title: Cervical chyloma after neck dissection: a case report.
abstract: Cervical chylomas are rare pseudocystic collections that lack an epithelial lining and arise from the thoracic duct or its tributaries; although they typically develop after neck surgery or trauma, they can arise from unknown causes. Treatment options include not only conservative therapy, such as dietary modification, repeated aspirations, and sclerotherapy, but also include surgical excision. We describe a case of a chyloma in a 64-year-old Japanese woman with squamous cell carcinoma of the gingiva. The chyloma developed following left segmental mandibulectomy with radical neck dissection and reconstruction, using a titanium plate and a pectoralis major myocutaneous flap. One month after surgery, a left supraclavicular swelling was noted, so ultrasound-guided fine-needle aspiration and cytology were performed to exclude a recurrence of neck metastasis. The aspiration yielded a milky fluid without atypical or malignant cells on cytology, confirming the diagnosis of chyloma. Although we performed continuous compressive dressing and started the patient on a low-fat diet, the mass persisted. When the patient died of bone, lung, and liver metastases five months after the second surgery, the mass had not changed in size. Awareness of this complication is important to ensure timely diagnosis and appropriate treatment.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohto
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Shibata
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Nishiwaki
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Umemura
mesh_terms: D002916:Chylothorax / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D009364:Neoplasm Recurrence, Local; D013897:Thoracic Duct / Q000473:pathology
keywords: cervical chyloma; conservative therapy; lymphocele; thoracic duct