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Wang X, Wang S, Li C, Ruan Y, Li Y, Liu J, Guo Z. Lymph or Chyle Leak After Neck Dissection in Patients With Thyroid Carcinoma: Results of a Study on 1724 Patients. Am Surg 2021; 88:109-114. [PMID: 33662220 DOI: 10.1177/0003134820981723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To discuss the prevention and treatment of lymph or chyle leak following neck dissection in patients with thyroid carcinoma. METHODS A total of 1724 patients with thyroid carcinoma received neck dissection in the Sun Yat-sen University Cancer Center between November 2009 and October 2014. The incidence and management of leak were analyzed. RESULTS A total of 92 (5.34%) patients developed leak, 28 (1.62%) developed lymph leak, 59 (3.42%) developed chyle leak, and 5 (.29%) developed chylothorax. Medical management to stop postoperative lymph or chyle leak included pressure dressing, reoperation, fasting, or low-fat diet therapy. CONCLUSIONS Lymph or chyle leak may occur in thyroid carcinoma patients who underwent neck dissection. Clinicians should alert to leak when there were IV + VI region lymph node metastasis and should become aware of chylothorax after pressure dressing. A careful identification and ligation of lymphatic duct may be an effective way to avoid lymph or chyle leak.
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Affiliation(s)
- Xi Wang
- Department of Otolaryngology, 369351Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Shunlan Wang
- Department of Otolaryngology, 369351Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Chunqiao Li
- Department of Otolaryngology, 369351Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Yan Ruan
- Department of Otolaryngology, 369351Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Yin Li
- Department of Head and Neck, 71067Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Liu
- Department of Otolaryngology, 369351Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Zhuming Guo
- Department of Head and Neck, 71067Sun Yat-sen University Cancer Center, Guangzhou, China
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2
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Bellier A, Pardo Vargas JS, Cassiba J, Desbrest P, Guigui A, Chaffanjon P. Anatomical variations in distal portion of the thoracic duct-A systematic review. Clin Anat 2019; 33:99-107. [PMID: 31576619 DOI: 10.1002/ca.23476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included "TD," "Jugular Vein," "Subclavian Vein," or "Cervical," and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99-107, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Alexandre Bellier
- Grenoble Alpes University Hospital, Boulevard de la Chantourne, INSERM CIC1406, 38700, La Tronche, France.,Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Juan Sebastian Pardo Vargas
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Julie Cassiba
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Paul Desbrest
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Alicia Guigui
- Grenoble Alpes University Hospital, Boulevard de la Chantourne, INSERM CIC1406, 38700, La Tronche, France
| | - Philippe Chaffanjon
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France.,GIPSA-Lab-Department of Parole et Cognition, UMR 5216, Grenoble Campus, 11 rue des Mathématiques, BP46, 38402, Saint Martin d'Hères Cedex, France
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3
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Ríos A, Rodríguez JM, Torregrosa NM, Hernández AM, Parrilla P. Fístula quilosa como complicación de la cirugía tiroidea en patología maligna. ENDOCRINOL DIAB NUTR 2019; 66:247-253. [DOI: 10.1016/j.endinu.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
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4
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Chen CY, Chen YH, Shiau EL, Liang HL, Chang HS, Chen HC. Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature. Head Neck 2015; 38:E54-60. [DOI: 10.1002/hed.24134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Chia-Yu Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Yu-Hung Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - En-Li Shiau
- Department of Radiology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Hui-Lung Liang
- Department of Radiology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Hao-Sheng Chang
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Dental Laboratory Technology; Shu Zen College of Medicine and Management; Kaohsiung Taiwan
| | - Hung-Chih Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Dental Laboratory Technology; Shu Zen College of Medicine and Management; Kaohsiung Taiwan
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Wei T, Liu F, Li Z, Gong Y, Zhu J. Novel Management of Intractable Cervical Chylous Fistula with Local Application of Pseudomonas aeruginosa Injection. Otolaryngol Head Neck Surg 2015; 153:561-5. [PMID: 26002958 DOI: 10.1177/0194599815584917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/10/2015] [Indexed: 02/05/2023]
Abstract
Objective Cervical chylous fistula is an uncommon complication after neck dissection, but it might lead to some serious clinical outcomes. Although most cervical chylous fistulas can heal in a few days with standard treatments, some can be intractable. In this study, we describe a new method with local application of Pseudomonas aeruginosa injection for intractable cervical chylous fistula. Study Design Case series with chart review. Setting West China Hospital, Sichuan University, Chengdu, China. Subjects and Methods The charts of 18 patients who were treated with P aeruginosa injection (PAI) for intractable cervical chylous fistula were retrospectively reviewed. Results All patients were successfully treated with PAI. Mild fever (temperature, <38°C) occurred in 9 patients, moderate fever (38°C-39°C) in 4 patients, and severe fever (>39°C) in 5 patients. All patients had mild to severe neck pain. Conclusions Local application of PAI is an effective method for the treatment of intractable cervical chylous fistula, of which the most common side effects are transient fever and local pain.
