title: Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction.
abstract: BACKGROUND
  The incidence of internal jugular vein thrombosis (IJVT) following a modified neck dissection remains uncertain. The effect of, or consequences following, IJVT upon pedicled and free flap head and neck reconstructions remains unexplored.
  
  
  METHODS
  Twenty-nine preserved internal jugular veins in 24 patients undergoing modified neck dissection were available for prospective study. All patients required a pedicled or free flap reconstruction and received a modified, unilateral or bilateral cervical lymphadenectomy. The patency of all jugular veins was determined preoperatively and postoperatively using a combination of computed tomography (CT) scanning, high-resolution ultrasound, and color-flow Doppler (CFD).
  
  
  RESULTS
  The IJVT rate was 14%. The presence of a pedicled myocutaneous flap and left-sided jugular dissections may represent risks to the postoperative patency of the internal jugular vein. Preoperative radiotherapy did not appear to impact negatively upon the thrombosis rate.
  
  
  CONCLUSIONS
  Thrombosis of the internal jugular vein may result in significant morbidity for the postoperative oncologic patient. An internal jugular-dependent-free-tissue transfer may risk venous compromise of the flap, whereas the use of a pedicled flap may place the jugular at increased risk for thrombosis. Strategies for deep venous system microvascular recipient recruitment in the head and neck are discussed. Wherever possible, we employ two deep venous systems, the internal jugular, and subclavian (via the external jugular) for flap drainage.
authors.affiliation: Department of Otolaryngology/Head and Neck Program, The Toronto Hospital, University of Toronto, Ontario, Canada.
authors.forename: D H
authors.initials: DH
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Mulholland
authors.forename: J H
authors.initials: JH
authors.lastname: Yoo
authors.forename: P J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: J C
authors.initials: JC
authors.lastname: Irish
authors.forename: P
authors.initials: P
authors.lastname: Neligan
authors.forename: A
authors.initials: A
authors.lastname: Keller
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D009333:Neck / Q000098:blood supply / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D016038:Skin Transplantation / Q000379:methods; D013350:Subclavian Vein / Q000473:pathology; D013524:Surgical Flaps / Q000473:pathology*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency