can be re-established later by adopting the stent in tube technique. The approach we used presents all the risks of infection common in trans-oral approaches. For this reason, closure of the pharynx in two layers must be meticulous and watertight and re-inforced by using a myofascial sternocleidomastoid flap, according to the trachoesophageal fistula closure technique. A correct alignment of the tongue, the pre-plating of the mandible and the correct suture of the vermillion border guarantee excellent cosmetic and functional results.

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.

Forestier's disease (diffuse idiopathic skeletal hyperostosis) is characterized by extensive spinal osteophyte formation and endo-chondral ossification of paravertebral ligaments and muscles. Dysphagia in the setting of Forestier's disease is a rare and hence often unrecognized entity. The dysphagia is due to mechanical obstruction in the initial stages and later by due to inflammation and fibrosis. Most of these patients are treated conservatively in the initial stages and later by excision of osteophytes through a lateral cervical approach. We present a case of dysphagia due to cervical osteophytes in the setting of Forestier's disease causing narrowing of the pharynx. The patient was treated surgically via a peroral-transpharyngeal route with excellent results.

A case of an acquired pharyngeal pouch which formed as a consequence of previous anterior cervical fusioins reported. This is a rare cause of pharyngeal pouch formation with only one such case previously reported in the English language literature. In our case adhesions had formed between the posterior pharyngeal wall and the area around the screw used to hold the Senegas plate on the anterior aspect of the fifth to seventh cervical spinal vertebrae.

Retropharyngeal abscesses in adults are very rare and usually secondary to chronic tuberculous cervical spine osteomyelitis. We report a case of Staphylococcus aureus septicaemia with multifocal abscesses and osteomyelitis of the cervical spine causing a retropharyngeal abscess. This presented as neck pain and dysphagia following a fall. In addition, we have reviewed related cases.

Cervical spine osteomyelitis is rare. Haematogenous spread is the usual method by which organisms reach the spine. A review of the English literature reveals very few reported cases of local spread of infection to the spine. Here we present the case of a 68-year-old woman with cervical spine osteomyelitis and cord compression complicating pharyngeal myotomy.

Ewing's sarcoma arising in the head and neck region is very rare. A case arising from C2 in a young child is presented. The unusual presentation, differential diagnosis and pathological features are discussed.