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Twenty-seven patients with oral malignant tumours, who underwent neck dissection with preservation of the internal jugular vein (IJV), were studied retrospectively to evaluate patency of the IJV. Twenty-three patients underwent ablative surgery of the primary lesion with neck dissection and 4 underwent neck dissection alone. Three patients received...
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Context 1
... study involved 27 patients with oral malignant tumours treated between 1998 and 2001. The clinical characteristics of these patients are shown in Tables 2 and 3. The histological diagnosis of the primary lesion was squamous cell carcinoma in 25 patients, osteosarcoma in 1 patient and mucoepidermoid carcinoma in 1 patient. ...Similar publications
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Citations
... During functional neck dissection, the surgeon tries to preserve the IJV. However, the incidence of IJV narrowing or obstruction following modified radical neck dissection (MRND) or selective neck dissection (SND) varies between 0% and 29.6% in different studies and can cause the same complications mentioned for the IJV ligation (4)(5)(6). ...
Introduction:
During functional neck dissection, the surgeon tries to preserve the internal jugular vein (IJV);
however, the incidence of its narrowing or obstruction following modified radical neck dissection
(MRND) or selective neck dissection (SND) varies between 0% and 29.6%. The most distressing
complication of IJV thrombosis (IJVT) is pulmonary embolism. This study aimed to evaluate the
incidence of IJVT following selective or modified radical neck dissection.
Materials and Methods:
In this study, 109 neck dissections were performed with the preservation of the IJV on 89 patients
from March 2011 to December 2012 in the Cancer Institute of Imam Khomeini Hospital Complex,
Tehran, Iran. Ultrasound evaluation of the IJV was performed in the early postoperative period and
three months after the surgery.
Results:
The study population consisted of 62 male and 27 female patients with a mean age of 57+17.57 years.
Ultrasound evaluation of the IJV among the participants (109 veins) indicated thrombosis in nine
veins (8.25%) in the early postoperative period, four of which remained thrombotic and without flow
three months after the surgery. Moreover, 96.33% of the IJVs were patent with a normal blood flow
three months after the neck dissection. Among the evaluated IJVs, the only factor that showed a
significant association with IJVT was the incidence of postoperative complications, including
hematoma and seroma (P=0.01).
Conclusion:
It seems that the most important factor for the prevention of the IJVT is a meticulous surgery and
surgical complication avoidance during neck dissection.
A BSTRACT
Background
Neck dissections in carcinoma oral cavity are associated with various postoperative comorbidities. Internal jugular vein (IJV) occlusion and stenosis is a rare serious complication, which leads to serious clinical sequalae. Existing medical literature reports an incidence of this complication varying from 0% to 30%. Lacunae exist regarding any correlation between clinicopathological parameters and treatment options, of such patients, with the incidence of this complication, which might aid in adapting a preventive approach accordingly.
Aims and Objectives: a. Primary objective
To study the patency of IJV postoperatively with preoperative status b. Secondary objective: Correlation of postoperative IJV patency with clinicopathological parameters (age, subsite, and pathological nodal status) and treatment options offered (neck dissection, radiotherapy, and reconstruction).
Subject and Methods
Patency of IJV was analyzed preoperatively and postoperatively and correlated with various parameters, after neck dissection in 50 carcinoma oral cavity patients.
Settings and Design
Prospective observational study at a tertiary care hospital done over 2 years.
Statistical Analysis Used
Data were recorded in Excel data sheet and statistically analyzed by using the SPSS Ver 22.0.
Results
IJV occlusion was demonstrated in 2 (4%) patients and IJV stenosis in 7 (14%) patients. Postradiotherapy patients had higher incidence of occlusion compared to patients who did not undergo radiotherapy (11.7% vs. 0%; P < 0.05). The incidence of stenosis and occlusion was significantly higher in left side neck dissection (20.6%; P < 0.05).
Conclusion
Radiotherapy and left sided neck dissection are statistically significant risk factors for postoperative IJV occlusion in carcinoma oral cavity patients.
Purpose:
The vascular anastomosis of free flap with the internal jugular vein stump is susceptible to thrombosis, thus resulting in flap compromise or failure. This study aims to explore the method of longitudinal contraction venoplasty in the prevention of internal jugular vein stump thrombosis after free flap vascular anastomosis and its feasibility.
