Complications of Neck Dissection

Complications of Neck Dissection can be divided into General and Local1. General Complications of Neck Dissection 1.Deep venous thrombosis 2. Pneumonia 3. Pneumothorax/ hemothorax (PNEUMOTHORAX: damage to apical pleura during dissecting low in neck leading to air leak.) 4.Metabolic complications- shock – hypovolaemic or septic or cardiogenic.5.Acid base imbalance. Local Complications of Neck Dissection Haemorrhage Intraoperative •Postoperative- immediate , reactionary (within 24 hrs) Management- 1.Diagnose the problem 2.Resuscitate the patient 3.Stop the bleeding 4.Treat the cause •Secondary hemorrhage – 5-10 days Avoid hemoatoma formation by meticulous hemostasis and closed suction drains. Immediate- inadequate control of bleeding by the end of surgical procedure Reactionary- opening up of vessel in spasm/inadequately applied clip to a vessel which gets opened after high BP/coughing Diagnose- if it is bleeding from incisional wound,mucosal surface,mouth,pharynx,larynx, or it is from tissue transferred or from vessel itself. Bleeding in lower resp tract may lead to aspiration . Those who have tracheostomy tube insitu with inflated cuff this complication can be avoided.Resuscitate- IV cannulas should be secured before surgery. While placing this cannula blood should be withdrawn and sent for cross matching.Stop the bleeding- ongoing bleeding requires reexploration. Wound is reopened and saline is irrigated . H’age points are identifed and controlledSecondary- infection,breakdown of clot . Re-exploration and proximal vascular control is required. Internal jugular vein injury Repair done by 6-0 vascular suture . If slipped ligature is the cause- possibility of air embolism should be considered. Management- 1. Placing the patient in Trendelunburg position may reduce the risk2.Direct pressure 3.Aspiration from the tip of CVP catheter if in situ 4.Re-exploration Carotid Artery Rupture2 Most dangerous & lethal- Incidence 3-4% Prevention: trifurcation away from carotids.Necrosis of arterial wall secondary to infection. Risk factors: prior radiotherapy, diabetes, malnutrition, atheromatous disease , tumour adherence Chances of rupture are high if - size of exposed segment is long, oropharyngocutaneous fistula is present history of previous irradiation. Nursing and house staff should be well informed, cross matched blood should be kept ready. In case of carotid rupture: 1.Manual pressure 2.Blood transfusion 3.Volume replacement 4.Maintainence of blood pressure 5.Proximal and distal ligation of the artery ( in ot.) 6.Levator scapulae flap can be tried. Adequacy of contralateral carotid to the circle of willis should be assessed. If collateral is insufficient then stenting or arterial bypass should be done Wound infection -Contamination of surgical field intraoperatively.-Contamination during an in-continuity radical neck dissection & primary excision.-Post op haematoma becoming infected.-Flap necrosis & wound breakdown. Facial Edema Seen if both IJV are ligated. More common in patients who have received radiotherapy. Prevention: Preservation of atleast 1 external jugular vein. Management: Mannitol,steroids. Complications of Neck Dissection CHYLOUS FISTULA1: Postop- prescence of milky white appearance in drain is indicative of chylous fistulaSeen in 1-3% of neck dissections Management : If leak is mild( 400ml/day, re-exploration & ligation of the source with 5-0 silkPersistent flow causes serious nutritional,immunological,electrolyte imbalance.If leak is identified intraop duct is ligated without going through vessel wall along with surrounding tissue with non absorbable suture or vascular clips.If this fails fibrin sealant and collagen/vicryl mesh can be used NERVE INJURIES: -Greater auricular nerve. -Marginal mandibular nerve. -Cervical plexus. -Hypoglossal nerve. -Lingual nerve. -Vagus nerve & sympathetic trunk. Most Common - Division of spinal accessory nerve leads to shoulder dysfunction syndrome. Clinical Features - Pain in the joint, limitation of abduction & drooping of shoulder(girdle tilted downwards) 60% of paitents after RND. Prevention: preservation of spinal accessory nerve and branches of C3 and C4 nerves.Post operative physiotherapy. Complications of Neck Dissection Complications of Neck Dissection 1. Kerawala C, Heliotos M. Prevention of complications in neck dissection. Head Neck Oncol. 2009;1:35. doi:10.1186/1758-3284-1-35 2. Malgonde M, Kumar M. Complications after neck dissection. Med J DY Patil Univ. Published online 2015:458. doi:10.4103/0975-2870.160785

Complications of Neck Dissection

Complications of Neck Dissection can be divided into General and Local¹.

General Complications of Neck Dissection

Local Complications of Neck Dissection

Haemorrhage

Continue reading

Complications of Neck Dissection can be divided into General and Local​1​.

General Complications of Neck Dissection

Local Complications of Neck Dissection

Haemorrhage

Continue reading

Complications of Neck Dissection can be divided into General and Local¹.