Timing of Carotid Blow-Out After Locoregional Recurrence in Head and Neck Cancer: A Single-Center Retrospective Study

Carotid blow-out syndrome (CBS) is a life-threatening complication of head and neck cancer, often occurring after prior treatment and locoregional recurrence. Data on the timing of carotid rupture after local tissue compromise remain limited. We aimed to present our institutional experience with recurrence-associated type III CBS, focusing on timing patterns and associated local factors.

In this retrospective single-center study, medical records of head and neck cancer patients who developed type III CBS between 2016 and 2025 were reviewed. Among 11 CBS cases, eight occurred in association with locoregional recurrence and constituted the study cohort. Locoregional recurrence was defined by clinical and radiologic evidence of recurrent disease and was histologically confirmed when feasible. All patients presented with acute carotid rupture and underwent emergent open carotid artery ligation. Demographic, tumor-related, treatment-related, local predisposing factors, rupture site, and relevant time intervals were analyzed.

Eight patients with recurrence-associated type III CBS were included. The mean time to locoregional recurrence after primary treatment was 8.3 ± 5.1 months (range, 6-19). Tumor infiltration was present in all patients; three had mucocutaneous fistula, five had wound infection, and six had soft-tissue necrosis at the rupture site. The mean interval between detection of recurrence or soft-tissue exposure and carotid rupture was 5.4 ± 3.1 months (range, 2-12). Rupture appeared to occur earlier among patients with mucocutaneous fistula and/or necrosis; however, this finding should be interpreted cautiously because of the small subgroup size. Major neurologic morbidity occurred in two patients, and seven patients died during follow-up due to disease progression.

In recurrent head and neck cancer with local tissue compromise, carotid rupture may occur within a short interval, particularly in the presence of necrosis or mucocutaneous fistula. These hypothesis-generating findings highlight the need for close surveillance, timely multidisciplinary planning, and early goals-of-care discussions.

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