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Hartl DM, Zafereo ME, Kowalski LP, Randolph GW, Olsen KD, Fernandez-Alvarez V, Nixon IJ, Shaha AR, Angelos P, Shah JP, Ferlito A. Occlusion of the internal jugular vein in differentiated thyroid carcinoma: Causes and diagnosis. Eur J Surg Oncol 2021; 47:1552-1557. [PMID: 33642089 DOI: 10.1016/j.ejso.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 01/27/2023] Open
Abstract
Occlusion of the internal jugular vein (IJV) can be observed in thyroid cancer either on preoperative imaging with ultrasound or cross-sectional imaging, particularly contrast-enhanced CT-scan, and can be detected during follow-up when using these same imaging modalities. For thyroid cancer, four different causes of occlusion of the IJV can be identified: venous thrombosis associated with a hypercoagulable state, tumor thrombus in the vein, compression or invasion of the IJV by thyroid disease or lymph node metastases, and fibrotic collapse of the IJV following lateral neck dissection. Clinicians managing patients with thyroid cancer need to be aware of and able to diagnose each of these conditions. The overall patient impact and appropriate management of each will be discussed.
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Affiliation(s)
- Dana M Hartl
- Department of Surgery, Gustave Roussy, Villejuif, France.
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | | | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Angelos
- Department of Surgery and Surgical Ethics, University of Chicago Medicine, Chicago, IL, USA
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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2
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Kitano D, Yonezawa K, Iwae S, Sakakibara S. Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery. J Plast Reconstr Aesthet Surg 2020; 74:1239-1245. [PMID: 33288470 DOI: 10.1016/j.bjps.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Free flap failure secondary to internal jugular vein thrombosis (IJVT) is a significant complication after head and neck reconstructive surgery. A consensus has not yet been reached among reconstructive surgeons regarding the treatment of IJVT. METHODS We retrospectively evaluated the incidence of IJVT in 118 patients who underwent free flap reconstruction at Hyogo Cancer Center, Akashi, Japan. The occurrence of IJVT-related flap circulation crisis and pulmonary thromboembolism (PTE) was studied. This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient. RESULTS From 118 patients who underwent head and neck reconstructive surgery, we included 116 internal jugular veins (IJVs) preserved after neck dissection in the present study. IJVT was confirmed in 25 (21.6%) IJVs from 23 patients. One patient (0.8%) developed venous congestion due to IJVT, which resulted in total flap necrosis. Two patients (1.7%) exhibited PTE associated with IJVT. They were treated with direct oral anticoagulants for 3 months and were discharged without any sequelae. CONCLUSION Our results suggest that IJVT after head and neck reconstructive surgery caused not only flap circulation crisis but also PTE. Reconstructive surgeons should be aware of the potential risks due to serious complications associated with IJVT.
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Affiliation(s)
- D Kitano
- Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - K Yonezawa
- Department of Head and Neck Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-0021, Japan
| | - S Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-0021, Japan
| | - S Sakakibara
- Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Makiguchi T, Yokoo S, Ogawa M, Miyazaki H. Factors influencing internal jugular vein patency after neck dissection in oral cancer. Int J Oral Maxillofac Surg 2015; 44:1218-24. [DOI: 10.1016/j.ijom.2015.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/29/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
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Karaman M, Tek A, Uslu C, Akduman D, Bi˙laç Ö. Effect of functional neck dissection and postoperative radiotherapy on the spinal accessory nerve. Acta Otolaryngol 2009; 129:872-80. [PMID: 18841512 DOI: 10.1080/00016480802441721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS We encountered shoulder syndrome after functional neck dissection (FND) less frequently than reported in the literature. This technique is a favorable treatment choice for appropriately selected patients with head and neck cancer with cervical metastasis. It depends on careful dissection of neurovascular tissues during surgery and preserved shoulder function due to chronic neurological degeneration caused by surgery. Also, radiotherapy has an evident negative effect on the accessory nerve. OBJECTIVES To perform postoperative electrophysiological tests on the spinal accessory nerve (SAN) after FND and postoperative radiotherapy. SUBJECTS AND METHODS A study group of 16 patients with head and neck cancer who underwent 22 FNDs and 10 volunteers in the control group were evaluated. The SAN latency and amplitude were measured and then upper trapezius muscle electromyography (EMG) was performed on all the patients and the volunteers. RESULTS The EMG results of the study group revealed 19 cases with normal findings, 1 with total and 2 with partial axonal degeneration. The amplitude levels of the SAN in the study group showed statistically significant decrease when compared with the control group. The latency levels of the SAN in the four patients who received postoperative radiotherapy were significantly longer than those in cases who did not receive this therapy.
