Clavicular osteomyelitis: a rare complication after surgery for head and neck cancer

Abstract

Clavicular osteomyelitis (COM) is a rarely described disease entity, occurring especially after head and neck surgery. We herein report the ninth case according to the English language literature and describe the pertinent diagnostic and therapeutic measures to treat this complication. A 63-year-old Caucasian male underwent total laryngectomy and partial pharyngectomy for a post-radiotherapy recurrence of a T2 hypopharyngeal cancer. He presented multiple systemic (cardiovascular problems, previous pneumonectomy, malnutrition) and local-regional (previous radiotherapy, neck dissection, tracheostomy) factors favoring postoperative complications. Sixteen days after surgery, he developed a painful swelling with overlying erythematous skin at the level of the medial portion of the left clavicle. A purulent discharge from the adjacent stomal dehiscence was also noted. COM, suspected on the base of patient's history and clavicular inspection, was confirmed by CT scan. Surgical debridement allowed for definitive diagnosis, ruling out any possible suspicion of stomal recurrence or secondary localization to the clavicle. Cultures from the debrided bone sequestra grew Streptococcus pyogenes Group A and allowed for proper targeting of antibiotic therapy, which was carried out for 4 weeks after surgery. Four years after surgery the patient is tumor-free and does not show any sequela related to the COM or its treatment. COM is a rarely encountered complication after major head and neck surgery. Nevertheless, prompt diagnosis and treatment are mandatory due to the potential life-threatening evolution of this condition.