Preservation of the external jugular venous drainage system in neck dissection
Received 7 June 2009; received in revised form 20 August 2009; accepted 31 August 2009. published online 02 November 2009.
Abstract
Objective
To investigate whether preserving the external jugular vein (EJV) in neck dissection reduces postoperative edema of the face and neck.
Study Design
A prospective, randomized controlled trial.
Setting
A tertiary hospital.
Subjects and Methods
Thirty-eight subjects were randomly assigned to two groups: EJV preservation versus sacrifice during neck dissection after stratification according to the neck dissection extent and type, the previous treatment, the primary site, and the reconstruction type. The relative soft-tissue thickness was evaluated by follow-up computed tomography (CT) scans at one week and four to five weeks postoperatively and compared with preoperative findings. The preserved EJV patency was also determined by contrast enhancement of EJV on follow-up CT scans. In addition, the scores for pain/discomfort on the upper neck/face and laryngeal edema were recorded at each time point.
Results
Relative soft-tissue thickness reached up to 160 percent of preoperative status at the hyoid and cricoid levels at one week postoperatively but resolved at four to five weeks. EJV preservation reduced the soft-tissue thickness significantly compared with EJV sacrifice (P < 0.05) at one week postoperatively, particularly at the mandible and hyoid level. All preserved EJVs remained patent at one week, and 18 of 19 remained patent at four to five weeks. In addition, EJV preservation diminished the discomfort/pain of the upper neck/face compared with EJV sacrifice at one week (P = 0.036). The extent of laryngeal edema did not differ between the two groups.
Conclusion
EJV preservation may reduce immediate postoperative neck edema and pain/discomfort related to neck dissection.
Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding author: Han-Sin Jeong, MD, PhD, Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Gu, Seoul, 135-710, Korea
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT