%0 Journal Article
%T Cervical Spine Osteomyelitis and Epidural Abscess after Chemoradiotherapy for Hypopharyngeal Carcinoma: A Case Report
%A Yushi Ueki
%A Jun Watanabe
%A Shigehisa Hashimoto
%A Sugata Takahashi
%J Case Reports in Otolaryngology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/141307
%X Osteomyelitis of mandible as a delayed adverse event following radiation therapy has been widely reported; however, osteomyelitis of the cervical spine has rarely been reported. In this study, we reported our experience with a case of cervical spine osteomyelitis and epidural abscess after concurrent chemoradiotherapy (CCRT) for hypopharyngeal carcinoma. The case involved a 68-year old man who underwent radical CCRT after a diagnosis of stage IVb, T4bN2cM0 posterior hypopharyngeal wall carcinoma. At 7 months after completing the initial therapy, the patient complained of severe pain in the neck and both shoulders and reduced muscular strength in the extremities. A large defect was found on the mucosa of posterior hypopharyngeal wall. On cervical magnetic resonance imaging, cervical spine osteomyelitis and an epidural abscess were observed. Because antimicrobial therapy was not effective, hyperbaric oxygen therapy was administered. Abscess reduction and improvement of the mucosal defect were observed. Because cervical spine complications after CCRT can be fatal upon worsening, adequate attention must be given. 1. Introduction Although concurrent chemoradiotherapy (CCRT) is indispensable for the treatment of head and neck carcinomas, various adverse events can occur. Osteonecrosis and osteomyelitis are among these events, and these conditions can worsen after occurrence, leading to potentially fatal results, despite control of the underlying disease. Therefore, these conditions are adverse events that require adequate attention. In this study, we reported our experience with a case of cervical spine osteomyelitis and epidural abscess after CCRT for hypopharyngeal carcinoma with a brief review of the literature. 2. Case Report A 68-year old man complained about swallowing difficulties in December 2011 and visited a nearby clinic in February 2012. He was referred to our department in March 2012 because of a suspected hypopharyngeal tumor. According to the patient¡¯s previous medical history, he suffered from hypertension, had smoked 15 cigarettes per day for 50 years, and consumed alcohol at the rate of 3£¿L of beer per day. During the initial examination, a tumor lesion was found on the posterior wall of the hypopharynx (Figure 1). Enlargement of bilateral retropharyngeal lymph nodes was seen on computed tomography (CT), whereas on magnetic resonance imaging (MRI), lesion infiltration from the posterior wall of hypopharynx to the prevertebral muscles was observed (Figure 2). Squamous cell carcinoma was identified on the basis of biopsy findings, and stage
%U http://www.hindawi.com/journals/criot/2014/141307/