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Affiliation(s)
- Tao Wei
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Liu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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6
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Ikeda Y. Thoracoscopic management of cervical thoracic duct injuries after thyroidectomy with lymphadenectomy. Asian J Endosc Surg 2014; 7:82-4. [PMID: 24450352 DOI: 10.1111/ases.12075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Abstract
We present a case of postoperative cervical chylous fistula after neck dissection of advanced thyroid carcinoma that was managed successfully by thoracoscopic ligation of the thoracic duct. A double lumen endobronchial tube was introduced for selective single-lung ventilation with the patient under general anesthesia. The patient was placed in the left decubitus position. Four thoracoports were introduced in the collapsed right lung. The thoracic duct was ligated at two points, and two clips were applied. Postoperatively, neck drainage ceased immediately. The chest tube and closed neck drains were removed on postoperative days 2 and 8, respectively. The patient was discharged on postoperative day 9. Thoracoscopy is a safe and effective treatment of chylous fistula in the neck. Compared to the open procedure, the minimally invasive thoracoscopic approach causes less pain and fosters faster rehabilitation and recovery.
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Affiliation(s)
- Yoshifumi Ikeda
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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7
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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8
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Drain removal and aspiration to treat low output chylous fistula. Eur Arch Otorhinolaryngol 2013; 271:561-5. [DOI: 10.1007/s00405-013-2534-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022]
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9
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Kadota H, Kakiuchi Y, Yoshida T. Management of chylous fistula after neck dissection using negative-pressure wound therapy: A preliminary report. Laryngoscope 2012; 122:997-9. [DOI: 10.1002/lary.23216] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 12/21/2011] [Accepted: 12/27/2011] [Indexed: 02/03/2023]
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10
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Kolomvos N, Skouteris CA, Papadogeorgakis N, Sklavounou A, Alexandridis C, Angelopoulos AP. Histopathologic Study of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2010; 68:2452-8. [DOI: 10.1016/j.joms.2009.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/02/2009] [Accepted: 10/03/2009] [Indexed: 10/19/2022]
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11
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Apostolakis EI, Kouerinis IA, Zografos GC, Tsilimingas N, Dougenis D. Conservative treatment of a cervical chylous fistula of the minor thoracic duct after thoracic trauma. ACTA ACUST UNITED AC 2009; 66:E52-4. [PMID: 18277269 DOI: 10.1097/01.ta.0000233648.49907.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Tsukahara K, Kawabata K, Mitani H, Yoshimoto S, Sugitani I, Yonekawa H, Beppu T, Fukushima H, Sasaki T. Three cases of bilateral chylothorax developing after neck dissection. Auris Nasus Larynx 2007; 34:573-6. [PMID: 17466474 DOI: 10.1016/j.anl.2007.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/27/2007] [Accepted: 03/16/2007] [Indexed: 11/26/2022]
Abstract
Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.
