Article Figures & Data
Figures
- Fig 1.
Patient 4. A 64-year-old man radiated for squamous cell carcinoma of the left lateral oropharyngeal wall. A, CT examination with contrast obtained before radiation therapy shows the lower aspect of the lesion in the vallecula, lying adjacent to the hyoid bone (arrow). There is a nodal metastasis in the left neck (arrowhead), also adjacent to the hyoid. B and C, Axial contrast-enhanced CT images obtained 5 months following treatment with 70 Gy show a defect in the lateral pharyngeal wall (arrow, B) and an exposed piece of hyoid (arrow in C). At this time, the hyoid was otherwise intact. D, CT bone window on follow-up imaging shows a missing resorbed hyoid.
- Fig 2.
Patient 10. A 67-year-old man after radiation therapy at an outside hospital for base-of-tongue cancer. A and B, Axial contrast-enhanced CT scans show an air-filled soft-tissue defect in the left posterior tongue (arrow, A). Lower down, this communicates with the hyoid (B). There is an unrelated nodal recurrence in the right neck (arrowhead, A). B, Soft-tissue CT image more inferiorly shows air (arrowheads) and fluid (arrows) surrounding the hyoid. C, CT bone window shows intraosseous air (arrowheads) and a hyoid fracture (arrow).
- Fig 3.
Patient 9. A 70-year-old man previously radiated for base-of-tongue carcinoma and subsequently re-irradiated for neck recurrence. A, Contrast-enhanced CT examination 6 months after the completion of the second course of radiation demonstrates an air-filled necrotic cavity in the tongue base without surrounding enhancement (arrow). B, CT image more inferiorly shows that the cavity contains fluid and internal air bubbles (arrow, B) and is in close contact with the hyoid. The hyoid was reported as being at risk for ORN. C, CT bone window obtained 2 months after B reveals that the hyoid is now fragmented (arrow).
- Fig 4.
Patient 3. A 66-year-old man status post 60 Gy for treatment of metastatic squamous cell carcinoma to the left neck, primary unknown, who subsequently developed a primary malignancy in the right oropharyngeal wall, for which an additional dose of 50.2 Gy was administered. A, CT bone window before XRT shows an intact hyoid. B and C, Contrast-enhanced CT, soft-tissue and bone windows, respectively, 5 months following completion of the second course of XRT. There is an enhancing process surrounding the right side of the hyoid (arrows, B) and an exposed fragment of hyoid surrounded by air (arrowhead, B and C). Hyoid fractures can be seen (arrow in C). D, Contrast-enhanced CT image 5 months after B and C shows dramatically increased enhancement extending to the left of midline (arrows). Because of these findings and relentless aspiration, a total laryngectomy was performed; at histologic examination, there was only necrosis and inflammation.
- Fig 5.
Patient 1. A 67-year-old man, 34 months following an unknown dose of XRT at an outside facility for treatment of squamous cell carcinoma of the tongue base. A, Axial bone window CT scan shows typical fragmentation and intraosseous air characteristic of hyoid ORN. B, PET/CT, obtained concurrent to A, demonstrates intense focal FDG uptake (SUV=7.5), which was regarded as suspicious for tumor. The patient was offered hyoidectomy but refused, and his symptoms of dysphagia and odynophagia gradually improved with hyperbaric O2 during the follow-up period of 14 months, after which the patient was lost to follow-up.
Tables
Summary of patients with hyoid ORN
No. Age/Sex Dose (Gy) Primary Adjacent to Hyoid Post-XRT ORN DX (mo) Preceding Soft-Tissue Ulceration Adjacent Enhancement Post-ORN Follow-Up (mo) 1 67/M OSH-N/A – 34 No Yes 12 2 46/M 71 Yes 5 No No 6 3 66/Ma 60, 50.2 No 2 No Yes 23 4 64/M 70.0 Yes 5 Yes No 30 5 45/M 66.8 Yes 5.5 Yes No 1 6 64/M 70.6 Yes 13 No No 16 7 54/M 70.1 Yes 8 No No 7 8 49/M 71.6 Yes 26 No No 16 9 70/M 60, 20 – 6 No No 14 10 67/M OSH-N/A – 1 No No 21 11 47/M OSH-N/A – 32 Yes Yes 7 12 67/M 41, 63 Yes 10 Yes Yes 2 13 61/M 50, 60 – 17 Yes Yes 4 -
a Patient was originally radiated for metastasis to the neck (60 Gy), primary unknown, and subsequently re-irradiated (50.2 Gy) for a pharyngeal wall squamous cell carcinoma.
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