Osteoradionecrosis of the hyoid bone: imaging findings.

BACKGROUND AND PURPOSE: ORN is a postradiation complication that has been well-documented in the medical literature. Most cases in the head and neck have been described in the mandible or larynx. Only a handful of cases in the hyoid bone are documented, all in the clinical literature. Our purpose is to present the clinical and imaging features of ORN involving the hyoid bone. MATERIALS AND METHODS: We present a case series of 13 patients with imaging findings highly suggestive of hyoid ORN after radiation therapy for head and neck cancers, in which we observed progressive features of hyoid disruption along with adjacent soft-tissue ulceration. RESULTS: Pretreatment imaging, when available, showed a normal hyoid. Typical postradiation imaging findings included an initial tongue base ulcerative lesion with air approaching the hyoid bone, and subsequent observation of hyoid fragmentation, often with intraosseous or peri-hyoid air and the absence of associated mass-like enhancement. CONCLUSIONS: Findings of hyoid fragmentation, cortical disruption, and soft tissue or intraosseous air in the postradiation therapy patient should strongly suggest the diagnosis of hyoid ORN. It is important recognize this entity because the diagnosis may preclude potentially harmful diagnostic intervention and allow more appropriate therapy.

[Treatment of laryngeal cancer: cordectomy or crico-hyoido-epiglottopexy versus radiotherapy]. / Traitement du cancer laryngé: cordectomie ou crico-hyoïdoépiglottopexie versus radiothérapie.

INTRODUCTION: Both radiotherapy and endoscopic or open functional surgery are recognised treatments for laryngeal cancer stage I and II. A comparison between two groups of patients treated with either modality may clarify the indications for both treatments. METHODS: Over a period of 13 years two separate series of patients were treated for laryngeal cancer (stage I and II) by either surgery (n = 72) or radiotherapy (n = 81). We have analysed and compared the two groups. RESULTS: Statistical analyses show a better local control among patients treated with surgery, when the anterior commissure was involved (p < 0.01) or with extension of the tumour (T2). However, long-term survivals were not significantly different in the two groups. As postradiation recurrence was diagnosed at an early stage, salvage (requiring total laryngectomy in many cases) was efficient but contributed to an appreciable difference in the long-term laryngeal preservation rate between the two groups (91% after radiotherapy and 99% after surgery). CONCLUSION: The treatment of laryngeal cancer must always compromise between oncological efficiency and functional preservation. With anterior commissure involvement (T1b) or more extensive disease (T2), surgery appears to be better. Therefore, preservation of perfect laryngeal function should be subordinate to oncological safety.

Osteoradionecrosis of the hyoid induced by combined modality therapy for laryngeal carcinoma.

Contemporary management of laryngeal carcinoma often incorporates multiple modalities of therapy. We report a case of osteoradionecrosis of the hyoid bone in a patient treated with surgery, chemotherapy, and radiation therapy for a supraglottic squamous cell carcinoma. A discussion regarding pathophysiology, radiation dosimetry and treatment options is also presented.