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Affiliation(s)
- Kiyoaki Tsukahara
- Division of Head and Neck, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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13
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Laidlaw JD. Iso-intense neuroenteric cyst in the lower cervical spine treated with ventral resection and anterior fusion utilising sternal notch exposure: case report, technical note and literature review. J Clin Neurosci 2003; 10:606-12. [PMID: 12948469 DOI: 10.1016/s0967-5868(03)00198-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 36-year-old female patient with a long-standing asymptomatic lower thoracic scoliosis presented with sensory symptoms involving all limbs. MRI scan demonstrated a rounded ventral intradural mass causing major deformity of the cervical cord at C6 and C7 levels. Unlike most previously reported neurenteric cysts, the MRI signal characteristics of this mass were such that it could not be determined if it is cystic or solid, being iso-intense on T1- and hyperintense T2-weighted images. Resection was performed through a median corporectomy of C6 and C7, the lesion being found to be a neurenteric cyst with an attachment to the anterior median fissure of the cord. Strut graft and cervical locking plate fixation from C5 to C6 was facilitated by extending the cervical incision into the sternal notch, with detachment of left-sided strap muscle insertion. The patient made an excellent recovery with complete resolution of neurological symptoms and solid fusion. The postoperative course was complicated by an anterior cervical CSF collection which resolved spontaneously within 2 months. The literature regarding this rare condition and its management is reviewed. Although the majority of intraspinal neurenteric cysts are situated ventral to the cord, most reports of excision have been from a dorsal approach. Drainage and subtotal excision of neurenteric cysts have been previously advocated; however, the recurrence rate is such that complete excision is advocated. This is facilitated by a ventral approach. A simplified method of utilising the sternal notch exposure is reported. The literature regarding the anatomical peculiarities pertinent to the sternal notch approach, and the reported literature regarding spinal neurenteric cysts is reviewed.
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Affiliation(s)
- John D Laidlaw
- Department of Neurosurgery and Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Parkville, Vic., Australia.
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14
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Kamasaki N, Ikeda H, Wang ZL, Narimatsu Y, Inokuchi T. Bilateral chylothorax following radical neck dissection. Int J Oral Maxillofac Surg 2003; 32:91-3. [PMID: 12653241 DOI: 10.1054/ijom.2002.0312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bilateral chylothorax as a complication of radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. We found only 14 cases reported in the English literature. Here, we report a case of bilateral chylothorax following right modified and left radical neck dissections that was successfully treated with conservative management.
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Affiliation(s)
- N Kamasaki
- Second Department of Oral and Maxillofacial Surgery, Nagasaki University School of Dentistry, Nagasaki, Japan.
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15
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Langford RJ, Daudia AT, Malins TJ. A morphological study of the thoracic duct at the jugulo-subclavian junction. J Craniomaxillofac Surg 1999; 27:100-4. [PMID: 10342146 DOI: 10.1016/s1010-5182(99)80021-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chylous fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of 1-3% after radical neck dissection. The majority occur on the left side (75-92%) and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. The macroscopic arrangement of the termination of the thoracic duct in the left neck was examined in 24 UK cadavers. Twenty-one ducts terminated as a single vessel, two ducts showed a bifid termination and one duct had three terminal branches. The precise site of termination was variable. Five thoracic ducts showed branching and reanastamosing patterns prior to their termination, irrespective of the number of terminal branches. Subsidiary cervical lymph trunks were identified in four dissections. These variations are described and their relevance to surgery involving the left side of the neck is discussed.
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Affiliation(s)
- R J Langford
- Department of Oral and Maxillofacial Surgery, Royal Shrewsbury Hospitals Trust, UK
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Seelig MH, Klingler PJ, Oldenburg WA. Treatment of a postoperative cervical chylous lymphocele by percutaneous sclerosing with povidone-iodine. J Vasc Surg 1998; 27:1148-51. [PMID: 9652477 DOI: 10.1016/s0741-5214(98)70017-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of postoperative leaks of the thoracic duct after neck dissection or vascular surgery of the subclavian and vertebral artery is a well-known but rare complication. Usually, an injury of the duct manifests immediately after the operation with chylous drainage. Presentation as a postoperative lymphocele is rare. Operative treatment may be an option, but identification of the leak often is impossible, resulting in a high rate of failure. Percutaneous catheter drainage in combination with sclerosis with povidone-iodine has proved to be highly effective in obliterating pelvic lymphoceles but has not been reported in patients who have undergone vascular surgery in the neck. We present a case in which a povidone-iodine solution was used successfully in percutaneous sclerosis of a cervical lymphocele after transposition of the left subclavian artery to the left common carotid artery.
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Affiliation(s)
- M H Seelig
- Department of Surgery, Mayo Clinic Jacksonville, FL 32224, USA
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