Differential diagnosis of newly occurring pain in a curatively treated tumor patient

Introduction:

A tumor patient complained about pain on the right side of the neck. Previously, a pT3 pN2 cM0 oropharyngeal carcinoma had been laser surgically removed on the right side and a neck dissection had been performed. The patient received adjuvant radiochemotherapy.

Method:

Computed tomography revealed a shift of the cornu majus from the hyoid and cartilago superius thyroidei to the right into the recessus piriformis. The bone fragments were sclerotically rebuilt and surrounded by air.

Result:

In panendoscopy, a vertically spiked bone fragment (2.1 cm x 0.4 cm) was removed from the hypopharynx on the right side. Postoperatively the patient was painless. Histologically, the resected bone was of human origin.

Conclusions:

In summary of all findings and the adjuvant radiation, the patient suffered from an osteoradionecrosis of the cartilago superius thyroidei, which led to pain due to its vertical position in the throat. The retrospective medical history showed that there was crackling in the jaw 6 – 8 weeks before the onset of pain. Presumably, the drift of bones in the soft tissues has led to subjective crackling and later it caused pain, after the bone fragment came to rest in the hypopharynx.

Osteoradionecrosis is often a life-threatening and difficult to treat long-term complication of radiation and affects mostly the jawbone, much less frequently the hyoid or the thyroid cartilage. The pain caused by osteoradionecrosis in this patient was easily removed surgically.

Publication History

Publication Date:
23 April 2019 (online)