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A wide choice of skin incisions and skin flaps is available to the surgeon contemplating radical neck dissection. The choice of incisions, however, may often be influenced by a number of existing or pre-existing conditions. Each situation has to be treated on its own merit depending on the prevailing cicumstances if all objectives are to be achieved.
The retrospective analysis of 238 patients treated because of laryngeal cancer was performed to examine the results of modified radical neck dissection. Authors estimated the presence of nodal metastases in clinically negative and clinically positive neck. Evaluation of the metastatic node levels was performed.
The influence of postoperative radiotherapy (RT) on the patency and blood flow of the internal jugular veins (IJV) after functional neck dissection (FND) was assessed in a prospective study. Doppler ultrasonography of the IJV was performed before and after surgery. Fifty-four FND were evaluated in 29 oncological patients who underwent surgery between September 1994 and February 1997. Twelve IJV received postoperative RT. There were no cases of thrombosis before or after surgery in any case. Blood-flow speed in the right Valsalva maneuver was the only parameter affected in irradiated patients.
Anatomical variants of the common carotid artery are rarely reported. Two different congenital anomalies of the common carotid artery, encountered during radical neck dissection, are documented and their surgical significance discussed.
A prospective computed tomographic (CT)-clinical study was made of 40 consecutive patients who had undergone myocutaneous flap surgery of the neck and 30 consecutive patients who had undergone radical neck dissection. The postoperative CT appearance of tumor and infection is reviewed. The normal CT landmarks of the neck are also described.
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PURPOSE: The study goal was to evaluate the change in hyoid bone position after neck dissection and tumor resection for oral cancer. PATIENTS AND METHODS: Twenty-seven patients who underwent surgery were retrospectively evaluated. The hyoid bone position was measured before and after the surgery using a topogram of computed tomography scans. RESULTS: There was a statistically significant difference in the hyoid bone position between preoperative and postoperative images in anteroposterior direction (Wilcoxon signed rank test, P <.05), but there was no significant difference in the superoinferior direction. The hyoid bone moved anteriorly when the submandibular region was resected. In cases in which the submental region was resected, it was variably displaced depending on the type of suspension or reconstruction of the resected suprahyoid muscles. CONCLUSION: This limited study suggests that the hyoid bone is displaced after surgery for oral cancer. The hyoid bone was displaced anteriorly if the submandibular region was resected, and it was displaced severely if the submental region was resected.
Anomalies of the carotid artery are rare in clinical experience. To our knowledge a tortuous common carotid artery with an abnormal course encountered during neck dissection has never been reported in the available world literature. During dissection of the lower neck in a 60-year-old Korean man, a tortuous right common carotid artery was found to cross over the lower cervical trachea anteriorly and then was positioned in its usual site in the carotid sheath in the mid-neck.
PURPOSE: There are many possible causes of airway edema in a patient being treated for squamous cell carcinoma of the head and neck. The differential diagnosis includes radiation changes, anaphylaxis, and venous or lymphatic obstruction secondary to mechanical compromise resulting from infection, recurrent tumor, or anatomic distortion. METHODS: A 60-year-old man underwent partial glossectomy and right radical neck dissection for squamous cell carcinoma of the tongue. He subsequently required insertion of a Hickman catheter for administration of chemotherapy to treat recurrent disease. Edema of the left neck, shoulder, and arm was noted to accompany the onset of laryngeal obstruction secondary to supraglottic edema. RESULTS: Catheter-induced thrombosis of the left brachycephalic vein obstructed the only residual jugular vein and was responsible for the sudden airway obstruction. CONCLUSION: Acute laryngeal edema may be caused by obstruction of venous outflow. Invasive catheters should be placed with caution in patients who have undergone surgical sacrifice of the contralateral internal jugular vein.
A retrospective study was done to assess the incidence and factors associated with neurological complications in patients who have undergone a functional neck dissection (FND). Four hundred forty-two epidermoid cancer patients operated on from January 1984 to December 2002 were included in the study. Clinical parameters, neurological sequelae, and other complications were evaluated in all cases. The incidence of neural damage was calculated on the nerves at risk (n =714). Paralysis of the 11th nerve occurred in 12 cases (1.68%). A lesion of the marginal branch of the 7th cranial nerve was observed in nine cases (1.26%). Bernard-Horner's syndrome and hypoglossal nerve paralysis were noted in four and three cases (0.56 and 0.42%), respectively. Thus, the incidence of neurological sequelae after FND is low. Neurological complications were not associated with either clinical parameters or non-neurological complications (P >0.05). None of the factors studied can predict the appearance of neural problems in the postoperative period.
We present the case of a 50-year-old man who developed bilateral cortical blindness and confusion following a seemingly uneventful right-sided radical neck dissection. Computed tomography (CT) scans confirmed bilateral occipital lobe infarctions. To our knowledge, there are no previously documented reports of this clinical event following head and neck surgical procedures. Although this is a rare occurrence, otolaryngologists should be aware of this potential post-operative complication. The possible aetiologies of this condition are discussed.
OBJECTIVES: To identify the incidence of level IIb lymph nodes metastasis in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma (SCC) of the oral cavity. STUDY DESIGN: Prospective analysis of a case series. METHODS: Forty-eight patients with SCC of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. The incidence of micrometastasis to level IIb lymph nodes after performing elective SOHND was evaluated by pathologic examination and molecular analysis. RESULTS: Of the 48 patients, 15 (31%) by pathologic analysis and 22 (46%) by molecular analysis had lymph nodes positive for metastatic SCC. By molecular analysis, 5 (10%) of the 48 patients had involvement of level IIb lymph nodes. All patients with metastasis to level IIb lymph nodes have their primary lesions in the tongue and constituted 22% of patients with tongue lesions. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. CONCLUSIONS: In this study, level IIb lymph node metastasis was only found in association with tongue carcinoma. Although this region may be preserved in elective SOHND in patients with SCC of the oral cavity, it should be included whenever the tongue is the primary site.
We describe an unusual brachial plexus anatomical variant that renders it vulnerable to injury in radical or modified neck dissection. It is represented by a looping redundant course of the most cephalad cervical division contribution to the brachial plexus. Unless recognized during development of the inferior surgical plane by blunt dissection techniques, injury to this portion of the brachial plexus may occur. An awareness of this infrequent variation in brachial plexus anatomy should be maintained.
A new pharmacological effect of somatostatin has been verified in the treatment of lymphorrea due to a thoracic duct injury, produced during left lateral neck dissection. The drug (stilamin 3 mcg/kg/h in continuous venous infusion) allowed in 3 case a strongly decrease of the lymphatic loss within 24 hours and the complete depletion within 6 days. Further studies are required to clarify the dynamic effects of the drug in this complication.