Complications Of Head And Neck Radiation – Beyond The Difficult Airway

Proposal Number:

MCC-7134 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Kathleen Cervo  
Stony Brook University Hospital

Co-Author:

Deborah C Richman  
Stony Brook University Medical Center

Abstract:

A 65 year old gentleman presented for preoperative evaluation for elective repair of symptomatic right inguinal hernia. Medical history was significant for tongue cancer treated in 2011 with chemotherapy and radiation. Possible airway difficulty from radiation effects was considered. During the past four years, he experienced progressively worsening dysphagia with a decline in physical function secondary to nutritional deficiency. Eventually, he required gastrostomy and became fully dependent on tube feeds. His dysphagia had progressed to chronic aspiration of secretions while speaking and with feeds. He coughs frequently to clear secretions and developed recurrent aspiration pneumonia. He now has exertional dyspnea and requires nocturnal oxygen supplementation. In addition to fibrosis, neck stiffness and upper extremity neuropathy, he also experiences labile blood pressure secondary to radiation-induced baroreflex failure. He does not have carotid bruits. We will present the perioperative management of the various sequelae of external beam radiation to the neck region.

Learning Objectives
1 .Review anatomic and functional changes of radiation-induced fibrosis
2. Understand radiation-induced baroreflex failure
3. Discuss preoperative optimization in patients with chronic dysphagia and aspiration

Professional Category:

Resident/Trainee

Keywords:

Educational
General

Enter up to two references.

  Reference
1. Sharabi Y, Dendi R, Holmes C, Goldstein D. Baroreflex failure as a late sequela of neck irradiation. Hypertension. 2003; 42(1):110-6.
2. Rosenthal D, Lewis J, Eisbruch A. Prevention and Treatment of Dysphagia and Aspiration After Chemoradiation for Head and Neck Cancer. J Clin Oncol. 2006; 24(17):2636-43