A morphological study of the thoracic duct at the jugulo-subclavian junction

Chylous fistulae are uncommon but serious complications of neck surgery, oc curring with an incidence of 1-3% after radical neck dissection. The majori ty occur on the left side (75-92%) and are due to damage to the terminal se gment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoraci c duct may be influenced by anatomical variations. The macroscopic arrangement of the termination of the thoracic duct in the left neck was examined in 24 UK cadavers. Twenty-one ducts terminated as a single vessel, two ducts showed a bifid termination and one duct had three terminal branches. The precise site of termination was variable. Five thora cic ducts showed branching and re-anastamosing patterns prior to their term ination, irrespective of the number of terminal branches. Subsidiary cervic al lymph trunks were identified in four dissections. These variations are d escribed and their relevance to surgery involving the left side of the neck is discussed.