PMC7217670_01
Post-tracheotomy, post-intubation, and post-dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma.
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He had medical histories of tracheotomy with intubation and dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma (Fig. 1).
Sagittal plane of CT scan before treatment (A). Sagittal T2-weighted MRI before treatment (B). These images show bone erosion of C2-C3 vertebrae (A) and cervical epidural abscess at the C2-C3 levels (B).
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Laboratory tests revealed an elevated inflammatory response, and computed tomography (CT) of the cervical spine demonstrated bone erosion in C2-C4 vertebrae (Fig. 2A). Subsequent T2-weighted magnetic resonance imaging revealed a high signal intensity lesion (Fig. 2B), indicating an abscess in C2-C4.
Transoral mandibular tongue-splitting approach. Median mandibular splitting, median longitudinal incision of the tongue, partial resection of eroded lesion of C2-C3 vertebrae, debridement of the abscess, suturing tongue, and titanium plate fixation of the mandible were performed.
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Transoral mandibular tongue splitting (Fig. 3) was achieved by an otolaryngologist and an oral surgeon.
Postoperative images. (A) Sagittal plane of CT scan. (B) Lateral radiograph.
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One week after the first operation (Fig. 4A), the patient underwent posterior occipitocervical arthrodesis (Oc-C4) with instrumentation (Synthes GmbH., Eimattstrasse, Oberdorf, Switzerland) (Fig. 4B).