Medial clavicle fracture with bone destruction after radical neck dissection combined with postoperative chemotherapy for secondary cervical lymph node metastasis of tongue cancer: a case report

• Published in: Oral radiology Vol. 37; no. 4; pp. 708 - 712
• Main Authors: Tashiro, Masayasu, Sano, Tomoaki, Sugiura, Kazutaka, Minamida, Yasuhito, Abiko, Yoshihiro, Nagayasu, Hiroki, Nakayama, Eiji
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.10.2021; Springer Nature B.V
• Subjects: Aged, 80 and over; Cancer; Case Report; Case reports; Chemotherapy; Clavicle; Clavicle - diagnostic imaging; Computed tomography; Dentistry; Dissection; Fractures; Head & neck cancer; Humans; Imaging; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Male; Medical diagnosis; Medicine; Metastases; Metastasis; Muscles; Myotonia; Neck; Neck Dissection; Oral and Maxillofacial Surgery; Oral cancer; Oral carcinoma; Radiation therapy; Radiology; Tongue; Tongue Neoplasms - diagnostic imaging; Tongue Neoplasms - drug therapy; Tongue Neoplasms - surgery; Trauma; Radical neck dissection; Diagnostic imaging; Oral cancer; Clavicle fracture
• DOI: 10.1007/s11282-021-00515-9
• ISSN: 0911-6028

Background Clavicle fractures (CF) after radical neck dissection (RND) for oral cancer are rare but are thought to occur as a result of myotonia and decreased blood supply to the muscles around the clavicle after RND. The current report presents a rare case of a non-neoplastic pathological CF after RND, and discusses the role of imaging examinations for the timely detection of CF. Case report An 82-year-old Japanese man underwent RND followed by chemotherapy without radiotherapy for secondary metastasis of the right cervical lymph node after resection of tongue cancer. Computed tomography at 6 months after RND revealed a fracture with bone destruction in the proximal end of the right clavicle. He had no history of trauma at the site of the fracture and no symptoms. The possibility of bone metastasis of the clavicle was considered; however, the bone destruction had not advanced 6 years after the discovery of the fracture. The CF was thus finally considered to be a side effect of RND, rather than metastasis. Conclusion CF is a rare complication following treatment for head and neck cancer but can be caused by neck dissection. Regular imaging examinations, including the clavicular region, are therefore needed before and after surgery to ensure the timely detection of CF.