120 COMPLICATIONS of NECK SURGERY Flashcards
Classification of neck surgery complications classification
Wound
Vascular
Nerve
Chyle
Blood supply to neck skin: (4)
FOST
branches of
F acial
O ccipital
branches of
Suprascapular
Transverse Cervical
Wound complications:
Incision Planning Wound Dehiscence and Flap Necrosis Seroma Wound infection Salivary Fistula Scar formation Lymphedema
Possible complication of untreated seroma:
Flap necrosis or infection
Seroma:
JP drain cut off in 24 hr period
25 mL
Causes of seroma formation:
Incorrect drain placement.
Drain failure.
Early removal of JP drain.
Management options for Seroma formation:
Needle aspiration
Drain placement
Observation (for small seromas)
Single most important factor that contributes to risk of wound infection:
Aerodigestive tract entry
Saliva may enter wound from:
Aerodigestive tract communication
Parotid leak
Management of salivary fistula
Antibiotics, broad spectrum
Continued closed drainage
- clinician should have low threshold for opening a suture line to divert drainage away from major blood vessels
What to do if fistula refractory to conservative measures
Closure with vascularized tissue
Manifestation of lymphedema in neck dissection, clinically:
Pitting edema
Most feared sequelae of neck surgery
Carotid artery hemorrhage
Treatment of carotid artery rupture
Direct pressure
Fluid resuscitation
Vessel ligation
TCVS consult
Factors to differentiate hematoma from seroma:
Firm on palpation
Skin echymossis
Clotted drain output
Branches of FN at risk during standard ND
Cervical
Marginal mandibular
Clinical manifestation of marginal mandibular nerve injury
Asymmetry of lower lip at rest, inability to depress lip during facial expression
High CN X injury clinical manifestations:
Dysphonia from vocal fold paralysis
Dysphagia with pooling of secretions - loss of pharyngeal muscle function and sensory loss
Dx to rule out chylothorax
CXR
Possible MOTOR nerves that can be injured during ND:
Cervical and Marginal mandibular branches of FN
CN X
CN XI
CN XII
Phrenic Nerve
Possible SENSORY nerves that can be injured during ND:
Lingual Nerve
GAN
Cervical sympathetic nerves
Nerve - Clinical manifestation of injury
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)
Horner syndrome
Miosis
Anhidrosis
Ptosis
Majority of chyle leaks occur on this side
Left
Diagnosis of chyle leak post op:
Change in character of drain output from serosanguinous to milky
Treatment for most chyle leaks
Conservative mnagement
Nerve: Area of dissection where prone to injury:
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
