Purpose <p>Oropharyngeal perforation is extremely rare but dreaded. The majority of previous reported cases were iatrogenic. Till now, there is no report of traumatic oropharyngeal perforation secondary to a cervical fracture. We report a case of oropharyngeal perforation identified in anterior cervical discectomy and fusion (ACDF).</p> Methods <p>A 78-year-old patient falling from a bicycle was diagnosed with C2 fracture. The patient complained of neck pain, odynophagia and hoarseness. No neurological deficit was identified. Radiographic examinations showed a type I Hangman’s fracture of C2. Intraoperatively, an approximately 3 cm of perforation was identified in the oropharynx, exposing the orotracheal intubation tube. The perforation was then sutured using resorbable 5/0 thread without applying excessive tension on the wound edges, which was followed by a regular ACDF at the level of C2/C3. A nasogastric tube was inserted to prevent complications. The patient received intravenous antibiotic therapy and oral administration of ciprofloxacin to prevent infections.</p> Results <p>The oropharyngeal perforation was resolved with considerable improvement in clinical signs after surgery (Aiolfi et al. in World J Emerg Surg 12(1):1–7, 2017. 10.1186/S13017-017-0131-8/TABLES/5). Follow-up radiological evaluation confirmed solid fusion and cervical spine stability, as well as the closure of the perforation on radiopaque X-rays.</p> Conclusion <p>Oropharyngeal perforation caused by cervical fracture is an extremely rare complication. High intraoperative suspicion rate is required to identify perforations that might be missed by regular radiological diagnosis. The combination of upper endoscopy and barium swallow study yields an almost 100% diagnosis accuracy. Early surgical treatment is of paramount importance to prevent major complications, cervical fracture with lesions of the pharynx often associates with an ankylosing spondylarthritis.</p>