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    Complications of Neck Dissection and Their Management

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    optimistsatish007
    This document discusses the complications that can occur during and after neck dissection surgery and their management. It covers intraoperative complications like hemorrhage and nerve injury. Immediate postoperative complications include bleeding, airway obstruction, and increased intracranial pressure. Intermediate complications include pulmonary issues, deep vein thrombosis, and infection. Delayed complications involve wound dehiscence, flap necrosis, and lymphedema.

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    Complications of Neck Dissection and Their Management

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    optimistsatish007
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    This document discusses the complications that can occur during and after neck dissection surgery and their management. It covers intraoperative complications like hemorrhage and nerve injury. Immediate postoperative complications include bleeding, airway obstruction, and increased intracranial pressure. Intermediate complications include pulmonary issues, deep vein thrombosis, and infection. Delayed complications involve wound dehiscence, flap necrosis, and lymphedema.

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    Neck dissection

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    COMPLICATIONS OF NECK DISSECTION AND THEIR MANAGEMENT

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    This document discusses the complications that can occur during and after neck dissection surgery and their management. It covers intraoperative complications like hemorrhage and nerve injury. Immediate postoperative complications include bleeding, airway obstruction, and increased intracranial pressure. Intermediate complications include pulmonary issues, deep vein thrombosis, and infection. Delayed complications involve wound dehiscence, flap necrosis, and lymphedema.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    29 views44 pages

    Complications of Neck Dissection and Their Management

    Uploaded by

    optimistsatish007
    This document discusses the complications that can occur during and after neck dissection surgery and their management. It covers intraoperative complications like hemorrhage and nerve injury. Immediate postoperative complications include bleeding, airway obstruction, and increased intracranial pressure. Intermediate complications include pulmonary issues, deep vein thrombosis, and infection. Delayed complications involve wound dehiscence, flap necrosis, and lymphedema.

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    © All Rights Reserved
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    of 44

    COMPLICATIONS OF NECK

    DISSECTION AND THEIR


    MANAGEMENT

    DR. BONU GOUDEL


    RESIDENT
    ORL AND HNS
    NAMS,BIR HOSPITAL
    INTRAOPERATIVE

    IMMEDIATE POST OPERATIVE

    LATE POST OPERATIVE

    DELAYED
    INTRAOPERATIVE COMPLICATIONS

    Haemorrhage
    Nerve injury
    Chyle leak
    Carotid sinus syndrome
    HAEMORRHAGE

    Most common cause: injury to internal jugular vein


    Precautions : a)Don’t use diathermy
    b)Don’t use artery forceps
    Management:1} pressure over the bleeding point
    2}ligation of the vein
    3}trendelenberg position
    4}stopping nitrous oxide from
    anaesthetic circuit.
    Injury to common carotid artery

    Most dreaded complication


    Extremely rare
    Cause of injury:
    1}Tumor attachment
    2}Previous surgery, radiation

    Management:
    Repair with ethilon 5-0.
    Vein Graft
    CHYLE LEAK

    During level IV L.N Dissection


    Incidence: 1-3 % cases
    FEATURES
    Whitish fluid in dissection area
    MANAGEMENT:
    DURING SURGERY: ligation of duct

    Valsalva performed at end of surgery.


    CAROTID SINUS SYNDROME

    Dissection across carotid bifurcation.

    MANIFESTATION: Bradycardia

    MANAGEMENT
    Cessation of manipulation to carotid sinus area
    Lignocaine
    Nerve injury

    Nerves damaged deliberately:


    1. Accessory nerve
    2. Branches of cervical plexus: a) lesser occipital
    b) greater auricular
    c) transverse cutaneous
    d) supraclavicular
    3. Descendens hypoglossi
    Spinal accessory nerve damage

    Shoulder syndrome
     Denervation of trapezius muscle.
     Approximately 60% of patients undergoing radical neck
    dissection.
    SYMPTOMS
    1. Limitation of abduction
    2. Pain in shoulder joint
    3. Dropping of affected shoulder
    Management:
     Physiotherapy
    Nerves damaged accidentally

    1. Sensory branches of cervical root


    2. Greater auricular nerve
    3. Facial nerve or its marginal mandibular branch or
    cervical branch
    4. Hypoglossal nerve
    5. Lingual nerve
    6. Vagus nerve
    7. Phrenic nerve
    8. Brachial plexus
    POSTOPERATIVE COMPLICATIONS

    IMMEDIATE POSTOPERATIVE

    1. Bleeding
    2. Carotid artery rupture
    3. Airway obstruction
    4. Increased intracranial pressure
    5. Pneumothorax/Haemothorax
    BLEEDING

    Immediate
    Reactionary
    Secondary

    PRESENTATION:
    Bleeding via the suture site
    Swelling of wound site (haematoma)
    MANAGEMENT
    Diagnose the problem
     Resuscitate the patient
     Stop the bleeding
     Treat the cause
    CAROTID ARTERY RUPTURE

