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Failed septal extension graft in a patient with a history of radiotherapy

  • Kang, Il Gyu (Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Gachon University of Medicine and Science, Gil Medical Center) ;
  • Kim, Seon Tae (Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Gachon University of Medicine and Science, Gil Medical Center) ;
  • Lee, Seok Ho (Department of Radiation Oncology, Graduate School of Medicine, Gachon University of Medicine and Science, Gil Medical Center) ;
  • Baek, Min Kwan (Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Gachon University of Medicine and Science, Gil Medical Center)
  • Received : 2016.07.22
  • Accepted : 2016.09.22
  • Published : 2016.12.31

Abstract

Background: This report describes the authors' experience of "melting" septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. Methods: Electronic medical records were used to obtain details of the patient's clinical history. Results: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). Conclusions: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

Keywords

References

  1. Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64:379-390 https://doi.org/10.1016/0030-4220(87)90136-8
  2. Lederman M (1972) Radiation therapy in cancer of the larynx. JAMA 221:1253-1254 https://doi.org/10.1001/jama.1972.03200240033009
  3. Jh E (2012) Radiology for the radiologist. Lippincott Williams & Wilkins, Philadelphia
  4. Keene M, Harwood AR, Bryce DP, van Nostrand AW (1982) Histopathological study of radionecrosis in laryngeal carcinoma. Laryngoscope 92:173-180 https://doi.org/10.1002/lary.1982.92.2.173
  5. Alves RV, Brandao FH, Aquino JE, Carvalho MR, Giancoli SM, Younes EA (2005) Intradermal melanocytic nevus of the external auditory canal. Braz J Otorhinolaryngol 71:104-106 https://doi.org/10.1016/S1808-8694(15)31295-7
  6. Alexander FW (1963) Micropathology of radiation reaction in the larynx. Ann Otol Rhinol Laryngol 72:831-841 https://doi.org/10.1177/000348946307200316
  7. Hugenberg ST, Myers SL, Brandt KD (1989) Suppression of glycosaminoglycan synthesis by articular cartilage, but not of hyaluronic acid synthesis by synovium, after exposure to radiation. Arthritis Rheum 32:468-474 https://doi.org/10.1002/anr.1780320417
  8. Willey JS, Long DL, Vanderman KS, Loeser RF (2013) Ionizing radiation causes active degradation and reduces matrix synthesis in articular cartilage. Int J Radiat Biol 89:268-277 https://doi.org/10.3109/09553002.2013.747015
  9. Ailland J, Kampen WU, Schunke M, Trentmann J, Kurz B (2003) Beta irradiation decreases collagen type II synthesis and increases nitric oxide production and cell death in articular chondrocytes. Ann Rheum Dis 62:1054-1060 https://doi.org/10.1136/ard.62.11.1054
  10. Lindburg CA, Willey JS, Dean D (2013) Effects of low dose X-ray irradiation on porcine articular cartilage explants. J Orthop Res 31:1780-1785