Radiation Mucositis

Inflammation of mucosa caused by cancer-treating radiation. Mucositis is to mucosa as dermatitis is to skin. This inflammation appears reddish with patches of greyish superficial necrosis or ulceration. Typically, radiation mucositis fully resolves four to six weeks after the last radiation treatment.

Photo Essays

Prior to start of radiation (1 of 4)

Patient with vocal cord carcinoma, primarily of the right true cord (left of picture). This is before radiation therapy began, so there is not yet any radiation mucositis.

Radiation mucositis, 1 week after radiation (2 of 4)

One week after the end of radiation therapy. The tumor has disappeared. Radiation mucositis is evident from the patches of grey (arrows), which are superficial ulceration.

Radiation mucositis, 4 weeks after radiation (3 of 4)

Almost four weeks after the end of radiation therapy. Note that the mucositis has begun resolving, especially on the right cord (left of picture).

Disappearing radiation mucositis, 10 weeks after radiation (4 of 4)

Almost ten weeks after the end of radiation therapy. The mucositis is virtually gone.

Laser Removal of Vocal Cord Cancer with Bilateral Disease

For treatment of early vocal cord cancer, both laser excision and radiotherapy are in competition as good treatment modalities. See also Early Vocal Cord Cancer: Remove with a Laser, or Radiate? Often, radiation is used when disease is bilateral, in the interest of preserving voice. This is an example of the ability to do fairly extensive laser surgery bilaterally, yet preserving good voice. This man had a friend who had severe difficulty with radiation, and he was therefore opposed to that option.

Stippling (2 of 10)

At higher magnification and using narrow band light, some of the vascular abnormality (stippling) is better seen (arrows).

1 week after excision (3 of 10)

A week after definitive excision of his cancer. Typical early wound appearance, with a suggestion of granulation on the left side (right of photo).

Reparative Granuloma emerges (4 of 10)

Six weeks later, healing is nearly complete other than a typical reparative granuloma on the left (right of photo).

Granuloma interferes with voicing (5 of 10)

During voicing, the granuloma interferes with closure, explaining in part his ongoing severe hoarseness. Note also the typical medial-to-lateral capillary reorientation.

Granuloma fades away (6 of 10)

Now 3 months postop, the granuloma is smaller. Classic capillary reorientation is again seen.

closer view of granuloma — Closer view (7 of 10)

Under strobe light, closed phase of vibration. Voice is highly functional, since the granuloma no longer interferes with closure.

Granuloma cleft (8 of 10)

Open phase of vibration under strobe light shows the bilobed, clefted nature of the granuloma, where the right vocal fold “fits into” the granuloma (arrows at cleft).

Blood tattoo (9 of 10)

At nearly 5 months postop, the granulation tissue has auto-detached, leaving only a small “blood tattoo.” Here, under strobe light and closed phase of vibration.

Open phase of vibration — Voice is improved (10 of 10)

Voice is somewhat hoarse but highly serviceable, and “better than it has been in years,” according to the patient.

Resources for Further Research

D’Aguillo C, Husain Q, Patel C, Soly Baredes, Eloy JA. Mucositis as a Complication of Radiation Therapy in Nasopharyngeal Carcinoma: A Systematic Review. Otolaryngology. 2013;149(S2). doi:10.1177/0194599813496044a115

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Radiation Mucositis

Photo Essays

Prior to start of radiation (1 of 4)