[Patency and flow of the internal jugular vein after selective neck dissection].
OBJECTIVE
Evaluating the function of the internal jugular vein after selective neck dissection on patients affected by squamous cell carcinoma of the head and neck by color Doppler ultrasonography.


METHODS
Forty patients (76 internal jugular veins) who had undergone bilateral selective neck dissection(36 patients) or unilateral selective neck dissection (4 patients) were collected and divided into 2 groups depending on operation area. Group A consisted of 39 internal jugular veins (IJVs) which dissected level II, III and group B included 37 IJVs which disseted level II - IVor II - V spring the IJV. All patients underwent Doppler ultrasonography before and after selective neck dissection at the 1st and 3rd postoperative months. The following measurements were assessed in each test: presence of thrombosis, expiratory jugular flow, expiratory caliber, area both during expiratory and Valsalva maneuver, expiratory flow speed, Valsalva flow speed. All data were statistically analyzed in two groups by comparisons of preoperative conditions and postoperative conditions.


RESULTS
(1) None of the 76 internal jugular veins showed thrombosis before or after selective neck dissection. (2) Patency rate at the 1st and 3rd postoperative months were respectively 85.5% and 96.1%. Patency rate of the internal jugular vein in two groups showed no significant changes at the 1st and 3rd postoperative months (P > 0.05). (3) In group A, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory calibe, area during Valsalva maneuve, expiratory flow speed and Valsalva flow speed had significant difference at the 3rd postoperative months (P < 0.05), compared with preoperative. In group B, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory jugular flow had no significant difference at the 3rd postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. All parameters at the 3rd postoperative months had significant difference compared with 1st postoperative months between these two groups, excepting expiratory flow speed. (4) Differences of the operation area had no significant impact on indications of the internal jugular vein (P > 0.05).


CONCLUSIONS
(1) None of the internal jugular veins showed thrombosis after selective neck dissection. The results indicate that thrombosis of the internal jugular veins can be avoided though careful operation, proper operative skill, appropriate management postoperation. (2) Although most of the parameters changed at early stage after selective neck dissection, many of them improved at the 3rd postoperative months, and expiratory jugular flow recovered to the normal range. The results indicate that the internal jugular veins can basically maintain its normal function at long time postoperation.
Department of Otorhinolaryngology, First Affiliated Hospital, Liaoning Medical College, Jinzhou, 121001, China. lnxingweiwei@163.com
Weiwei
W
Xing
Xiaoni
X
Cai
Jingcheng
J
Gu
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000502:physiology*; D037981:Neck Dissection / Q000009:adverse effects*; D011184:Postoperative Period; D012039:Regional Blood Flow / Q000502:physiology; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000517:prevention & control