[Subcutaneous and intramuscular heterotopic calcification of the neck 42 years after radiotherapy]. / Subcutan és intramuscularis heterotop kalcifikáció a nyakon 42 évvel a sugárkezelést követoen.

Radiotherapy-induced heterotopic tissue calcification is an exceedingly rare complication in the head and neck region. We report a patient with extensive, radiotherapy-induced, combined subcutaneous and intramuscular, heterotopic calcification of the neck. An 80-year-old male presented with a 2-month history of severe dysphagia and a painful ulcer on the neck 42 years after salvage total laryngectomy following radiotherapy (total dose: 80 Gy) for a T3N0M0 glottic squamous cell carcinoma. We excluded recurrence or secondary malignancy by biopsy and performed computed tomography, which revealed subcutaneous and intramuscular calcification in the area of the skin ulcer and close to the hypopharyngeal wall, moreover, total occlusion of the common carotid and vertebral arteries bilaterally. Surgical correction involved removing the calcified lesions and closure using fasciocutaneous flap transposition. The patient has been asymptomatic for the past 48 months. Radiotherapy plays an essential role in the treatment of patients with head and neck squamous cell carcinoma. Distorted postoperative anatomy, excessive scar formation, radiotherapy-induced fibrosis as well as skin and subcutaneous tissue calcification can present as atypical findings. Orv Hetil. 2023; 164(10): 383-387.

Testosterone Therapy for Dropped Head Syndrome: A Case Report.

ABSTRACT: Dropped head syndrome (DHS) is an impairment of neck extension resulting in a chin-on-chest deformity. DHS is rarely seen but a major hindrance to daily function in affected patients. DHS has been associated with movement disorders, neuromuscular disorders, and electrolyte and endocrine abnormalities. DHS has also been seen in survivors of Hodgkin lymphoma (HL) years after irradiation. HL survivors are also at risk for endocrine hypogonadism after chemotherapy. We present the case of a 58-year-old male HL survivor with dropped head and limited strength in his atrophic neck extensor muscles. Laboratory testing and imaging, nerve conduction studies, electromyography, and muscle biopsy of the neck extensors revealed myopathic and neurogenic changes. Conservative management was unsuccessful. With a desire to avoid surgical fixation, he asked his primary care physician to check his testosterone levels, which returned as low normal. Within 4 months of starting testosterone therapy, he no longer experienced dropped head.

Cytokine and Growth Factor Response in a Rat Model of Radiation Induced Injury to the Submental Muscles.

Submental muscles (i.e., mylohyoid and geniohyoid) play a vital role during swallowing, protecting the airway from ingested material. To design therapies to reduce the functional deficits associated with radiation treatment relies in part on our understanding of the changes in the cytokine and growth factor response that can impact muscle function. The purpose of this study is to quantify changes in the inflammatory, pro-fibrotic, and pro-angiogenic factors following 48 Gy of fractionated radiation to the mylohyoid muscle. We hypothesized that (1) irradiation will provoke increases in TGF-1ß and MMP-2 mRNA in the mylohyoid muscle; and (2) muscles surrounding the target location (i.e., geniohyoid and digastric muscles) will exhibit similar alterations in their gene expression profiles. Rats were exposed to 6 fractions of 8 Gy using a 6 MeV electron beam on a clinical linear accelerator. The highest dose curve was focused at the mylohyoid muscle. After 2- and 4-weeks post-radiation, the mylohyoid, geniohyoid, and digastric muscles were harvested. Expression of TNF-α, IFNγ, IL-1ß, IL-6, TGF-1ß, VEGF, MMP-2, and MMP-9 mRNA was analyzed via PCR and/or RT-PCR. TGF-1ß, MMP-2, and IL-6 expression was upregulated in the irradiated mylohyoid compared to non-irradiated controls. No notable changes in TNF-α, IFNγ, and IL-1ß mRNA expression were observed in irradiated muscles. Differing expression profiles were found in the surrounding muscles post-radiation. Results demonstrated that irradiation provokes molecular signals involved in the regulation of wound healing, which could lead to fibrosis or atrophy in the swallowing muscle after radiation.

Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma.

