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

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.

Pathologic Effects of External-Beam Irradiation on Human Vocal Folds

“…Together with the long-standing hypovascularity that contributes to complications from radiotherapy following a long posttreatment latency period, this finding emphasizes the chronic and indolent nature of radiation-induced tissue changes well beyond the acute treatment period. 12 It may also support the role of ongoing "wound" maturation and collagen deposition following radiation-induced injury. The overall increase in collagen content is clearly representative of radiation-induced fibrosis, correlating with the clinically observed limitations in vocal function.…”

Laryngeal chondronecrosis after radiation therapy in a dog

“…The diagnosis of radiation necrosis is made on clinical presentation and examination. Most patients become symptomatic within the first 3 months after radiotherapy due to the longstanding hypovascularity (Takiguchi et al 2003). However, there are case reports of patients presenting with necrosis up to 44 years after radiotherapy because of fibrosis and endarteritis continuing with time (Takiguchi et al 2003).…”

“…Most patients become symptomatic within the first 3 months after radiotherapy due to the longstanding hypovascularity (Takiguchi et al 2003). However, there are case reports of patients presenting with necrosis up to 44 years after radiotherapy because of fibrosis and endarteritis continuing with time (Takiguchi et al 2003). Due to limited mobility and impairment of the ability to fully abduct or adduct the arytenoid cartilages and vocal folds, mild stridor or exercise intolerance occurs and become progressive.…”

“…Grades III and IV are severe complications and may progress or become fatal despite aggressive treatment measures. Although the vast majority of human ttp://www.bsava.com/ Journal of Small Animal Practice • Vol 59 • December 2018 • © 2017 British Small Animal Veterinary Association patients who develop these clinical symptoms present within the first year after treatment, delayed presentations have been reported up to 44 years after radiation (Robson & Dawes 1961, Berger et al 1984, Takiguchi et al 2003.…”

Colgajo de perforante de arteria mamaria interna (IMAP) en paciente con condronecrosis laríngea

“…Para formas leves de afectación debemos instaurar tratamiento con medidas conservadoras. Reservaremos el tratamiento quirúrgico para los casos graves, que pueden incluir fístulas cutáneas y que clásicamente consiste en el desbridamiento de los tejidos laríngeos desvitalizados y la cobertura del defecto en la superficie anterior del cuello con colgajos pediculados torácicos, fundamentalmente colgajo deltopectoral o miocutáneo pectoral (3)(4)(5).…”