A diagnostic challenge: risk factors and surgical treatment of laryngeal chondroradionecrosis

Abstract

Objectives: thirteen cases of laryngeal chondroradionecrosis unresponsiveto conservative treatment and treated with laryngectomy were presented with an analysis of possible risk factors. Methods: retrospective analysis of 13 patients operated on for chondroradionecrosis was made. Characteristics of the primarytumor, chondroradionecrosis grade, number of biopsies needed to rule out recurrence, and laryngectomy indications were analyzed. The possible predisposing factors such as alcohol and tobacco use and other major chronic diseases were investigated. Results: all of the patients had a history of smoking. The most common comorbidity was hypertension (46.2%), followed by chronic obstructive pulmonary disease (23.1%). The onset of symptoms was documented within the 10 monthsfollowing the radiation therapy in 12 of the patients (93.3%) and 12 years after the primary radiation therapy in 1 patient. Asthe most common symptom, fetor oris was observed in all of the patients, followed by dysphagia (69.2%), hoarseness (61.5%), pain (53.8%), dyspnea (46.2%), and necrotic fistula formation in the anterior neck (15.4%) consecutively. Tumor suspicion (84.6%) was the most common indication for laryngectomy followed by chronic aspiration or feeding disorder (61.5%). Twelve patients were treated with total and 1 with supraglottic laryngectomy. Pectoralis major muscle flap was used in all of the patients for pharyngeal reconstruction or protection against salivary fistula. Conclusion: diagnosis of chondroradionecrosis is challenging, and tumor recurrence should always be kept in mind. Patients must be informed about the possibility of chondroradionecrosis complications including laryngectomy. Introduction: chondroradionecrosis is a rare and the most severe complication of radiation therapy for laryngeal carcinoma.