Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-18T01:26:44.009Z Has data issue: false hasContentIssue false
  • English
  • Français

Clavicle fracture with osteomyelitis after neck dissection and post-operative radiotherapy: case report

Published online by Cambridge University Press:  15 August 2017

R Shodo ,
Y Sato ,
H Ota  and
A Horii
R Shodo*
Affiliation:
Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Y Sato
Affiliation:
Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
H Ota
Affiliation:
Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
A Horii
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
*
Address for correspondence: Dr Ryusuke Shodo, Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahi-machi, Chuo-ku, Niigata 951-8510, Japan. Fax: +81 25 227 0786 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Non-traumatic bone fractures in cancer patients are usually pathological fractures due to bone metastases. In head and neck cancer patients, clavicle stress fractures may occur as a result of atrophy of the trapezius muscle after neck dissection in which the accessory nerve becomes structurally or functionally damaged.

Case report:

A 71-year-old man underwent modified radical neck dissection with accessory nerve preservation and post-operative radiotherapy for submandibular lymph node metastases of tongue cancer. Four weeks after the radiotherapy, a clavicle fracture, with osteomyelitis and abscess formation in the pectoralis major muscle, occurred. Unlike in simple stress fracture, long-term antibiotic administration and drainage surgery were required to suppress the inflammation.

Conclusion:

As seen in the present patient, clavicle stress fractures may occur even after neck dissection in which the accessory nerve is preserved, and may be complicated by osteomyelitis and abscess formation owing to risk factors such as radiotherapy, tracheostomy and contiguous infection.

Keywords

ClavicleNeck DissectionOsteomyelitisRadiotherapyStress Fracture
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 11 , November 2017 , pp. 1026 - 1029
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Cummings, CW, First, R. Stress fracture of the clavicle after a radical neck dissection: case report. Plast Reconstr Surg 1975;55:366–7CrossRefGoogle ScholarPubMed
2 Ord, RA, Langdon, JD. Stress fracture of the clavicle. A rare late complication of radical neck dissection. J Maxillofac Surg 1986;14:281–4Google Scholar
3 Hao, SP, Chang, PT. Stress fracture of the clavicle after selective neck dissection. Otolaryngol Head Neck Surg 1998;118:732–3Google ScholarPubMed
4 Throckmorton, T, Kuhn, JE. Fractures of the medial end of the clavicle. J Shoulder Elbow Surg 2007;16:49–54 CrossRefGoogle ScholarPubMed
5 van der Meijden, OA, Gaskill, TR, Millett, P. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 2012;21:423–9CrossRefGoogle ScholarPubMed
6 Ferlito, A, Shaha, AR, Silver, CE, Rinaldo, A, Mondin, V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:202–7Google Scholar
7 Sobol, S, Jensen, C, Sawyer, W, Costiloe, P, Thong, N. Objective comparison of physical dysfunction after neck dissection. Am J Surg 1985;150:503–9Google Scholar
8 Gorman, JB, Stone, RT, Keats, TE. Changes in the sternoclavicular joint following radical neck dissection. Am J Roentgenol Radium Ther Nucl Med 1971;113:584–7Google Scholar
9 Cantlon, GE, Gluckman, JL. Sternoclavicular joint hypertrophy following radical neck dissection. Head Neck Surg 1983;5:218–21Google Scholar
10 Vu, TT, Yammine, NV, Al-Hakami, H, Hier, MP, Black, MJ. Sternoclavicular joint osteomyelitis following head and neck surgery. Laryngoscope 2010;120:920–3Google Scholar