Artikel
Post-radiation necrosis of larynx cartilage as late complication after therapy of larynx carcinoma
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Veröffentlicht: | 30. Juli 2013 |
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A post-radiation necrosis of larynx cartilage counts besides laryngeal edema, skin involvement and perichondritis to late complications after radiotherapy of the larynx or hypophaynx cancer. An optimization of radiation techniques and shedules led to the decrease of complication rate to 1%, but because of the widely-spread application of adjuvant and neoadjuvant radiochemotherapy complications remain relevant for the daily ENT practice.
In this paper we present the case of thyreoid cartilage by one patient after laser assisted hemi-laryngectomy with neck dissection on the right side (Level II–III). Histologically, there was a glottic carcinoma (pT3, G1, pN0 (0/3), R0, cM0). Four weeks after the surgery, the patient received radiation to the former tumor region and bilateral cervical lymph nodes of a daily dose of 1.8 Gy until the common dose of 50.4 Gy was reached as well as saturation of the tumor region of a daily dose of 1.8 Gy until the common dose of 59.4 Gy was reached. Four weeks after completion of radiation there was no evidence of a residual tumor. 5.5 months after radiotherapy the patient was admitted to the hospital emergently for several dyspnoea and dysphonia. Laryngeal oedem and unknown mass in the anterior larynx commissure were found during the ENT examination. After unsuccessful decongesting therapy, direct laryngoscopie was performed. The mass was estimated endoscopically as a foreign body and was removed. After taking a biopsy from the anterior larynx commissure the edematose mucosa was removed by laser. Histologically, there was evidence of a necrotic infected cartilage without tumor recurrence. After postoperative decongesting, mycolytic and antibiotic therapy the patient was discharged free of complains.
This case presents potential diagnostic difficulties in distinguishing between post-radiation necrosis of larynx cartilage, foreign body, and local tumor recurrence and demonstrates the relevance of this complication in the management of ENT emergencies.