Management of chyle fistulization in association with neck dissection
Date
2000
Authors
Gregor R.T.
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Abstract
Chylous fistula after neck dissection is a relatively rare but potentially lethal complication. Sequelae range from severe fluid, electrolyte, and protein loss to fistula formation, skin-flap necrosis, and carotid blowout. A thorough knowledge of the anatomy is essential to avoid injury to the thoracic duct or right lymph duct. After surgery, drainage of large amounts of fluid, particularly if milky, may alert the surgeon to the danger of chylous leakage. Certain diagnosis, however, is not so easy. Once the diagnosis is made, the management has to address the immediate and late effects of the loss of chyle into an operative site. This article seeks to examine these factors through review of the literature and personal experience with the problem. Total parenteral nutrition allows for control of the fluid and protein loss while avoiding flow of chyle, and in most cases it results in resolution. In those cases that do not resolve, fibrin glue with some type of mesh and muscle flaps usually succeed in closure.
Description
Keywords
fibrin glue, adult, aged, article, chyle, clinical article, clinical feature, diagnostic approach route, fistula, head and neck carcinoma, human, male, muscle flap, neck dissection, reoperation, surgical anatomy, surgical equipment, surgical technique, total parenteral nutrition, Adult, Aged, Chyle, Cutaneous Fistula, Humans, Male, Middle Aged, Neck Dissection, Neoplasm Staging, Otorhinolaryngologic Neoplasms, Postoperative Complications, Reoperation, Thoracic Duct
Citation
Otolaryngology - Head and Neck Surgery
122
3
122
3