Please enter verification code
Confirm
An Analysis of Complications of Neck Dissection in Head and Neck Cancers
International Journal of Clinical Oncology and Cancer Research
Volume 5, Issue 2, June 2020, Pages: 24-28
Received: Apr. 12, 2020; Accepted: May 3, 2020; Published: May 19, 2020
Views 337      Downloads 102
Authors
Shashidhar Kallappa, Department of Surgical Oncology, Karnataka Institute of Medical Sciences, Hubli, India
Prajwal Dange, Department of Otorhinolaryngology, Karnataka Institute of Medical Sciences, Hubli, India
Article Tools
Follow on us
Abstract
The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century. During this time its role has expanded from a purely therapeutic option to an elective setting. Since vital anatomical structures are close, certain risks and complications are inherent to this procedure. Since neck surgery remains the most frequently performed form of therapeutic surgery in head and neck cancer irrespective of primary disease site, our objective is to report the complications in various types neck dissections and to seek improved outcome. A cross sectional retrospective study of 52 patients who underwent neck dissection from August 2015 to August 2019 was conducted to analyse intra operative and post-operative complications which aroused due to neck dissection. Indications for neck dissection depended on neck staging (N): selective neck dissection was done when evident disease was absent; Modified radical neck dissection was done if there was clinically evident neck node, preserving non-lymphatic neck structures (accessory nerve, internal jugular vein and internal jugular vein) as long as surgical completeness was not compromised. Bilateral neck dissection was indicated if contralateral disease was suspected or present. Out of 52 patients, one radical neck dissection, 14 modified radical and 37 selective neck dissection, of which 32 underwent supra omohyoid neck dissection and 5 underwent anterolateral and posterolateral neck dissection. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (2.1%). There was one death. A careful preoperative assessment of the patient, meticulous surgical techniques, good-quality postoperative care and appropriate rehabilitation are the cornerstones of preventing and managing complications of neck dissection.
Keywords
Neck Dissection Complications, Head and Neck Cancers, Marginal Mandibular Nerve Injury, Spinal Accessory Nerve Injury, IJV Injury
To cite this article
Shashidhar Kallappa, Prajwal Dange, An Analysis of Complications of Neck Dissection in Head and Neck Cancers, International Journal of Clinical Oncology and Cancer Research. Vol. 5, No. 2, 2020, pp. 24-28. doi: 10.11648/j.ijcocr.20200502.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Smullen JL, Lejeune FEJ. Complications of neck dissection. J La State Med Soc. 1999 Nov; 151 (11): 544–7.
[2]
Crile G. Excision of Cancer of the Head and Neck. With special reference to the plan of dissection based on 132 patients. Jama. 1906; 47: 1780–6.
[3]
Suarez O. El problema de las metastasis linfáticas y alejadas del cáncer de laringe e hipofaringe. Rev Bras Otorrinolaringol. 1963; 23,: 83-99.
[4]
Ferlito A, Gavilàn J, Buckley JG, Shaha AR, Miodoński AJ, Rinaldo A. Functional neck dissection: Fact and fiction. Head Neck. 2001 Sep 1; 23 (9): 804–8.
[5]
Paleri V WJ. in: Stell & Maran’s Textbook of Head and Neck Surgery and Oncology. 5th ed. London: Hodder Arnold. 2012. 663 p.
[6]
Malgonde M, Kumar M. Complications after neck dissection. Med J Dr DY Patil Univ. 2015; 8 (4): 458.
[7]
Arnold H. Complications and their managment. In: Stell & Maran’s Textbook of Head and Neck Surgery and Oncology, fifth edition. 2012. p. 195–213.
[8]
Coskun H, Erisen L BO. Factors affecting wound infection rates in head and neck surgery. Otolaryngol Neck Surg. 2000; 123: 328–33.
[9]
Scottish Intercollegiate Guidelines Network. Antibiotic prophylaxis in surgery, Guideline number 104,. Available from: www.sign.ac.uk/pdf/sign104.pdf.
[10]
Grandis JR, Vickers RM, Rihs JD, Yu VL, Wagner RL, Kachman KK, et al. The efficacy of topical antibiotic prophylaxis for contaminated head and neck surgery. Laryngoscope. 1994; 104 (6): 719–24.
[11]
Walker FDL, Cooke LD. Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery. Clin Otolaryngol. 2007; 32 (5): 405.
[12]
Williams J, Toews D, Prince M. Survey of the use of suction drains in head and neck surgery and analysis of their biomechanical properties. J Otolaryngol. 2003 Feb; 32 (1): 16–22.
[13]
Martin D. Batstone BS, Derek Lowe SNR. Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance. Head Neck. 2009; 31: 673–678.
[14]
Prim MP, De Diego JI, Verdaguer JM, Sastre N, Rabanal I. Neurological complications following functional neck dissection. Eur Arch Oto-Rhino-Laryngology. 2006; 263 (5): 473–6.
[15]
Nason RW, Binahmed A, Torchia MG TJ. Clinical observations of the anatomy and function of the marginal mandibular nerve. Surg, Int J Oral Maxillofac. 2007; 36: 712–715.
[16]
Edwards BM, Kileny PR. Intraoperative neurophysiologic monitoring: indications and techniques for common procedures in otolaryngology-head and neck surgery. Otolaryngol Clin North Am. 2005 Aug; 38 (4): 631–42, viii.
[17]
Charles R RS. Rob Charles Operative Surgery. London: Butterworths; 1983; 524–5.
[18]
Rödel R LJ. Peripheral branches of the facial nerve in the cheek and chin area. Anatomy and clinical consequences. HNO. 1996; 44: 572–6.
[19]
Converse JM. Head and neck surgery. In: Plastic and Reconstructive Surgery 2nd ed, Vol 5 Philadelphia, Landon, Toronto: WB Saunders and Company. 1979. p. 112.
[20]
Shockley WW, McQueen CT PG. Complications of neck surgery. In: Weissler MC, Pillsbury HC (eds) Complications of head and neck surgery Thieme, New York,. 1995. p. 122–158.
[21]
Short SO, Kaplan JN, Laramore GE CC. Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve. Am J Surg. 1984; 148: 478–82.
[22]
Nori S, Soo KC, Green RF, Strong EW MS. Utilization of intraoperative electroneurography to understand the innervation of the trapezius muscle. Muscle Nerve. 1997; 20: 279–285.
[23]
El Ghani F, Van Den Brekel MWM, De Goede CJT, Kuik J, Leemans CR, Smeele LE. Shoulder function and patient well-being after various types of neck dissections. Clin Otolaryngol Allied Sci. 2002; 27 (5): 403–8.
[24]
McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ et al. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: A randomized controlled trial. Cancer. 2008; 113: 214–22.
[25]
Weisberger EC, Lingeman RE. Cable grafting of the spinal accessory nerve for rehabilitation of shoulder function after radical neck dissection. Laryngoscope. 1987 Aug; 97 (8 Pt 1): 915–8.
[26]
Suhas N. Bhushan AHN. Management of neck dissection complications in head and neck cancers Suhas N. Bhushan, Arun H. N. Int Surg J. 2019; Mar; 6 (3): 664–8.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186