We report 2 cases of carotid artery rupture after irradiation that was performed 1 year and 17 years before the ruptures. When irradiation-induced arterial rupture occurs, it usually does so within a few months following irradiation. However, the histopathological sections obtained in the present cases revealed carotid artery necrosis that was presumably induced by irradiation. Carotid artery rupture is sudden, massive hemorrhage that ranks among the most dreaded complications in the head and neck. However, several patients have been saved by hospital personnel who discovered the rupture in time to take appropriate measures such as cleaning of the wound and protection with myocutaneous or myofascial flaps. Therefore, it is important to be aware of the possibility of rupture or perforation of major vessels after irradiation, even when the radiation therapy was performed a long time ago.

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.

New surgical treatment for the intractable nasal obstruction in patients with nasal allergy by using Argon Plasma Coagula tor (APC) was introduced. Of patients with allergic rhinitis treated at our institute, 28 patients complaining nasal obstruction were treated APC surgery. Epithelization of the mucosa of inferior turbinate was almost completely accomplished at 4 weeks after surgery, at which time mucosal swelling was reduced, and nasal obstruction was ameliorated in all cases, though a crust and fibrin membrane adhered to the mucosa between 2 to 4 weeks after surgery, resulting in temporary exacerbation of nasal obstruction. Nasal obstruction was again aggravated in only one patient about 6 months after surgery, but such symptom could be ameliorated by re-coagulation. No bleeding and no smoke occurred in the operation. No morbidity was also noticed after operation. APC is easy to perform safely and effectively compared with another laser surgeries, and is useful for intractable nasal obstruction occurring in patients with allergic rhinitis.

Our findings suggest that COX is involved in the secretion of nasal discharge from the nasal glands and that prostaglandins in the nasal discharge are probably secreted directly from the nasal glands.

No abstract