Severe Chondroradionecrosis of the Larynx as a long-term Sequela of Radiotherapy

Introduction The main complication of radio (chemo) therapy of laryngeal carcinoma is skin damage, laryngeal edema, perichondritis and cartilage necrosis. Symptoms range from redness of the skin, pain, dysphonia and dysphagia, to dyspnea and fistula formation. Radionecrosis of cartilage is a rare complication with an incidence of about 1 % and usually occurs within one year after radiotherapy. Individual cases with a latency of up to 50 years are described.

Methods A 79-year-old male presented with dysphonia, sore throat and prelaryngeal skin erythema after combined radio-chemotherapy of a supraglottic laryngeal carcinoma 30 years ago. Endolaryngeal generalized edematous mucosal swelling was found. CT-morphologically, only calcifications in the thyroid cartilage were seen. Recurrence was histologically excluded by a panendoscopy. The patient's perichondritis was treated with antibiotics. 3 weeks later a tracheostomy had to be done due to progressive laryngeal edema and fistula formation. This was followed by a debridement with removal of cartilage sequins of the thyroid cartilage and extensive wound cleansing.

Results Histologically, necrotic cartilage was detected without evidence of recurrence. Overall, severe radionecrosis of the larynx grade IV according to Chandler was found. The patient still will be treated with antibiotics and steroids. Hyperbaric oxygen therapy has been declined so far.

Discussion Radionecrosis of the larynx is a rare but serious complication and can still occur after decades. To differentiate from a recurrence can be difficult and it requires further diagnosis and intensive therapy.

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Publication History

Article published online:
10 June 2020