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      Lingual Raynaud's Phenomenon after Surgical and Radiotherapeutic Intervention for Oral Squamous Cell Carcinoma

      case-report

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          Abstract

          Raynaud's phenomenon of the tongue after radiation therapy with or without chemotherapy is an exceedingly rare complication. Symptoms are similar to Raynaud's disease of other sites and involve pallor and discomfort on exposure to cold temperatures that resolve with rewarming. Presentation occurs approximately 18-24 months after radiotherapy on average and can usually be managed effectively with lifestyle modification and pharmacotherapy. Here, we present a case of lingual Raynaud's following surgery and adjuvant radiation therapy in a patient with squamous cell carcinoma of the oral cavity.

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          Raynaud’s Phenomenon: Reviewing the Pathophysiology and Management Strategies

          Iqra Nawaz, Yashfa Nawaz, Eisha Nawaz … (2022)
          Raynaud’s phenomenon (RP) is a multifactorial vasospastic disorder characterized by a transient, recurrent, and reversible constriction of peripheral blood vessels. RP is documented to affect up to 5% of the general population, but variation in its prevalence is commonly recognized owing to many factors, including varied definitions, gender, genetics, hormones, and region. Furthermore, RP may be idiopathic or be a clinical manifestation of an underlying illness. Patients with RP classically describe a triphasic discoloration of the affected area, beginning with pallor, followed by cyanosis, and finally ending with erythema. This change in color spares the thumb and is often associated with pain. Each attack may persist from several minutes to hours. Moreover, the transient cessation of blood flow in RP is postulated to be mediated by neural and vascular mechanisms. Both structural and functional alterations observed in the blood vessels contribute to the vascular abnormalities documented in RP. However, functional impairment serves as a primary contributor to the pathophysiology of primary Raynaud’s. Substances like endothelin-1, angiotensin, and angiopoietin-2 play a significant role in the vessel-mediated pathophysiology of RP. The role of nitric oxide in the development of this phenomenon is still complex. Neural abnormalities resulting in RP are recognized as either being concerned with central mechanisms or peripheral mechanisms. CNS involvement in RP may be suggested by the fact that emotional distress and low temperature serve as major triggers for an attack, but recent observations have highlighted the importance of locally produced factors in this regard as well. Impaired vasodilation, increased vasoconstriction, and several intravascular abnormalities have been documented as potential contributors to the development of this disorder. RP has also been observed to occur as a side effect of various drugs. Recent advances in understanding the mechanism of RP have yielded better pharmacological therapies. However, general lifestyle modifications along with other nonpharmacological interventions remain first-line in the management of these patients. Calcium channel blockers, alpha-1 adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors, nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors are some of the common classes of drugs that have been found to be therapeutically significant in the management of RP. Additionally, anxiety management, measures to avoid colder temperatures, and smoking cessation, along with other simple modifications, have proven to be effective non-drug strategies in patients experiencing milder symptoms.
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            Lingual Raynaud phenomenon.

            Alireza Ghiam, John Cho (2015)
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              Raynaud's phenomenon of the tongue: uncommon presentation of a classical sign.

              B. Lioger, E Diot (2013)
              Article 0 comments Cited 2 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Farzan Siddiqui:
                ORCID: https://orcid.org/0000-0003-1547-835X
                Journal
                Journal ID (nlm-ta): Case Rep Vasc Med
                Journal ID (iso-abbrev): Case Rep Vasc Med
                Journal ID (publisher-id): CRIVAM
                Title: Case Reports in Vascular Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-6986
                ISSN (Electronic): 2090-6994
                Publication date Collection: 2022
                Publication date (Electronic): 19 August 2022
                Volume: 2022
                Electronic Location Identifier: 1567581
                Affiliations
                1Wayne State University School of Medicine, 540 E. Canfield Ave. Detroit, MI 48201, USA
                2Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd Detroit, MI 48202, USA
                3Department of Radiation Oncology, Henry Ford Hospital, 2799 W Grand Blvd Detroit, MI 48202, USA
                Author notes

                Academic Editor: Muzaffer Sindel

                Author information
                https://orcid.org/0000-0002-9265-994X
                https://orcid.org/0000-0003-1547-835X
                Article
                DOI: 10.1155/2022/1567581
                PMC ID: 9417770
                PubMed ID: 36035460
                SO-VID: 28839714-1e55-4621-ad94-3850e16d0d8d
                Copyright © Copyright © 2022 Nicholas J. Murphy et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 June 2022
                Date accepted : 9 August 2022
                Categories
                Subject: Case Report

                Data availability:

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