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Late laryngo-tracheal cartilage necrosis with external fistula 44 years after radiotherapy

Published online by Cambridge University Press:  08 March 2006

Yoshitaka Takiguchi ,
Hiro-Oki Okamura ,
Ken Kitamura  and
Seiji Kishimoto
Yoshitaka Takiguchi
Affiliation:
Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
Hiro-Oki Okamura
Affiliation:
Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
Ken Kitamura
Affiliation:
Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
Seiji Kishimoto
Affiliation:
Departments of Otolaryngology and Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
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Abstract

Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

Keywords

Laryngeal CartilagesNecrosisRadiotherapy
Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 117 , Issue 8 , August 2003 , pp. 658 - 659
Copyright
© Royal Society of Medicine Press Limited 2003

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