Erosion of the carotid artery due to osteoradionecrosis of the temporal bone following extensive surgery and radiotherapy for an auricle carcinoma

Introduction Osteoradionecrosis (ORN) is a well recognized complication following radiotherapy for head and neck tumors. ORN in the mandible with an incidence between 10 and 15 %  is common, but the temporal bone is a very rare site of ORN.

Case report We present a case of an 90 year old man, who underwent repeated surgery and radiotherapy for an auricle carcinoma on the left side. About one year after extensive surgery an repeated radiotherapy (total amount in 2013 an 2014: 102 Gy) for recurrent carcinoma of the skull base a small skin defekt on the mastoid occured. In the next weeks he developed typical symptoms of ORN with otorrhea, hearing loss an otalgia. He received conservative therapy, including topical antibiotics and long-term antibiosis. Because of local necrosis of the bone he received local debridement. In the next years bony necrosis increased and 3 years after radiation facial nerve paralysis occured. A debridement with plastic reconstruction was rejected. About 5 years after radiothearpy he was hospitalised with intermittent significant bleeding due to an erosion of the internal carotid artery (ICA). With a pressure bandage the bleeding could be temporarily controlled. He subsequently unterwent angiography in which the skull-based ICA could be identified as the source of bleeding. An endovascular stent-graft was immediately delivered to stop the bleeding. Due to the old age, the patient died of cardiovascular failure shortly afterwards.

Conclusion ORN of the temoral bone is a very rare complication of radiation, that can be life-threatening due to its proximity to the large vessels. This case shows a potential management of such a uncommon complication.

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Artikel online veröffentlicht:
13. Mai 2021