Internal Jugular Vein Thrombosis Following Different Types of Neck Dissection

Document Type : Original

Authors

1 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Oncologic Surgery, Cancer Institute, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran.

3 Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:
During functional neck dissection, the surgeon tries to preserve the internal jugular vein (IJV); however, the incidence of its narrowing or obstruction following modified radical neck dissection (MRND) or selective neck dissection (SND) varies between 0% and 29.6%. The most distressing complication of IJV thrombosis (IJVT) is pulmonary embolism. This study aimed to evaluate the incidence of IJVT following selective or modified radical neck dissection. 
 
Materials and Methods:
In this study, 109 neck dissections were performed with the preservation of the IJV on 89 patients from March 2011 to December 2012 in the Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Ultrasound evaluation of the IJV was performed in the early postoperative period and three months after the surgery.
 
Results:
The study population consisted of 62 male and 27 female patients with a mean age of 57+17.57 years. Ultrasound evaluation of the IJV among the participants (109 veins) indicated thrombosis in nine veins (8.25%) in the early postoperative period, four of which remained thrombotic and without flow three months after the surgery. Moreover, 96.33% of the IJVs were patent with a normal blood flow three months after the neck dissection. Among the evaluated IJVs, the only factor that showed a significant association with IJVT was the incidence of postoperative complications, including hematoma and seroma (P=0.01).

 Conclusion:
It seems that the most important factor for the prevention of the IJVT is a meticulous surgery and surgical complication avoidance during neck dissection.

Keywords


  1. Ferlito A, Rinaldo A, Silver CE, Shah JP, Suárez C, Medina JE, et al. Neck dissection: then and now. AurisNasus Larynx.2006 Dec; 33(4):365-74.

2.                    Mamede RC, Figueiredo DL, Mamede FV. Blindness after laryngectomy and bilateral neck dissection in a diabetic patient: case report.Sao Paulo Med J. 2001 Sep; 119(5):181-3.

  1. Howe DJ, Henderson MJ, Ahmad I. Superior sagittal sinus thrombosis complicating neck dissection. J Laryngol Otol. 2010 Oct; 124(10): 1126-8.
  2. Makiguchi T, Yokoo S, Ogawa M, Miyazaki H. Factorsinfluencing internal jugular vein patency after neck dissection in oral cancer. Int J Oral Maxillofac Surg. 2015 Oct; 44(10):1218-24.
  3. Nagata T, Matsunaga K, Kawazu T, Kawano S, Oobu K, Ohishi M. Patencyassessment of the internal jugular vein after neck dissection..Int J Oral Maxillofac Surg. 2006 May; 35(5):416-20.
  4. Harada H, Omura K, Takeuchi Y. Patencyand caliber of the internal jugular vein after neck dissection. Auris Nasus Larynx. 2003 Aug; 30(3): 269-72.
  5. Wüstenberg EG, Offergeld C, Zahnert T, Hüttenbrink KB, Kittner T. Extension of intracranial thrombosis after unilateral dissection of the internal jugular vein. Arch Otolaryngol Head Neck Surg. 2005 May;131(5):430-3.

8.                    Yucel EA, Orhan KS, Guldiken Y, Aydin K, Simsek T, Erdamar B, et al. Evaluation of factors concerning the patency of the internal jugular vein after functional neck dissection. Eur Arch Otorhinolaryngol.  2003 Jan; 260(1):35-8.

  1. Hudgins PA, Kingdom TT, Weissler MC, Mukherji SK. Selective neck dissection: CT and MR imaging findings. AJNR Am J Neuroradiol. 2005 May; 26(5):1174-7.
  2. Brown DH, Mulholland S, Yoo JH, Gullane PJ, Irish JC, Neligan P, et al. Internaljugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction. Head Neck. 1998 Mar; 20(2):169-74.
  3. Cappiello J, Piazza C, Berlucchi M, Peretti G, De Zinis LO, Maroldi R, et al. Internal  jugular Vein patency after lateral neck dissection:  prospective study. Eur Arch Otorhinolaryngol.2002 Sep; 259(8): 409-1.