Complications in Neck Dissection : A Comprehensive, Illustrated Guide

This book is intended as a comprehensive reference on the anatomy, pathophysiology, and management of complications in neck dissection. The informative text is complemented by detailed clinical photos, high-quality illustrations, and clinical material from experienced and respected leaders in the field of neck surgery. An understanding of potential complications and early recognition of their signs and symptoms will prepare the surgeon to mitigate risk, minimize morbidity, and improve outcomes for each of their patients. Early recognition of the signs and symptoms of post-operative complications can prevent exacerbating the problem. Complications in Neck Dissection aims to shed light on these complications in greater detail and elaborate on their management. Written by experts in the field, the book reflects upon common and rare complications that are encountered and elaborates on how neck surgeons can prevent them. Preface Acknowledgment Contents Contributors 1: Neck Dissections: History, Classification, and Indications History of Neck Dissections for Oral/Head and Neck Cancer Cervical Lymph Nodes in Relation to Oral Cancer and Classification of Neck Dissections Comprehensive Neck Dissections for the Clinically Positive Neck Type I Modified Radical Neck Dissection Selective Neck Dissections for the Clinically Negative Neck Functional Neck Dissection (II–V) Supraomohyoid Neck Dissection (I–III) Indications for Neck Dissection and Their Outcomes Conclusion References 2: Complications Related to Skin Incisions, Design, and Skin Flaps Skin Anatomy and Physiology Histological Layers of the Skin Neurovascular Supply Skin Physiology General Skin Physiology Skin Flap Design and Blood Supply The Angiosome-Based Approach Flap Tension Flap Undermining Aging Wound Healing Skin Incision Designs MacFee Incision The Single Transverse Incision Schobinger Incision The Apron Incision Risk Factors Related to Neck Dissection Skin Incisions Management of Skin Incision Complications Prevention of Skin Incision Complications/General Considerations Nutritional Status/Diet Modification Habit Modification Medical Optimization Surgical Planning/Technique Management of Skin Incision Complications Conservative Management Wet to Dry Therapy Negative Pressure Wound Therapy [NPWT] Closed Surgical Drains [CSD] Invasive Measures Sharp/Surgical Debridement Surgical Management of Keloids/Hypertrophic Scars References 3: Infectious Complications Definitions, Epidemiology, and Risk Factors Pathogens Antibiotic Prophylaxis Other Forms of Mitigation Recognition Management Necrotizing SSI Outcomes Carotid Blowout Financial Burden Conclusion References 4: Complications Related to Lymphatics and Chyle Leak Introduction Embryology Anatomy of the Thoracic Duct Drainage Patterns of Various Anatomic Subsites of the Head and Neck Risk Factors of Chyle Leak The Risk of Lower Neck Nodal Involvement in Head and Neck Cancer Complications Arising from Chyle Leak Diagnosis of Chyle Leak Intraoperative Valsalva Maneuver Management of Chyle Leak Immediate Intraoperative Management Identification and Ligation Local Flaps Postoperative Diagnosis of Chyle Leak Postoperative Management Conservative Management Activity Modification Diet Modification Medium Chain Triglyceride (MCT) Elemental Formula Total Parenteral Nutrition (TPN) Wound Care Suction Drains Pressure Dressings Negative Pressure Wound Therapy Pharmacological Methods Somatostatin Orlistat Etilefrine Invasive and Surgical Treatment Percutaneous Transabdominal Lymphatic Access Transcervical Thoracic Duct Puncture Surgical Exploration Thoracoscopic Ligation of the Thoracic Duct Conclusion References 5: Vascular Complications Introduction Preoperative Considerations Intraoperative Vascular Complications Early Postoperative Complications Carotid Blowout Syndrome Internal Jugular Vein Blowout Pathophysiology of Early CBS and IJB Presentation and Management Late Postoperative Complications Management and Outcomes Vascular Considerations Related to Free Flaps with Concomitant Neck Dissection References 6: Neural Complications Complications Marginal Mandibular Nerve Spinal Accessory Nerve Lingual Nerve/Hypoglossal Nerves Great Auricular Nerve Cervical Plexus Brachial Plexus Phrenic Nerve Vagus Nerve Superior Laryngeal Nerve Cervical Sympathetic Chain References 7: Complications Related to Radical Neck Dissections and Management of Recurrent Neck Disease Introduction Chyle Complications Vascular Complications Nerve Complications Spinal Accessory Nerve Marginal Mandibular Branch of the Facial Nerve Vagus Nerve Phrenic Nerve Infection Management of Recurrent Neck Disease Workup and Diagnosis Salvage Surgery Reirradiation Systemic Therapy Palliative Care References 8: Other Complications Related to Neck Dissection Introduction Preoperative Considerations Intraoperative Complications Immediate Postoperative Complications Distant Postoperative Complications Conclusion References Index