Dropped head syndrome (DHS) is a rare condition, characterised by weakness of the cervical paraspinal muscles with sagging of the head. It is usually seen in association with neurological disorders and rarely can follow radiotherapy. We report a case of a 54-year-old man survivor of Hodgkin lymphoma (HL), who developed DHS 28 years after radiotherapy. He was referred to our department due to progressive weakness and atrophy of cervical paraspinal and shoulder girdle musculature. Physical and neurophysiological examination, electromyography and MRI confirmed the diagnosis of DHS. In the following years, there was no progression of symptoms.

[A survivor of Hodgkin lymphoma manifesting dropped head syndrome as a late-onset complication of radiotherapy: a case report].

We report the case of a 50-year-old female survivor of Hodgkin lymphoma (HL), who developed dropped head syndrome (DHS). The patient was diagnosed with HL at 20 years of age, and underwent chemo-radiotherapy, which led to complete remission. Undergoing supplemental therapy for post-radiation hypothyroidism, she had twin babies. She noticed white stains on her neck at the age of 30, and the decolored area gradually expanded. Sixteen years after the radiotherapy (RT), her posterior neck muscle strength began to decline. She had to make considerable efforts to keep her neck straight, and came to experience a severe pain in the neck and shoulders. The patient visited our department due to DHS at the age of 50. She had leukoderma, muscle weakness, and muscle atrophy in the neck and para-spinal region, which were consistent with the area of RT. The strength was preserved in the other parts of the muscle, including the proximal upper limbs. Sensory nerve disorder was not detected. The serum creatine kinase level was slightly elevated. Cervical spine or cervical cord disease that can cause DHS was not detected by MRI examination. The MRI and CT images revealed marked atrophy in the posterior neck and para-spinal muscles. The electromyogram revealed myopathic changes, and the cause of her DHS was diagnosed as radiation-induced myopathy. DHS is a well-known late-onset radiation injury, and Japanese cases have been reported in elderly persons with laryngeal or lung cancer. However, there have been no Japanese case reports of radiation-induced DHS due to RT against HL in younger persons. The patient had visited several clinics and hospitals before she came to our hospital, but RT-induced DHS had been overlooked. Greater recognition and consideration is required for DHS as one of the various issues arising after long passage of HL survivors.

Low-level laser therapy (LLLT) accelerates the sternomastoid muscle regeneration process after myonecrosis due to bupivacaine.

BACKGROUND: Because of its long-lasting analgesic action, bupivacaine is an anesthetic used for peripheral nerve block and relief of postoperative pain. Muscle degeneration and neurotoxicity are its main limitations. There is strong evidence that low-level laser therapy (LLLT) assists in muscle and nerve repair. The authors evaluated the effects of a Gallium Arsenide laser (GaAs), on the regeneration of muscle fibers of the sternomastoid muscle and accessory nerve after injection of bupivacaine. METHODS: In total, 30 Wistar adult rats were divided into 2 groups: control group (C: n=15) and laser group (L: n=15). The groups were subdivided by antimere, with 0.5% bupivacaine injected on the right and 0.9% sodium chloride on the left. LLLT (GaAs 904nm, 0,05W, 2.8J per point) was administered for 5 consecutive days, starting 24h after injection of the solutions. Seven days after the trial period, blood samples were collected for determination of creatine kinase (CK). The sternomastoid nerve was removed for morphological and morphometric analyses; the surface portion of the sternomastoid muscle was used for histopathological and ultrastructural analyses. Muscle CK and TNFα protein levels were measured. RESULTS: The anesthetic promoted myonecrosis and increased muscle CK without neurotoxic effects. The LLLT reduced myonecrosis, characterized by a decrease in muscle CK levels, inflammation, necrosis, and atrophy, as well as the number of central nuclei in the muscle fibers and the percentage of collagen. TNFα values remained constant. CONCLUSIONS: LLLT, at the dose used, reduced fibrosis and myonecrosis in the sternomastoid muscle triggered by bupivacaine, accelerating the muscle regeneration process.

Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers

BACKGROUND: 18F-fluoro-2-deoxy-D-glucose (18F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. MATERIAL AND METHODS: 18F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. RESULTS: According to the extent of ND of cervical lymph nodes, the rate of patients with 18F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. CONCLUSIONS: In evaluating 18F-FDG accumulations after ND for oral cancers, we should pay attention to the 18F-FDG distributions in neck-related muscles including the non-surgical side as false-positive findings

Comparison of organ-at-risk sparing and plan robustness for spot-scanning proton therapy and volumetric modulated arc photon therapy in head-and-neck cancer.

