Radical neck dissection: a 19-year experience

Abstract

A series of 394 radical neck dissections performed over the 17 year period 1969–1986 is presented. The shortest period of follow-up is two years. Of the major complications reviewed, wound breakdown was associated with T stage, prior radiotherapy and incision used but not with age or N stage. Cervical recurrence was associated with N stage, prior radiotherapy and surgical incision and inversely associated with age. Wound breakdown and recurrence were lowest in parotid primary tumours. Carotid artery rupture occurred in 17 patients (4.3 per cent), was fatal in all cases and was strongly associated with wound breakdown and previous radiotheraphy. The importance of the choice of incision, clearance of the posterior belly of the digastric muscle and carotied artery protection are discussed.

Acute Life-Threatening Hemorrhage in Patients with Head and Neck Cancer Presenting with Carotid Blowout Syndrome: Follow-Up Results after Initial Hemostasis with Covered-Stent Placement

“…1,2 The reported incidence of carotid artery rupture after radial neck dissection is 4.3%. 3 Patients with CBS can have a variety of presentations with the most significant being acute life-threatening hemorrhage. CBS more frequently occurs in patients with HNC and those with radiationinduced necrosis, recurrent tumors, wound complications from neck dissection, or vessel erosion from pharyngocutaneous fistulas.…”

Carotid Blowout Treated by Direct Percutaneous Puncture of Internal Carotid Artery with Temporary Balloon Occlusion

“…In patients with head and neck cancers, previous irradiation increases their risk of carotid blowout syndrome 7.6-fold 2,4 . The carotid artery ruptures if its wall is damaged as a result of ischemia, as it receives 80% of its blood supply from the adventitia 7 . Emergency surgical ligation of the ICA or common carotid artery is typically used to treat carotid blowout syndrome.…”

Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout

“…[1][2][3][4] Patients with head and neck cancer who have radiation-induced necrosis, tumor recurrence, pharyngocutaneous fistulas, or wound complications are more prone to develop CBS. 5,6 The emergency surgical management of CBS, which involves ligating the common carotid artery (CCA) or ICA, is a technically challenging procedure that is associated with high risk of cerebral ischemia.…”

“…5,6 The emergency surgical management of CBS, which involves ligating the common carotid artery (CCA) or ICA, is a technically challenging procedure that is associated with high risk of cerebral ischemia. 4,7,8 For a patient with CBS and a diseased CCA and/or ICA, permanent CCA and/or ICA occlusion (PCO) with coils is an effective treatment that produces better clinical outcomes compared with stent-graft placement 9 and has been the standard treatment in our institution. Still, thromboembolic infarction and borderzone infarction occurred in approximately 20% of patients.…”