The fibroatrophic process has gained acceptance as a main mechanism of ORN. No gold standard treatment or consensus guidelines exist, though a combination of therapeutic strategies should be considered, taking into account the severity of disease and individual patient characteristics.

Background: Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare malignancy of the head and neck, with fewer than 60 cases reported in the literature. We report a case of PSCCT and provide a brief review of the literature. Case Report: A 66-year-old female with a history of a hemithyroidectomy for a benign thyroid lesion presented with 3 months of progressively worsening compressive symptoms and shortness of breath. Physical examination revealed right-sided thyromegaly and right-sided true vocal fold immobility. Preoperative imaging with ultrasound and computed tomography scan confirmed an enlarged right thyroid, as well as right anterior cervical lymphadenopathy, subglottic stenosis, and bilateral pulmonary nodules. Fine needle aspiration of the thyroid was suggestive of carcinoma. Intraoperative findings of gross tracheal invasion during a planned completion thyroidectomy prompted limited resection and impromptu tracheotomy. Histopathologic and immunohistochemical evaluation confirmed a squamous cell carcinoma of thyroid origin. Further oncologic workup with core lung biopsy and positron emission tomography scan demonstrated metastasis to the lung and cervical spine. Palliative chemotherapy was begun, but the patient died 1 week into therapy. Conclusion: PSCCT is a rare but aggressive malignancy of the head and neck. Histopathologic and immunohistochemical evaluations are essential for diagnosis. While locoregional surgery and radiation therapy may improve the length of survival, the prognosis of patients with PSCCT is poor. Physicians should be mindful of this unique but deadly disease process, as early diagnosis and rapid treatment initiation are essential to optimize treatment outcomes.