PURPOSE: Proton radiotherapy for head-and-neck cancer (HNC) aims to improve organ-at-risk (OAR) sparing over photon radiotherapy. However, it may be less robust for setup and range uncertainties. The authors investigated OAR sparing and plan robustness for spot-scanning proton planning techniques and compared these with volumetric modulated arc therapy (VMAT) photon plans. METHODS: Ten HNC patients were replanned using two arc VMAT (RapidArc) and spot-scanning proton techniques. OARs to be spared included the contra- and ipsilateral parotid and submandibular glands and individual swallowing muscles. Proton plans were made using Multifield Optimization (MFO, using three, five, and seven fields) and Single-field Optimization (SFO, using three fields). OAR sparing was evaluated using mean dose to composite salivary glands (CompSal) and composite swallowing muscles (CompSwal). Plan robustness was determined for setup and range uncertainties (±3 mm for setup, ±3% HU) evaluating V95% and V107% for clinical target volumes. RESULTS: Averaged over all patients CompSal/CompSwal mean doses were lower for the three-field MFO plans (14.6/16.4 Gy) compared to the three-field SFO plans (20.0/23.7 Gy) and VMAT plans (23.0/25.3 Gy). Using more than three fields resulted in differences in OAR sparing of less than 1.5 Gy between plans. SFO plans were significantly more robust than MFO plans. VMAT plans were the most robust. CONCLUSIONS: MFO plans had improved OAR sparing but were less robust than SFO and VMAT plans, while SFO plans were more robust than MFO plans but resulted in less OAR sparing. Robustness of the MFO plans did not increase with more fields.

Radiation-induced camptocormia and dropped head syndrome: Review and case report of radiation-induced movement disorders.

BACKGROUND: In recent years, camptocormia and dropped head syndrome (DHS) have gained attention as particular forms of movement disorders. Camptocormia presents with involuntary forward flexion of the thoracolumbar spine that typically increases during walking or standing and may severely impede walking ability. DHS is characterized by weakness of the neck extensors and a consecutive inability to extend the neck; in severe cases the head is fixed in a "chin to chest position." Many diseases may underlie these conditions, and there have been some reports about radiation-induced camptocormia and DHS. METHODS: A PubMed search with the keywords "camptocormia," "dropped head syndrome," "radiation-induced myopathy," "radiation-induced neuropathy," and "radiation-induced movement disorder" was carried out to better characterize radiation-induced movement disorders and the radiation techniques involved. In addition, the case of a patient developing camptocormia 23 years after radiation therapy of a non-Hodgkin's lymphoma of the abdomen is described. RESULTS: In total, nine case series of radiation-induced DHS (n = 45 patients) and-including our case-three case reports (n = 3 patients) about radiogenic camptocormia were retrieved. Most cases (40/45 patients) occurred less than 15 years after radiotherapy involving extended fields for Hodgkin's disease. CONCLUSION: The use of wide radiation fields including many spinal segments with paraspinal muscles may lead to radiation-induced movement disorders. If paraspinal muscles and the thoracolumbar spine are involved, the clinical presentation can be that of camptocormia. DHS may result if there is involvement of the cervical spine. To prevent these disorders, sparing of the spine and paraspinal muscles is desirable.

Organ sparing and clinical outcome with step-and-shoot IMRT for head and neck cancer: a mono-institutional experience.

