# Sternoclavicular Joint Tracheal Fistula: An Unusual Postradiation Complication in a Laryngectomee

## TL;DR

A man who had radiation therapy for throat cancer developed a rare infection and fistula near his trachea, requiring surgery and long-term treatment.

## Contribution

This case highlights a rare post-radiation complication and discusses diagnostic and therapeutic challenges.

## Key findings

- A fistula formed between the sternoclavicular joint and trachea after radiation therapy for laryngeal cancer.
- The patient required prolonged antibiotics and surgical resection to manage the infection.
- Histopathology confirmed osteoradionecrosis and osteomyelitis, which can be hard to distinguish after radiotherapy.

## Abstract

A 68-year-old man previously treated for a large laryngeal neoplasm (pT4 pN0 squamous cell carcinoma) developed osteomyelitis of the medial third of the right clavicle with the formation of a fistula between the sternoclavicular joint and tracheal wall near the tracheostomy border. The clinical course was tedious, required prolonged antibiotic trials, and extended surgical bone resection to control the infection. The final outcome was favorable with wound closure although the patient was left with permanent limitation of shoulder abduction (his shoulder mobility had been normal prior to this process). Histopathological examination of the resected bone suggested a diagnosis of both osteoradionecrosis and osteomyelitis. Indeed, differential diagnosis between these two entities can be challenging after radiotherapy. Here, we present a review of the relevant academic literature and discuss the therapeutic options.