Early squamous cell head and neck cancer traditionally has been treated with radiotherapy and surgery. Proponents of radiotherapy believe that the quality of voice post radiotherapy surpasses that following surgery. This belief spurred development of different reconstructive techniques using various kinds of grafts.
A 73-year-old man noted episodes of coughing up hair over several weeks. He also had slowly progressive shortness of breath, daytime somnolence, fatigue, hoarseness and wheezing. His past history included laryngeal surgery 15 years ago for a benign laryngeal tumor. He gave up cigarette smoking after his laryngeal surgery. He was noticed to have an audible inspiratory wheeze at the time of admission. Vital signs were within normal limits. On examination, he had extensive hair growth of the skin all over the body including the neck area. An old midline neck scar was seen without keloid formation, discharge or sinus tract. Examination of the chest revealed transmitted inspiratory wheezing with no rhonchi or crackles. The remainder of the examination was normal. Chest X-ray was normal. Fiberoptic bronchoscopy showed abnormal anatomy due to previous laryngeal reconstructive surgery. There was extensive meshwork of hair filaments below the epiglottis obscuring the vocal cord area. Some hair filaments were as long as 6 cm and were covered with mucus. Bronchial washing was negative for malignant cells. The patient did not return for follow up.
This patient illustrates trichoptysis (coughing up hair), a complication of reconstructive surgery for laryngeal tumors. Many patients who undergo flap reconstruction require postoperative external beam radiation therapy, a technique to reduce ectopic hair growth. Our patient underwent reconstructive surgery with a mucosal flap and did not receive radiation therapy. This problem may be obviated by utilizing partial thickness skin graft (without hair follicles). Once the problem develops, hair removal by laser or epilation may be necessary. Management of this problem includes hair removal by laser or epilation therapy.
Trichoptysis is seen rarely nowadays due to improved techniques of reducing hair growth in flaps and grafts for reconstructive surgery. The diagnosis is readily established by bronchoscopy. Hair fulguration techniques are usually successful in treating this condition.
M.B. Bakry, None.