Head and Neck Imaging

Chondronecrosis, laryngeal

necrosis of the laryngeal cartilaginous framework, an uncommon complication of radiation treatment for laryngeal cancer. The CT appearance of laryngeal chondroradionecrosis is often nonspecific. The soft tissue changes and cartilage alterations observed in some patients can also be seen in cases of local tumour recurrence. Progressive crico-arytenoidal sclerosis with surrounding soft tissue swelling, anterior dislocation and possibly eventual sloughing of the arytenoid, can be signs of chondroradionecrosis. Patients with a large pretherapeutic tumour mass and/or tumour abutting or involving the thyroid cartilage are at higher risk of developing chondroradionecrosis; the occurrence of gas bubbles around the thyroid cartilage and fragmentation and collapse of the thyroid cartilage are suggestive of laryngeal chondroradionecrosis (Fig.1).

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Fig.1

a. Pretreatment CT study of a patient with a stage T3 glottic carcinoma. Thickening of right true vocal cord, extending into the subglottic region (arrows). Focal defect in right thyroid lamina (arrowheads) is suggestive of cartilage invasion. b. CT study obtained 3 months after completion of radiotherapy. Ulceration of the laryngeal soft tissues overlying the cartilage defect, with some progression of lysis (arrow). Thickening of the overlying extralaryngeal soft tissue. c. CT study obtained 8 months after radiotherapy. Progressive lysis of the thyroid cartilage which has collapsed. More endo- and prelaryngeal soft tissue thickening is apparent. Total laryngectomy revealed pyogenic granulomata and necrosis of ossifying cartilage (from: Hermans R., Pameijer F.A., Mancuso A.A., Parsons J.T., Mendenhall W.M.: CT findings in chondroradionecrosis of the larynx. AJNR Am J Neuroradiol 1998, 19; 711-718, with permission).
Chondronecrosis, laryngeal, Fig.1 (a)
Chondronecrosis, laryngeal, Fig.1 (b)
Chondronecrosis, laryngeal, Fig.1 (c)