Very Late-Onset Lingual Necrosis Post-radiation in an Adult: A Case Report

Lingual necrosis is a rare but serious late complication of radiotherapy for head and neck cancer, despite the tongue's rich vascular supply. We report the case of a 59-year-old man who developed unilateral tongue necrosis 16 months after chemoradiotherapy for oropharyngeal carcinoma. A cervico-facial CT scan showed occlusion of the right lingual artery and compensatory dilation of collateral vessels. Surgical debridement of necrotic tissue was performed, and histopathology confirmed the lingual necrosis. The delayed onset and extent of necrosis in this case suggest progressive, radiation-induced microvascular injury. This case highlights the importance of prolonged follow-up and early recognition of atypical post-treatment lesions.