PURPOSE: Intensity-modulated radiotherapy has been suggested as the technique of choice for locally advanced head and neck cancer patients. In the last decade, most radiotherapy departments have focused their efforts in programs to implement this technique. We report our experience for parotid gland and constrictor muscle sparing with intensity-modulated radiotherapy in head and neck cancer using a step-and-shoot technique. METHODS: Thirty-four consecutive patients with squamous cell carcinoma of the nasopharynx, oropharynx and larynx treated between June 2008 and June 2011 were retrospectively evaluated. A simultaneous integrated boost was adopted to treat different volumes in 30 fractions over 6 weeks. Priority as organs at risk was given to the parotid glands as well as the constrictor muscle of the pharynx in 53 % (n = 18). Dysphagia and xerostomia were evaluated according to RTOG/EORTC scale at 6, 12 and 24 months. Outcomes were analysed using Kaplan-Meier curves. RESULTS: The median follow-up was 43 months. The 5-year overall survival was 70 %, and local control was 94 %. Grade 2 dysphagia and xerostomia at 6, 12 and 24 months were as follows: 26 % (n = 9), 23 % (n = 8), 23 % (n = 8) and 21 % (n = 7), 12 % (n = 4), 12 % (n = 4), respectively. No grade 3 or 4 toxicity was found. Ordinal logistic regression analysis demonstrated that hyposalivation was the main predictive factor for late dysphagia. CONCLUSION: Excellent loco-regional results were achieved with acceptable acute and late toxicities. The low rate of late dysphagia was related to parotid gland sparing; we did not observe a correlation between late dysphagia and dose to pharyngeal constrictors.

Dose reduction in orthodontic lateral cephalography: dosimetric evaluation of a novel cephalographic thyroid protector (CTP) and anatomical cranial collimation (ACC).

OBJECTIVES: To test the dose-reducing capabilities of a novel thyroid protection device and a recently introduced cranial collimator to be used in orthodontic lateral cephalography. METHODS: Cephalographic thyroid protector (CTP) was designed to shield the thyroid while leaving the cervical vertebrae depicted. Using a RANDO(®) head phantom (The Phantom Laboratory, Salem, NY) equipped with dosemeters and a Proline XC (Planmeca, Helsinki, Finland) cephalograph, lateral cephalograms were taken, and the effective dose (ED) was calculated for four protocols: (1) without shielding; (2) with CTP; (3) with CTP and anatomical cranial collimator (ACC); and (4) with a thyroid collar (TC). RESULTS: The ED for the respective protocols was (1) 8.51; (2) 5.39; (3) 3.50; and (4) 4.97 µSv. The organ dose for the thyroid was reduced from 30.17 to 4.50 µSv in Protocols 2 and 3 and to 3.33 µSv in Protocol 4. CONCLUSIONS: The use of just the CTP (Protocol 2) resulted in a 36.8% reduction of the ED of a lateral cephalogram. This was comparable to the classical TC (Protocol 4). A 58.8% reduction of the ED was obtained when combining CTP and ACC (Protocol 3). The dose to the radiosensitive thyroid gland was reduced by 85% in Protocols 2 and 3 and by 89% in Protocol 4.

Neck spasm after chemoradiotherapy for head and neck cancer: natural history and dosimetric correlates.

BACKGROUND: Little is known about the determinants of postradiation neck spasms in patients with head and neck cancer. METHODS: Patients with head and neck cancer treated with radiation therapy (RT) from 2004 to 2010 who experienced neck spasms werereviewed. Radiation doses were generated for their sternocleidomastoid (SCM) muscles bilaterally. Unaffected SCMs were used as controls. RESULTS: Thirty-four patients reported neck spasms. Thirty had received definitive chemoradiation, and 4 had RT alone. Seven also had an ipsilateral neck dissection. Median time to onset was 23 months (range, 6-67 months). There were significantly higher radiation doses to the affected SCMs with a median of the mean dose to the affected and unaffected SCM of 62.3 Gy (range, 29-71 Gy) and 53.7 Gy (range, 27-65 Gy), respectively (p < .0001). Other dosimetric variables were also statistically significant but were highly correlated with the mean SCM dose. Neck dissection did not affect our results. CONCLUSION: Neck spasms after chemotherapy intensity-modulated radiation therapy (IMRT) shows a strong dose-response relationship.

Dosimetry of a cone-beam computed tomography machine compared with a digital x-ray machine in orthodontic imaging.