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Nagata T, Matsunaga K, Kawazu T, Kawano S, Oobu K, Ohishi M. Patency assessment of the internal jugular vein after neck dissection. Int J Oral Maxillofac Surg 2005; 35:416-20. [PMID: 16376052 DOI: 10.1016/j.ijom.2005.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 04/29/2004] [Accepted: 09/15/2005] [Indexed: 10/25/2022]
Abstract
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 simple closure and skin grafting of the primary lesion, and 20 received reconstruction surgery (4 platysma flaps, 3 radial forearm flaps, 3 lateral upper arm flaps, 2 pectoralis major myocutaneous flaps and 8 rectus abdominis myocutaneous flaps). The maximum and minimum diameters of the IJV as measured on computed tomographic (CT) scans were used to assess patency. The cross-sectional area of the IJV and the ratio of its long axis to short axis (L/S ratio) were calculated. The relation between the change in IJV status and the type of flap used for reconstruction was also examined. Occlusion of the IJV was present in 3.7% of the patients, and 'narrowing' was present in 63.6%. The size of the flap significantly correlated with 'narrowing' of the IJV, suggesting that 'narrowing' was caused mainly by compression due to the flap.
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Affiliation(s)
- T Nagata
- Department of Oral and Maxillofacial Surgery, Hamamatsu University School of Medicine, 1-20-1, Handa-yama, Hamamatsu City, Shizuoka, 431-3125 Hamamatsu, Japan.
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Miyasaka M, Ichikawa K, Nishimura M, Yamazaki A, Taira H, Imagawa K, Tanino R. Salvage operations of free tissue transfer following internal jugular venous thrombosis: a review of 4 cases. Microsurgery 2005; 25:191-5. [PMID: 15744722 DOI: 10.1002/micr.20104] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The internal jugular vein (IJV) is used as the optimal recipient for free-tissue transfer in reconstruction following modified radical neck dissection. Some reports documented rare cases of flap compromise following IJV thrombosis, but large sample studies are few. We present cases of emergent exploration and an analysis of factors to improve salvage rates of compromise due to IJV thrombosis. From a survey of 756 patients, four developed congestion due to IJV thrombosis and returned to the operating room. A restrospective analysis was made from the case records. This represents a rate of 0.5% for the entire series. Three flaps survived,and one failed. Detection of compromise ranged from 7-25 h postoperatively. All four IJVs recovered to provide adequate drainage after thrombectomy. While flap compromise following IJV thrombosis is rare, careful observation and early exploration are crucial for salvage, as in other microvascular venous crises.
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Affiliation(s)
- Muneo Miyasaka
- Department of Plastic Surgery, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
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Harada H, Omura K, Takeuchi Y. Patency and caliber of the internal jugular vein after neck dissection. Auris Nasus Larynx 2003; 30:269-72. [PMID: 12927290 DOI: 10.1016/s0385-8146(03)00053-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the incidence of thrombosis and change in caliber of the internal jugular vein after neck dissection. PATIENTS AND METHODS Between September 1999 and December 2000, we studied 68 patients who underwent 76 neck dissection that spared the internal jugular vein. Thrombosis of the internal jugular vein was determined using duplex Doppler scans. The examination was performed about 10 days after the operation. Preoperative and postoperative imaging was available for 28 patients who underwent 32 neck dissections after April 2000. These 28 patients were divided into three groups. Group 1 consisted of 5 internal jugular veins which were treated with supraomohyoid neck dissection. Group 2 included 17 internal jugular veins which were treated with functional neck dissection. For group 3, ten patients underwent simultaneous bilateral neck dissections that spared the ipsilateral internal jugular vein with concurrent contralateral radical neck dissection. For each group, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was calculated. Measurements were planned for 7 days, 1 month, and 3 months postoperatively. RESULTS The overall patency of the 76 internal jugular veins after neck dissection was 100%. In all groups, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was lowest during the early postoperative period, and gradually increased within 3 months after surgery. CONCLUSION The caliber of the internal jugular veins decreased the most during the early postoperative period; however, internal jugular vein thrombosis is uncommon.
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Affiliation(s)
- Hiroyuki Harada
- Oral Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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Kubo T, Haramoto U, Yano K, Kakibuchi M, Takagi S, Nakai K, Sakai Y, Inohara H, Hosokawa K. Internal jugular vein occlusion in head and neck microsurgical reconstruction. Ann Plast Surg 2002; 49:490-4. [PMID: 12439016 DOI: 10.1097/00000637-200211000-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The internal jugular vein has been the preferred recipient vein in head and neck microsurgical reconstruction. However, recent reports have demonstrated internal jugular vein occlusion after functional neck dissection. The purpose of this article is to demonstrate and discuss the possibility of recipient internal jugular vein occlusion after free tissue transfer. Of 58 patients who received an end-to-side venous anastomosis with the internal jugular vein, four cases of recipient internal jugular vein occlusion were detected during the early postoperative period. Although the success rate of end-to-side anastomosis with the internal jugular vein may be high, microsurgeons should be aware of the possibility of internal jugular vein occlusion.
