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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.
Key words: Laryngeal Cartilages; Necrosis; Radiotherapy
Introduction
Radiotherapy is one of the mainstays of treatment for head and neck carcinoma. Immediate and late complications of radiotherapy include reaction of the skin, mucous membranes, bone, and cartilage. More severe changes involve necrosis of the above tissues, resulting in fistula formation. Local and general factors such as infection, tumour invasion, and immune status can affect tissue tolerance of radiation. Although the interval between radiotherapy and development or radionecrosis varies, most reported cases have developed between three and 12 months after irradiation.1
The present case report describes an unusual case demonstrating a fistula in the anterior neck with laryngotracheal necrosis 44 years after radiotherapy.
Case report
A 77-year-old female presented with skin ulceration and a fistula in the anterior neck in 1999. She had undergone total thyroidectomy and radiotherapy for thyroid tumour in 1955. The histological diagnosis of that tumour was unknown. Despite the absence of tumour recurrence, skin ulceration without fistula developed in 1977 and surgical treatment with skin grafting was performed. In November 1999, the patient again noticed...