Delayed radionecrosis of the larynx

Introduction The most common complications of laryngeal radiotherapy are skin damage, perichondritis, and edema. Larynx necrosis can occur in 1-5% of patients. Most patients become symptomatic within the first 12 months, although cases up to 50 years after radiotherapy have been described.

Method A 67-year-old patient presented to us with severe redness and swelling of the neck and dysphagia for about 2 months. A total thyroidectomy and bilateral neck dissection were performed in 1992 for thyroid carcinoma, followed by therapy with radioiodine and cobalt. The ENT examination revealed a clear reddening and livid discoloration in region 6 with accompanying hardening. Fistula formation in the larynx with purulent secretion was found at the level of the thyroid cartilage.

Results After treatment with piperacillin/tazobactam 4.5 g, there was a slight improvement in the findings. Neoplasia was ruled out by panendoscopy. Image morphology revealed a typical finding of radionecrosis of the larynx. Various treatment options were discussed with the patient. Surgical therapy was not desired, so we opted for long-term antibiotic therapy and hyperbaric oxygen therapy.

Discussion Radiation necrosis of the larynx is a typical, albeit rare, complication of radiation therapy that can occur decades after therapy. The risk factors are alcohol and tobacco consumption, local tumor invasion, postoperative infection, trauma, and method of radiotherapy. The cartilaginous structure of the larynx becomes destroyed and unstable, which can lead to dysphagia, odynophagia, dysphonia, stridor, and dyspnea

Publication History

Article published online:
12 May 2023