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Affiliation(s)
- Tateki Kubo
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Japan
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9
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Gueret G, Cosset MF, McGee K, Luboinski FB, Bourgain JL. Sudden death after neck dissection for cancer. Ann Otol Rhinol Laryngol 2002; 111:115-9. [PMID: 11860062 DOI: 10.1177/000348940211100202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this study was to analyze the mortality data following neck dissection and determine the risk factors of early death. The hospital mortality records were analyzed from 3,015 consecutive patients who underwent neck dissection. A case control study analyzed risk factors of death during the first 3 postoperative days. The mortality incidences were 0.50% and 1.33%, respectively, during the first 3 and the first 30 postoperative days. Eleven of the 12 unexplained deaths occurred during the first 3 postoperative days, and most of these patients died suddenly. They were more likely to be alcoholic and to have undergone nerve section. In most of the patients who died after the third postoperative day, death was related to a postoperative complication. Although the mechanisms of sudden death remain unclear, careful follow-up of these patients during the early postoperative days should be performed to reduce the mortality risk by shortening the delay of care.
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Affiliation(s)
- Gildas Gueret
- Department of Anesthesiology, Gustave Roussy Institute, Villejuif, France
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Prim MP, de Diego JI, Fernández-Zubillaga A, García-Raya P, Madero R, Gavilán J. Patency and flow of the internal jugular vein after functional neck dissection. Laryngoscope 2000; 110:47-50. [PMID: 10646715 DOI: 10.1097/00005537-200001000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the patency and flow of the internal jugular vein after functional neck dissection. STUDY DESIGN Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. METHODS Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. RESULTS In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. CONCLUSIONS According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.
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Affiliation(s)
- M P Prim
- Department of Otorhinolaryngology, La Paz Hospital, Autonomous University of Madrid, Spain.
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Katou F, Echigo S, Ito M, Shirai N, Ohtani H, Motegi K. Reliability of internal jugular vein in oral microvascular reconstruction. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:529-33. [PMID: 9830643 DOI: 10.1016/s1079-2104(98)90341-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to review the reliability of the internal jugular vein when used as a recipient vein in oral microvascular reconstruction. STUDY DESIGN A retrospective study was done of 36 consecutive cases in which microvascular reconstruction was accomplished with a free flap using the internal jugular vein in an end-to-side fashion. The postoperative patency of 25 internal jugular veins used as recipient veins was examined by postcontrast computed tomography scanning. RESULTS The overall flap success rate was 97%. Venous thromboses occurred in 2 cases. A common venous thrombosis occurred in one case, but the flap survived after re-anastomosis. In another case, internal jugular vein thrombosis occurred at 5 days of anastomosis, and the flap could not be salvaged by exploratory surgery. All other cases were completely uneventful. All internal jugular veins assessed on postcontrast computed tomography scans were patent at 51 to 107 days after surgery (mean, 89 days). CONCLUSION Internal jugular vein, if available, is reliable when used as a recipient vein in oral microvascular reconstruction. However, it is not necessarily flawless.
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Affiliation(s)
- F Katou
- Department of Oral and Maxillofacial Surgery 1, School of Dentistry, Tohoku University, Sendai, Japan
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12
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Myers EN, Fagan JJ. Treatment of the N+ neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Clin North Am 1998; 31:671-86. [PMID: 9687328 DOI: 10.1016/s0030-6665(05)70079-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article discusses the following aspects of the management of the N+ neck: evolution of neck dissection; specificity of staging of the clinically N+ neck; limitations of neck dissection in patients with adverse histologic features; management of bilateral nodal metastases, fixed nodes, and nodes with involvement of skin, nerves or the carotid artery; retropharyngeal nodes; and salvage treatment of the N+ neck following prior irradiation. A summary of the author's own approach is then presented.
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Affiliation(s)
- E N Myers
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wax MK, Quraishi H, Rodman S, Granke K. Internal jugular vein patency in patients undergoing microvascular reconstruction. Laryngoscope 1997; 107:1245-8. [PMID: 9292611 DOI: 10.1097/00005537-199709000-00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long-term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.
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Affiliation(s)
- M K Wax
- Department of Otolaryngology, Buffalo General Hospital, New York 14203, U.S.A
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