120 COMPLICATIONS of NECK SURGERY

Question 1

Classification of neck surgery complications classification

Answer 1

Wound
Vascular
Nerve
Chyle

Question 2

Blood supply to neck skin: (4)

Answer 2

FOST

branches of

F acial
O ccipital

branches of
Suprascapular
Transverse Cervical

Question 3

Wound complications:

Answer 3

Incision Planning
Wound Dehiscence and Flap Necrosis
Seroma
Wound infection
Salivary Fistula
Scar formation
Lymphedema

Question 4

Possible complication of untreated seroma:

Answer 4

Flap necrosis or infection

Question 5

Seroma:

JP drain cut off in 24 hr period

Answer 5

25 mL

Question 6

Causes of seroma formation:

Answer 6

Incorrect drain placement.

Drain failure.

Early removal of JP drain.

Question 7

Management options for Seroma formation:

Answer 7

Needle aspiration
Drain placement
Observation (for small seromas)

Question 8

Single most important factor that contributes to risk of wound infection:

Answer 8

Aerodigestive tract entry

Question 9

Saliva may enter wound from:

Answer 9

Aerodigestive tract communication

Parotid leak

Question 10

Management of salivary fistula

Answer 10

Antibiotics, broad spectrum
Continued closed drainage

• clinician should have low threshold for opening a suture line to divert drainage away from major blood vessels

Question 11

What to do if fistula refractory to conservative measures

Answer 11

Closure with vascularized tissue

Question 12

Manifestation of lymphedema in neck dissection, clinically:

Answer 12

Pitting edema

Question 13

Most feared sequelae of neck surgery

Answer 13

Carotid artery hemorrhage

Question 14

Treatment of carotid artery rupture

Answer 14

Direct pressure

Fluid resuscitation

Vessel ligation

TCVS consult

Question 15

Factors to differentiate hematoma from seroma:

Answer 15

Firm on palpation
Skin echymossis
Clotted drain output

Question 16

Branches of FN at risk during standard ND

Answer 16

Cervical

Marginal mandibular

Question 17

Clinical manifestation of marginal mandibular nerve injury

Answer 17

Asymmetry of lower lip at rest, inability to depress lip during facial expression

Question 18

High CN X injury clinical manifestations:

Answer 18

Dysphonia from vocal fold paralysis

Dysphagia with pooling of secretions - loss of pharyngeal muscle function and sensory loss

Question 19

Dx to rule out chylothorax

Answer 19

CXR

Question 20

Possible MOTOR nerves that can be injured during ND:

Answer 20

Cervical and Marginal mandibular branches of FN

CN X

CN XI

CN XII

Phrenic Nerve

Question 21

Possible SENSORY nerves that can be injured during ND:

Answer 21

Lingual Nerve
GAN

Cervical sympathetic nerves

Question 22

Nerve - Clinical manifestation of injury

Answer 22

CN VII:
Mm branch - asymmetry of lower lip and inability to depress lip

CN X - dysphonia, dysphagia

XI: shoulder drooping, abberant scapular rotation, inability to fully abduct shoulder,
Constant dull ache secondary to atrophy of trapezius and adhesive capsulitis of GH joint

Hypoglossal: ipsilateral tongue weakness, deviation of tongue to affected side with protrusion, difficulty with speech and swallowing

Phrenic nerve: ipsilateral diaphragm elevation, cough, chest pain or abdominal discomfort

Lingual nerve: loss in taste and sensation in anterior 2/3 of tongue

GAN: sensory deficit of auricle that usually decreases with time; ear lobule numbness persists

Cervical sympathetic nerves: Horner syndrome (full transection)

Question 23

Horner syndrome

Answer 23

Miosis
Anhidrosis
Ptosis

Question 24

Majority of chyle leaks occur on this side

Answer 24

Left

Question 25

Diagnosis of chyle leak post op:

Answer 25

Change in character of drain output from serosanguinous to milky

Question 26

Treatment for most chyle leaks

Answer 26

Conservative mnagement

Question 27

Nerve: Area of dissection where prone to injury:

Answer 27

CN VII Mm - level I - as it descends along inferior border if mandible and lateral to SMG

CN X - Ivl III/IV - posterolateral to anteromediql clearance of level III and IV; ligation of IJV in inferior neck or skull base

CN XII: lvl I and II, near greater cornu of hyoid bone, adjacent to carotid artery

Lingual: level I, other surgical procedures of SM triangle

GAN: emerges from under posterior border of SCM in too half of level V and travels across lateral surface of SCM towards auricle