Patients and methods:
A retrospective review was performed of 16 patients who underwent internal jugular vein resection because of cancer ablation and longitudinal contraction venoplasty to prevent internal jugular vein stump thrombosis after free flap vascular anastomosis from January 2013 through December 2014 at Second Xiangya Hospital. The methods for longitudinal contraction venoplasty and its efficacy are reported.
Results:
Venous anastomosis of all flaps was performed with the internal jugular vein stump, and single venous anastomosis was made in all cases. Postoperatively, all flaps survived completely, without vascular compromise. All the patients were followed for approximately 9 to 33 months, and they were satisfied with the esthetic and functional results of the donor and recipient sites after reconstruction.
Conclusions:
Longitudinal contraction venoplasty may be an effective new method for prevention of internal jugular vein thrombosis after free flap vascular anastomosis.
Background:
Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become common surgical procedures for treating head and neck cancer. Postoperative severe asymmetry of the neck and severe atrophy of the SCM, however, have been demonstrated.
Methods:
Using computed tomographic images, cross-sectional areas of the SCMs were measured in 99 patients with carcinoma of the oral cavity who underwent unilateral mRND or supraomohyoid neck dissection. An asymmetry index was used.
Results:
Innervation to the SCM was preserved in 91 patients. The spinal accessory nerve and the innervation were sacrificed in 3 patients; the innervation was repaired in 5 patients. Sacrifice of innervation to the SCM resulted in extremely severe asymmetry. Repair of the innervation prevented severe asymmetry in 40%. Preservation of the innervation prevented severe asymmetry in 75% at the middle portion of the neck and in 56% at the lower portion after mRND.
Conclusion:
Preserving innervation to the SCM and gentle handling of the nerve during neck dissection could prevent severe asymmetry after neck dissection.
The objective was to investigate factors influencing internal jugular vein stenosis or occlusion after neck dissection, including the reconstructive procedure. The subjects were 73 patients (81 veins) who underwent a modified radical neck dissection, in which the internal jugular vein was preserved, or an extended supraomohyoid neck dissection (E-SOHND). All procedures were performed by the same surgeon. Internal jugular vein patency was evaluated by contrast-enhanced computed tomography. Patency was evaluated in relation to gender, side of dissection, number of pathological lymph node metastases, extracapsular spread of lymph node metastases, radiotherapy, and the reconstruction method (no reconstruction, free flap, or pedicle flap). All internal jugular vein occlusions were on the left side and all except one of these patients underwent radiotherapy. Thus, radiotherapy and left side dissection were significant risk factors for occlusion. Free flap reconstruction was not a risk factor for vein stenosis or occlusion. Patients undergoing reconstruction with pedicled musculocutaneous flaps or E-SOHND were less likely to have vein occlusion. Particular care is required for left neck dissection in patients who have undergone radical neck dissection on the right side. This study suggests that covering the internal jugular vein with the muscle might prevent vein occlusion.
Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
The internal jugular vein (IJV) has been described as the optimal recipient vessel in oral and maxillofacial microsurgical rehabilitation and reconstruction. However, few studies have been reported on IJV thrombosis, which could compromise flap survival. In the current study, a case of flap vascular crisis following IJV thrombosis is presented, and salvage operation as a management strategy is discussed. Although rare, surgeons specializing in oral and maxillofacial microsurgical reconstruction should be aware of the possibility of the occurrence of this condition, considering early surgical intervention is critical.
The aim of this study was to verify the role of the venous drainage system in the pathogenesis of complications in microsurgical head and neck reconstruction. In a nonrandomized cohort study, 52 consecutive cases of complex head and neck microsurgical reconstruction were evaluated. The patients were divided in two groups based on the treatment: the deep (DVDG; n = 30) and superficial (SVDG; n = 22) venous drainage groups. The complications evaluated included vascular obstruction with partial or total loss of the microsurgical flap, inadequate healing (fistulas or suture dehiscence), and infections. The arterial anastomotic site, neoplastic recurrence, use of medications and neoadjuvant radiotherapy, flap selection, tumor histology, smoking/alcoholism, and systemic diseases had no effect on postoperative complications, while the venous component influenced the overall complication rate (chi-square test, P = 0.006). A protective effect was achieved in the DVDG when the overall complication rate was considered--relative risk (RR) 0.65, 95% confidence interval (CI) 0.45-0.94. The recipient vein should be the surgeon's main concern as it influenced the outcomes of patients undergoing complex microsurgical head and neck reconstruction. A protective effect was observed when the internal jugular vein drainage system was used for this purpose.
