Clavicular osteomyelitis: a rare complication of head and neck cancer surgery.
BACKGROUND
We report the 10th case in the English-language literature describing clavicular osteomyelitis that presented after radical treatment for laryngeal carcinoma and discuss the pertinent diagnostic and therapeutic measures. It presented a diagnostic dilemma. The differential diagnosis included tumor recurrence, metastatic bone disease, and postradiotherapy complications.


RESULTS
A 45-year-old man who was a heavy smoker and known drug abuser presented with acute airway compromise and was diagnosed with squamous cell carcinoma involving the glottis and subglottis. Total laryngectomy, total thyroidectomy, and bilateral neck dissection were performed, and the patient underwent chemoradiotherapy. On follow-up 1 year later, the patient was seen with left stomal dehiscence and a large area of cellulitis extending across the left clavicle and down to the axilla. At surgery, a large anterior chest wall abscess was found. Biopsy showed no evidence of tumor. After aggressive treatment, the patient remains disease free.


CONCLUSIONS
This condition is rarely encountered after major head and neck surgery. Aggressive surgical debridement and antibiotic therapy remains the mainstay of treatment. Prompt diagnosis and treatment are mandatory due to the potential life-threatening complications associated with the condition. Bony resection will aid in adequate flap placement.
Burns
Paul
P
Department of Otalaryngology-Head and Neck Surgery, St. James's Hospital, Dublin, Ireland. pauljburns@eircom.net
Sheahan
Patrick
P
Doody
Jaime
J
Kinsella
John
J
D002294:Carcinoma, Squamous Cell / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002968:Clavicle / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000175:diagnosis*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000628:therapy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010019:Osteomyelitis / Q000209:etiology*; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D013203:Staphylococcal Infections / Q000175:diagnosis; D054047:Surgical Stomas; D013529:Surgical Wound Dehiscence / Q000382:microbiology / Q000601:surgery; D013965:Thyroidectomy