A case of laryngeal radionecrosis caused by nasogastric tube intubation

Abstract

It has been reported that long-term intubation of a nasogastric tube （NGT） might cause laryngeal necrosis. We report a case of laryngeal radionecrosis caused by NGT during chemoradiotherapy for hypopharyngeal carcinoma. A 71-year-old male received chemoradiotherapy for hypopharyngeal and esophageal carcinoma, and NGT insertion became necessary due to severe mucositis. Thereafter, the mucositis remained, resulting in hypopharyngeal mucosal ulcer along the run of the NGT. The tube was removed and the ulcer showed a tendency to recover, but bilateral vocal cord fixation was confirmed, resulting in the diagnosis of laryngeal necrosis. Total laryngo-pharyngectomy was performed, and the permanent specimen showed no evidence of malignancy but only necrosis. It was thought that severe mucositis and long-term intubation of NGT induced the onset of necrosis. We consider that percutaneous gastrostomy should be performed before radiation of the head and neck in cases of extensive irradiation range because such patients will need nutrition support due to poor oral intake.