An Unknown Foreign laryngeal Object: an exotic complication of skull base osteoradionecrosis

TL;DR

A rare case of skull base osteoradionecrosis led to a dislocated bone fragment causing a life-threatening airway blockage, requiring urgent surgical intervention.

Contribution

This case report highlights an unusual and dangerous complication of skull base osteoradionecrosis not previously well-documented in the literature.

Findings

A dislocated part of the clivus caused airway obstruction after skull base osteoradionecrosis.

Awake tracheotomy and transoral removal of the dislocated bone fragment resolved the emergency.

The patient experienced significant pain relief following successful intervention.

Abstract

Osteoradionecrosis (ORN) of the skull base is a rare complication after head and neck radiation with a broad variety of subsequent complications.

A 68-year-old woman with a complex oncological history (right-sided sphenoid meningioma; left-sided neck metastasis of a Cancer of Unknown Primary—CUP) was admitted with a right-sided epi—/ oropharyngeal mass and severe pain exacerbations for further evaluation. CT scan revealed an advanced ORN of the skull base with subsequent abruption of the ventral part of the clivus. This dislocated part of the clivus wedged in the oropharynx for 48 h and then moved towards the larynx, resulting in dyspnea and almost complete airway obstruction.

Due to the dangerous airway situation, an urgent exploration and removal of the dislocated clivus was necessary. After a potential cervical spine instability was ruled out, the patient’s airway was initially secured with an awake tracheotomy and the clivus was removed transorally. The tracheostomy tube was removed during the ongoing inpatient stay, and the patient was discharged with significant pain relief.

The present case illustrates an orphan complication of skull base ORN resulting in a major airway emergency situation.

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