    Dreaded complication
    3-4 %(stell and maran’s,5th edition)

    CAUSES
    Prior radiation (RISK INCREASES BY 7 FOLD)
     Significant atheromatous disease
    Tumour adherence
     Extensive deep scarring
    Wound infection
    MANAGEMENT

    GENERAL
    Fluid resuscitation (crystalloid and blood)
    Pressure application
    Debridement and wound toilet
    Appropriate antibiotic therapy
    Adequate nutrition
    SPECIFIC
    Exploration ,debridement and ligation
    AIRWAY OBSTRUCTION

    In bilateral neck dissections


    SIGNS:
    Stridor/stretor
    Increased respiratory rate
    Use of accessory muscles of respiration
    Agitation/confusion
    Peripheral cyanosis
    MANAGEMENT:
    Humidified oxygen
    Systemic corticosteroids
    Nebulization

    IN CASE OF FAILURE:
    TRACHEOSTOMY
    INCREASED INTRACRANIAL PRESSURE

    Rises three-fold when one internal jugular vein is


    divided
     Five-fold when both are tied

    CLINICAL FEATURES
    Restlessness and headache
    Bradycardia
     Increasing blood pressure
     Facial cyanosis and swelling
    MANAGEMENT

    Measures to help reduce the risk of raised ICP


     No constricting dressings around the neck
     Avoid hyperextension of neck (especially after
    bilateral dissection)
     Nurse upright.
    TREATMENT
    Osmotic diuresis : intravenous mannitol (200mL of
    25 per cent )
    Prompt diuresis will occur within 10–15 minutes
    PNEUMOTHORAX

    Damage to apical pleura


    CLINICAL FEATURES:
    MANAGEMENT
    1. Small iatrogenic pneumothorax: conservative
    management.
    2. Large pneumothorax: placement of chest drain
    INTERMEDIATE POSTOPERATIVE COMPLICATIONS

    Pulmonary complications
    Deep vein thrombosis
    Chylous fistula
    Carotid artery rupture
    PULMONARY COMPLICATIONS

    Basal collapse
    Bronchopneumonia

    RISK FACTORS
    Smokers
    COPD
    DEEP VEIN THROMBOSIS

    Longer
    Old age duration of
    surgery

    Long Previous
    bedridden history of
    patients DVT
    CLINICAL FEATURES

    Pain
    Edema
    Warmth
    Tenderness
    MANAGEMENT

    D-dimer test
    Usg
    Venography

    Management:
    Leg elevation
    Heparin,warfarin
    CHYLOUS FISTULA

    Presence of milky fluid in drain


    CONFIRMTION:
    Triglycerides more than 100mg/dl
    Chylomicrons more than 4 % in drained fliud.

    Mangement:
    Conservative:aspiration,pressure bandage,low fat diet
    Surgical: re-exploration and ligation of duct.
    Infection

    RISK FACTORS:
    Inadequate hemostsis Poor wound care
    Inadequte drainage Poor nutrition

    Intraopea Post
    Longer duration of procedure Early mobilization
    Inadequate surgical procedure Patient in ICU,HDU

    rative operative
    risk risk
    factor factor
    FEATURES

    Erythema
    Warmth
     Induration of the cervical skin flaps
     Abscess formation from an infected seroma or
    hematoma, or fistula
    MANAGEMENT:
    Daily dressing
    Antibiotics
    Proper nutrition
    BLINDNESS

    Following bilateral neck dissection

    CAUSES
    Hypotension during surgery
    Anaemia
    Increased venous pressure
    SEROMA

    Frequent complication
    PRESENTATION:
    Occurs 3-4 days following surgery
    Fullness in the neck

    MANAGEMENT
    Repeated aspiration
    PREVENTION
    Maintain mean arterial pressure
    Normalization of haemoglobin level
    Vein graft if bilateral IJV sacrificed
    DELAYED COMPLICATIONS

    Wound dehiscence
    Flap necrosis
    Lymphedema
    Hypertrophic scars
    WOUND DEHISCENCE

    FACTORS :

    Wound infection
    Poor nutrition
    Prior radiation therapy
    Poor incision and flap design
    Continued smoking during the perioperative period.
    FLAP NECROSIS

    Skin Flaps :Sub-platysmal.


    Skin flaps should not be allowed to dry out
    Underlying hematoma and seroma should be
    corrected.
    References:
    • Scott brown 8th edition, volume 3
    • Scott brown 7th edition, volume 3
    • Cummings ORL HNS 6th Edition
    • Stell& maran textbook of head and neck surgery and
    oncology
    • Saataloff’s comprehensive textbook of otolaryngology
    head and neck surgery
    Complications of Neck Dissection Nader Saki and
    Soheila Nikakhlagh Cancer Research Center of Ahvaz
    Jundishapur University of Medical Science,Iran
     Management of neck dissection complications in head
    and neck cancers, International Surgery Journal
    Bhushan SN et al. Int Surg J. 2019 Mar;6(3):664-668
    THANK YOU

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