Airway Edema after Keloid Resection and Superficial Radiation: Unexpected Event in an Unusual Location

Postoperative radiation therapy has been shown to significantly reduce recurrence rates of keloids after surgical excision. Adverse effects of radiation therapy in this setting are generally minimal because the radiation utilized quickly dissipates below the skin, and the radiation effects on the internal organs are usually negligible. This case report describes a patient who underwent excision of a wide anterior neck keloid and received postoperative external beam radiation therapy of the incision. She presented with extensive upper airway edema, dyspnea, and dysphagia requiring readmission and steroids. Re-evaluation of the radiation protocol revealed an inadvertent intersection of the multiple abutting radiation fields at the supraglottic region, resulting in tripling of the dose in the area, and likely leading to her complication. She did well with conservative management with IV steroids, and did not require intubation. She has had no long-term sequelae and no recurrence at 6 months postoperative.