Radial forearm free flap reconstruction of a nasopharyngeal defect secondary to cervical osteoradionecrosis

Objectives: 1) Present a case of cervical spine osteoradionecrosis and nasopharyngeal defect which was reconstructed with a radial forearm free flap; and 2) review the literature on the management and reconstruction of cervical spine osteoradionecrosis. Study Design: Case report. Methods: Retrospective case review including a review of the relevant literature. Results: The case of a 57 year old man with osteoradionecrosis of the cervical spine is presented. He had previously undergone surgery and proton beam radiation for hepatocellular carcinoma metastatic to the C2 body, and subsequently developed osteoradionecrosis and osteomyelitis of the cervical spine. Biopsy of the area was negative for tumor recurrence. Treatment with hyperbaric oxygen and intravenous antibiotics was unsuccessful. Operative debridement of the necrotic bone was therefore performed, and the nasopharyngeal soft tissue defect was reconstructed with a radial forearm free flap. At 3 months follow-up he was doing well with normal swallow function. Conclusions: Osteoradionecrosis of the cervical spine is an uncommon complication of radiation treatment of head and neck tumors. Management with hyperbaric oxygen therapy and intravenous antibiotics for associated osteomyelitis has been described, however, operative management may be required. The use of the fibula osteocutaneous free flap has been described for reconstruction of both bony and composite defects related to cervical spine osteoradionecrosis. For patients where bone is not required, the radial forearm free flap provides thin, pliable soft tissue which is advantageous in pharyngeal reconstruction.