INTRODUCTION: Cone-beam computed tomography (CBCT) has become a routine imaging modality for many orthodontic clinics. However, questions remain about the amount of radiation patients are exposed to during the scans. This study determined the amounts of radiation potentially absorbed by a patient during orthodontic imaging with a CBCT machine with various scan settings compared with a conventional 2-dimensional digital x-ray machine. METHODS: The radiation exposures delivered by a next generation i-CAT CBCT machine (Imaging Sciences International, Hatfield, Pa) at various scan settings and orthopantomograph OP100/OC100 digital x-ray machine (Instrumentarium Dental, Tuusula, Finland) during panoramic and cephalometric radiography were recorded using thermoluminescent dosimeters placed inside a head and neck phantom. The manufacturer-recommended settings for an average adult male were used for both types of machines. Effective doses were calculated using the tissue-weighting factors recommended by the 2007 International Commission on Radiological Protection. RESULTS: The effective doses at various voxel sizes and field of view settings ranged from 64.7 to 69.2 µSv for standard resolution CBCT scans (scan time 8.9 s) and 127.3 to 131.3 µSv for high resolution full field of view scans (scan time 17.8 s), and measured 134.2 µSv for a high-resolution landscape scan with a voxel size as would be used for SureSmile (OraMetrix, Richardson, Tex) therapy (scan time 26.9 s). The effective doses for digital panoramic and lateral cephalometric radiographs measured 21.5 and 4.5 µSv, respectively. CONCLUSIONS: CBCT, although providing additional diagnostic and therapeutic benefits, also exposes patients to higher levels of radiation than conventional digital radiography.

Progressive muscle atrophy and weakness after treatment by mantle field radiotherapy in Hodgkin lymphoma survivors.

PURPOSE: To describe the damage to the muscles and propose a pathophysiologic mechanism for muscle atrophy and weakness after mantle field radiotherapy in Hodgkin lymphoma (HL) survivors. METHODS AND MATERIALS: We examined 12 patients treated by mantle field radiotherapy between 1969 and 1998. Besides evaluation of their symptoms, the following tests were performed: dynamometry; ultrasound of the sternocleidomastoid, biceps, and antebrachial flexor muscles; and needle electromyography of the neck, deltoid, and ultrasonographically affected arm muscles. RESULTS: Ten patients (83%) experienced neck complaints, mostly pain and muscle weakness. On clinical examination, neck flexors were more often affected than neck extensors. On ultrasound, the sternocleidomastoid was severely atrophic in 8 patients, but abnormal echo intensity was seen in only 3 patients. Electromyography of the neck muscles showed mostly myogenic changes, whereas the deltoid, biceps, and antebrachial flexor muscles seemed to have mostly neurogenic damage. CONCLUSIONS: Many patients previously treated by mantle field radiotherapy develop severe atrophy and weakness of the neck muscles. Neck muscles within the radiation field show mostly myogenic damage, and muscles outside the mantle field show mostly neurogenic damage. The discrepancy between echo intensity and atrophy suggests that muscle damage is most likely caused by an extrinsic factor such as progressive microvascular fibrosis. This is also presumed to cause damage to nerves within the radiated field, resulting in neurogenic damage of the deltoid and arm muscles.

Primary amyloidosis presenting as "dropped head syndrome".

A 77-year-old man, with a history of lymphoma, presented with isolated neck extensor weakness and a 2-year history of bilateral carpal tunnel syndrome (CTS). Needle electromyography showed myopathic changes, and biopsy of cervical paraspinal muscles showed amyloid deposition in blood vessels. Amyloidosis should be considered in the differential diagnosis of dropped head syndrome.

Volumetric change of selected organs at risk during IMRT for oropharyngeal cancer.

PURPOSE: To assess volumetric changes of selected organs at risk (OAR) during intensity-modulated radiotherapy (IMRT) for oropharyngeal carcinoma. MATERIALS AND METHODS: Twenty-six consecutive patients that were treated with definitive IMRT ± chemotherapy between November 2007 and November 2008 were selected for the present study. As part of an internal quality assurances program, a repeat kilovolt (KV) computed tomography was planned weekly during the 7-week treatment course. On each available scan, a single observer contoured the parotid submandibular, and thyroid glands (PG/SMG/TG), larynx (L), and constrictor, masticatory, and sternocleidomastoid muscles (CM/MM/SCM) as appropriate. The volume at each scan was compared with the one at planning CT in a pair-wise fashion. p values <0.05 after correction for multiple testing were considered significant. RESULTS: A total of 159 scans was obtained during treatment for a total of 185 scans, including the baseline imaging. All OARs showed statistically significant changes over baseline by week 5. At week 7, the PG showed the largest absolute change with an average reduction of ∼10 mL followed by both the SCM and MM (∼-5 mL). The largest (∼-30%) relative change was observed for the salivary glands. L and CM showed a ∼15% increase in volume during treatment. CONCLUSION: All selected OAR undergo significant volumetric changes during a course of IMRT for oropharyngeal squamous cell carcinoma.

