INTERNAL JUGULAR-VEIN THROMBOSIS AFTER FUNCTIONAL AND SELECTIVE NECK DISSECTION

Objective: To determine the incidence of internal jugular vein thrombo sis after functional or selective neck dissection. Design: Patients un derwent serial Doppler ultrasonographic examinations of their internal jugular veins, on postoperative days 1 and 7, following functional ne ck dissection. Long-term follow-up was conducted at a minimum of 3 mon ths. Setting: Department of Otolaryngology, West Virginia University, Morgantown. Patients: Sixty-five patients (51 men and 14 women) underw ent 100 functional neck dissections between 1993 and 1995. Thirty-five patients had N0, 10 had N1, and 20 had N2 node involvement, respectiv ely. Thirty-five patients underwent bilateral neck dissection, 17 unde rwent left neck dissection, and 13 underwent right neck dissection. Ma in Outcome Measures: Thrombosis of the internal jugular veins was dete rmined using duplex Doppler scanning. Correlation with the length of t he procedure, intraoperative blood loss, preoperative radiation therap y, stage of neck disease, presence of extracapsular spread, wound infe ction, and pedicled musculocutaneous flap closure was determined. Resu lts: Of the 100 internal jugular veins studied, 20 (24.7%) of 81 and 1 9 (26.4%) of 72 were found to have evidence of thrombosis on postopera tive days 1 and 7, respectively. On long-term follow-up, the incidence of internal jugular vein thrombosis was significantly lower (5.8%; P< .001). None of the variables examined correlated significantly with th e presence of thrombosis. Of the 20 veins that were thrombosed initial ly, on follow-up 13 had normal-flow and 2 had persistent thrombosis. F ive patients were unavailable for follow-up. No thrombosis developed a s a late finding. Conclusions: Our results indicate that even though t he incidence of internal jugular vein thrombosis is relatively high im mediately following neck dissection, a significant number of these vei ns will undergo recanalization and have excellent long-term patency.