Chandler’s Classification of Laryngeal Radionecrosis

• The Chandler Classification (1979)¹ remains widely accepted as the standard grading system for laryngeal chondroradionecrosis.
  • Grade 0: No symptoms or clinical findings.
  • Grade I:
    • Symptoms: Slight hoarseness and dryness.
    • Signs: Slight edema and telangiectasis.
    • Treatment: No treatment required.
  • Grade II:
    • Symptoms: Moderate hoarseness and dryness.
    • Signs: Moderate edema and erythema. Slight impairment of cord mobility.
    • Treatment: No treatment required.
  • Grade III:
    • Symptoms: Severe hoarseness with dyspnea, moderate odynophagia and dysphagia.
    • Signs: Severe impairment or fixation of at least one vocal fold, marked edema, or skin changes
    • Treatment: Antibiotics, hyperbaric oxygen, possible tracheostomy.
  • Grade IV:
    • Symptoms: Respiratory distress, severe pain, severe odynophagia, weight loss, dehydration, fevers.
    • Signs: Fistula, oral fetor, skin fixation to the larynx, laryngeal obstruction, airway occlusion, toxicity.
    • Treatment: tracheostomy and/or laryngectomy.
• Chandler described Grades I and II as minor and intermediate changes, Grade III as fibrotic changes requiring specific conservative treatment, and Grade IV as requiring surgical treatment.
• The increasing use of antibiotics and hyperbaric oxygen has decreased the need for surgical intervention in these patients.

Laryngeal Radionecrosis Classification (Chandler)