Head, Neck Disorders Resulting from Iranian-Iraqi Conflict Chemical Warfare

Newswise — The Iran-Iraq war lasted eight years, led to at least 300,000 killed, with the wounded and captured soldiers pushing the casualty total over one million, and some estimates of total casualties exceeded two million. What made this conflict so terrible was the use of poison gas, a weapon not seen since World War I.

Iraq has admitted making 2,850 tones of mustard gas, has filled bombs with it and used it against Iranian soldier in late of Iran –Iraq war (1985-1988) and Kurds at Halabja in 1988. Now, Iranian medical officials who are treating veterans of the Iranian-Iraqi conflict are reporting on the consequences of exposure to chemical warfare as applied to head and neck disorders. The authors of “Head & Neck Manifestation of Chemical Warfare Agent (CWA) in Iranian Veterans,” are Zojaji Ramin MD, Assistant Professor, and H. Sadeghi, Assistant Professor, both at Azad Medical University, in Tehran; and M. Balali, Professor at Mashhad, all in Iran. Their findings are to be presented at the 109th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, being held September 25-28, 2005, at the Los Angeles Convention Center, Los Angeles, CA.

Background: Chemical warfare is defined as the use of non-explosive chemical agents to cause injury or death. Chemical agents used about 2000 BC in wars between India and China: dried red peppers in rice paper set on fire and thrown at enemy (incapacitating, not lethal). 423 BC: the Spartans captured an Athenian fort by directing smoke into the fort through a hollowed out beam. The Byzantine Empire developed “Greek Fire” in 600 A.D., a liquid which auto-ignited when exposed to air, helping to keep Constantinople in power for five centuries.

The first major use of chemical warfare agents was during World War I, with the use of various agents including chlorine, mustard gas, and phosgene gas by the German army. Other armies quickly responded with chemical weapons of their own. They were not extensively used during World War II due to the fear of retaliation and because chemical weapons are of limited use in a mobile front in which their use would slow the advance of one's own troops.

The primary types of agents used in chemical warfare are nerve agents, mustard agents hydrogen cyanide-based agents, botulinum, arsines, toxins, tear gases, pepper spray incapacitating agents such as psychotomimetic agents, and potential chemical warfare agents. Sulfur Mustard (SM) is a Chemical warfare agent (CWA) that was widely used against Iranian soldiers in the latter part of Iran-Iraq war (1985 to 1988).

'Mustard' is liquid at room temperature, but is more commonly used in its gas form - which has a strong smell likened to horseradish or garlic. Absorption is made through contact with skin or inhalation. The effect of mustard gas is a blistering agent, burning eyes and skin exposed to it and lungs, mouth and throat if it is inhaled. It is not normally lethal, but can cause cancer and serious disfigurement. Symptoms include conjunctivitis, skin burns, throat pain, cough and susceptibility to infection and pneumonia. Symptoms are not usually noticed until one to six hours after exposure. The only protection is protective clothing and early decontamination, followed by antibiotics.

Methodology: This two-year prospective study examined 43 male patients age 34 to 48 with mean age of 41.8. All Iranian veterans, exposed to CWA, and who had disability more than 40 percent due to sulfur mustard, were studied through clinical investigations.

Investigations, which included hematological, immunological, and electrophysiological tests, as well as spirometry, chest X-ray, HRCT of the lungs and skin biopsies, were performed by certain specialized staff and were recorded in pre-designed forms.

Results: The researchers found the most affected organ were the lungs (95 percent of patients). This was followed by the peripheral nerves (77 percent), skin (73 percent), eye (68 percent) and head and neck (16.2 percent). Three patients presented with head and neck cancer .

Seven patients were diagnosed with mostly head and neck manifestation: four skin disorders (hyper pigmentation, erythematous papular rash, and dry skin); two had thyroid Cancer (one patient with undifferentiated carcinoma of thyroid 12 years after exposure to SM and the other papillary cell carcinoma of thyroglossal cyst 14 years after exposure to SM) and one patient had nasopharyngeal carcinoma 12 years after exposure to SM.

Conclusions: The Iranian medical team found that sulfur mustard offered a wide range of delayed toxic effects that can be categorized into three groups: (1) direct irritant effect on the skin and mucosal surfaces such as eyes and the respiratory tract; (2) Systemic abnormalities like neuromuscular complications and impairment of cellular and humeral immunity which result in infections, septicemia; and (3) Carcinogenicity. Based on laboratory studies, SM is classified as a carcinogen. Carcinoma of naspharynx, bronchogenic carcinoma, adenocarcinoma of stomach, was reported in Iranian veterans.

Three patients were diagnosed with head and neck carcinoma due to massive exposure to SM.

A significant excess of cancer due to SM are found among all Iranian veterans with massive exposure to SM, compared with the other Iranian veterans, indicating the deadly nature of this chemical warfare agent.