Late-onset cervicoscapular muscle atrophy and weakness after radiotherapy for Hodgkin disease: a case series.

Patients with cervical or mediastinal Hodgkin disease (HD) classically underwent chemotherapy plus extended-field radiation therapy. We report six patients who gradually developed severe atrophy and weakness of cervical paraspinal and shoulder girdle muscles 5-30 years after mantle irradiation for HD. Although clinical presentation was uniform, including a dropped head syndrome, electrophysiological and pathological findings were rather heterogeneous. Either neurogenic or myogenic processes may be involved and sometimes combined. We discuss the pathophysiological mechanisms underlying these cervicoscapular motor complications of mantle irradiation in HD.

Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationships: MRI-based study.

PURPOSE: Dysfunction of pharyngeal constrictors (PCs) after chemo-irradiation of head and neck (HN) cancer has been proposed as major cause of dysphagia. We conducted prospective MRI study to evaluate anatomical changes in the PCs after chemo-irradiation, to gain insight of the mechanism of their dysfunction and their dose-effect relationships. The PCs were compared to the sternocleidomastoid muscles (SCMs), which receive high doses but do not relate to swallowing. PATIENTS AND METHODS: Twelve patients with stage III-IV HN cancer underwent MRI before and 3 months after completing chemo-irradiation. T1- and T2-weighted signals and muscle thickness were evaluated for PCs (superior, middle, and inferior), and SCMs. Mean muscle doses were determined after registration with the planning CT. RESULTS: T1-weighted signals decreased in both PCs and SCMs receiving >50 Gy (p<0.03), but not in muscles receiving lower doses. T2-weighted signals in the PCs increased significantly as the dose increased (R(2)=0.34, p=0.01). The T2 signal changes in the PCs were significantly higher than the T2 changes in the SCMs (p<0.001). Increased thickness was noted in all PCs, with muscles receiving >50 Gy gaining significantly more thickness than PCs receiving lesser doses (p=0.02). In contrast, the SCM thickness decreased post-therapy (p=0.002). CONCLUSIONS: These MRI-based findings, notably the differences between PCs and SCMs, suggest that underlying causes of PC dysfunction are inflammation and edema, likely consequential to acute mucositis affecting the submucosa-lying PCs. These results support reducing mean PC doses to 50 Gy, as well as reducing acute mucositis, to improve long-term dysphagia.

Late appearance of dropped head syndrome after radiotherapy for Hodgkin's disease.

We present three cases of dropped head syndrome that occurred as a complication of mantle field (i.e., lymph nodes of the neck, axillae, and mediastinum) or whole-body radiation therapy for Hodgkin's disease. These cases are characterized by a late onset (2-27 years after radiation treatment), fibrosis, and contraction of the anterior cervical muscles, and atrophy of the posterior neck and shoulder girdle. This report adds to the increasing literature about the late neurological complications of radiation therapy and describes a previously unrecognized cause of dropped head syndrome.

Head and neck muscle spasm after radiotherapy: management with botulinum toxin A injection.

OBJECTIVE: To introduce the concept of neck muscle pain and spasm after radiotherapy and its treatment with botulinum toxin A. DESIGN: Case series. SETTING: Ambulatory patients at a tertiary care medical center. PATIENTS: Individuals who had undergone primary or adjuvant radiotherapy for treatment of carcinoma of the head and neck were asked about painful spasms of the neck musculature. A volunteer sample was used. If they desired treatment with botulinum toxin A, they were included in the study. INTERVENTION: Patients received botulinum toxin A injections to the affected sternocleidomastoid muscle(s) in 1 or 2 locations. OUTCOME MEASURE: Subjective pain relief. RESULTS: Four of 6 patients with painful tightness of the neck who received botulinum toxin A injections to the sternocleidomastoid muscle achieved pain relief. CONCLUSIONS: A subset of patients with irradiation-induced cervical muscle spasm benefit from treatment with botulinum toxin A injections. Further study is needed to more clearly define the entity and treatment.