Author(s)
Jake Morgan, MD
Liyang Tang, MD
Karla O’Dell, MD
Affiliation(s)
University of Southern California Caruso Department of Otolaryngology-Head and Neck Surgery
Abstract:
Background/Objectives: In-office intralesional steroid injections (ILSI) are a well-described treatment for airway stenosis outside of traditional airway dilation in the operating room. In general, they are thought to have minimal side effects and low risk of significant adverse events. Here, we describe a 54-year-old man with a history of radiation to the neck who developed a neck abscess that progressed to severe wound dehiscence requiring rotational flap reconstruction after receiving a single in-office ILSI.
Methods: A retrospective chart review was performed on a single patient whose treatment course ranged from May, 2022 to September, 2024. Specific attention was placed upon interventions for airway stenosis, resulting complications, surgery to address such complications, and overall treatment course.
Results: A 54-year-old man with a history of pediatric Hodgkin’s lymphoma treated with radiation therapy and newly diagnosed tracheal stenosis treated with two separate airway dilations with steroid injection in the operating room presented to clinic for his first in-office intralesional steroid injection. He presented three weeks later with a small neck abscess under his injection site that progressed and caused hemorrhage from the right internal jugular vein requiring surgical intervention and negative pressure wound therapy. Continued wound breakdown prompted a cervicodeltopectoral flap that was complicated by dehiscence, and the defect was ultimately reconstructed with a pectoralis major flap. The patient was then followed closely until the wound stabilized.
Conclusion: This case demonstrates that patients who have risk factors for poor wound healing such as prior radiation therapy can experience significant complications following ISLI despite its minimally-invasive nature.