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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: ryusuke.s.0415@gmail.com
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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 

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