Internal Jugular Vein Injury Research Articles

Pediatric vagal nerve stimulator explantation: A comprehensive literature review and tertiary care experience.

Patients with medically-refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require device removal. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. This comprehensive literature review and case series studies safety outcomes among pediatric patients undergoing complete VNS explantation. Literature review and tertiary care case series. PubMed, Embase, Web of Science, and Google Scholar were searched to identify all articles involving VNS explantation prior to January 2023. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009 to 2023at our tertiary center was also conducted. After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary VF paresis or dysphonia (n=14; 3.6%), permanent vocal fold (VF) paralysis/paresis (n=6; 1.5%), internal jugular vein injury (n=4; 1.0%), temporary dysphagia (n=2; 0.50%), and cable-bowstring phenomenon (n=1; 0.25%). Data from our tertiary care center revealed eight patients (6M: 2F) with a mean age of 11.4±6.2 years. Devices were removed for clinical ineffectiveness (n=2), infection (n=2), lead failures (n=2), and increased lead impedance (n=2). Mean total length of implantation was 44.4±40.3 months. Mean follow-up was 44.8±35.2 months. No complications were identified. Complete VNS device removal in pediatric patients is technically feasible with low reported complications. Working alongside neurosurgery, otolaryngologists offer unique expertise in dissection along the vagus nerve and may thus add value to the practice of VNS surgery.

Completion thyroidectomy and lateral neck dissection revealed adhesions in the lateral neck compartment after gasless transaxillary endoscopic thyroidectomy: a case report

Endoscopic thyroidectomy is effective and safe surgical option for thyroid surgery while providing satisfactory cosmetic results. Gasless transaxillary endoscopic approaches have been reported to achieve endoscopic thyroidectomy in our center. We present a patient who previously underwent gasless transaxillary endoscopic lobectomy with ipsilateral central neck dissection who underwent open completion thyroidectomy and lateral neck dissection (LND) (reoperation) in our center. The ultrasound test before the first treatment did not reveal abnormal lymph nodes in the central and lateral neck compartments. Further evaluation of the neck lymph nodes was not performed. Meanwhile, this patient did not participate in the originally planned follow-up at the 3- and 6-month visits. At the one-year visit, imaging tests revealed enlarged and suspicious malignant lymph nodes in levels III and IV of the lateral neck compartments. We believed that reoperation was performed for persistent, rather than truly recurrent disease for this patient. During the second surgery, we found that the surface of internal jugular vein (IJV) was significantly adhered to the surrounding fibroadipose tissue and the omohyoid muscle was adhered to the IJV. After carefully dissected the IJV, the dissection of the lateral neck compartment had been performed successfully. Exposure of the lateral neck compartment in the gasless transaxillary procedure, especially exposure of the IJV, causes adhesions of the lateral neck compartment and brings difficulties for possible future LND. Gasless transaxillary endoscopic thyroid surgery should be performed in strictly selected patients with adequate preoperative assessment. The IJV should be carefully dissected to avoid IJV injury, and the lateral neck compartment could be dissected successfully during reoperation.

Delayed Horner's Syndrome After Multiple Penetrating Stab Injury of the Neck.

Horner's syndrome is characterized by a triad of symptoms (ipsilateral miosis, ptosis, and anhidrosis) with damage of the sympathetic nervous system. The condition may be congenital or acquired from traumatic conditions including cardiovascular surgery. Horner's syndrome can be also caused by neck trauma especially when cervical vital structures such as blood vessels, the aerodigestive tract, and nerves are disrupted. This report describes a 16-year-old woman with delayed Horner's syndrome who initially presented with internal jugular vein injury caused by multiple penetrating stab injury to the neck. To the best of our knowledge, this is the first reported case of Horner's syndrome resulting from neck trauma of which symptoms were presented after a couple of weeks after initial trauma. Understanding this rare clinical course may help surgeons pay attention to not only early hospital course but also long-term complications of patients with neck trauma.

"Massive hemoptysis" and shock after fever and cough

A boy, aged 11 years, was admitted due to intermittent fever for 15 days, cough for 10 days, and "hemoptysis" for 7 days. The boy had fever and cough with left neck pain 15 days ago, and antibiotic treatment was effective. During the course of disease, the boy developed massive "hemoptysis" which caused shock. Fiberoptic bronchoscopy revealed a left pyriform sinus fistula with continuous bleeding. In combination with neck and vascular imaging examination results, the boy was diagnosed with internal jugular vein injury and thrombosis due to congenital pyriform sinus fistula infection and neck abscess. The boy was improved after treatment with temperature-controlled radiofrequency ablation for the closure of pyriform sinus fistula, and no recurrence was observed during the follow-up for one year and six months. No reports of massive hemorrhage and shock due to pyriform sinus fistula infection were found in the searched literature, and this article summarizes the clinical features, diagnosis, and treatment of this boy, so as to provide a reference for the early diagnosis of such disease and the prevention and treatment of its complications.

Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases

BackgroundThe safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined.MethodsClinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. The sensory change and paralysis results from this technique and patients’ satisfaction with the cosmesis were also studied.ResultsFifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. No evidence of recurrence was found during the follow-up period.ConclusionsGasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients.

Qin\u2019s seven steps for endoscopic selective lateral neck dissection via the chest approach in patients with papillary thyroid cancer: experience of 35 cases

BackgroundEndoscopic thyroidectomy is widely performed as it does not result in neck scar. However, there is a paucity of reports pertaining to completely endoscopic lateral neck dissection (LND). In this study, we introduce our step-wise approach for performing endoscopic selective LND via the chest–breast approach. We refer to this approach as Qin’s seven steps.MethodsThe Qin’s seven steps are: (1) establishment of working space range; (2) dissection of lymph nodes between the SCM and the sternohyoid muscle (level IV) and exposure of omohyoid; (3) dissection of lymph nodes at level IV; (4) dissection of lymph nodes at level III; (5) dissection of lymph nodes at carotid triangle (level III); (6) exposure of accessory nerve and dissection of lymph nodes at level II a; (7) dissection of lymph nodes at level II b. We reviewed the clinical data of 35 patients with papillary thyroid cancer (PTC) who were operated using the Qin’s seven steps.ResultsAll 35 patients successfully underwent LND; bilateral LND was performed in 5 patients. The mean tumor size was 1.8 ± 1.0 cm; seven patients had multiple lesions. The mean number of retrieved lymph nodes in level II, III and IV were 8.8 ± 5.6, 6.1 ± 4.0 and 9.3 ± 5.1, respectively. As for complications, there were 3 cases of accessory nerve injury and 1 case of hypoglossal nerve injury. Internal jugular vein injury, cervical plexus injury and lymphatic leakage occurred in 2, 7, and 1 patients, respectively.ConclusionThe Qin’s seven steps for performing endoscopic selective LND could be safely used in PTC patients with lateral lymph node metastasis. Satisfactory results were achieved in the short-term follow-up period. We recommend the use of Qin’s seven steps for PTC patients who are not desirous of neck scar.

Mechanism of injury and in-hospital mortality in penetrating jugular vein injuries: a National Trauma Data Bank (NTDB) study.

Timely intervention is the key to the successful management of penetrating injuries to jugular veins; however, the optimal clinical management of these perforations and associated risk factors for mortality are not fully established. This study examined the trauma characteristics, vital signs, and in-hospital mortality in penetrating external and internal jugular vein injuries (PEJVI and PIJVI, respectively). In this National Trauma Data Bank database study on patients with penetrating jugular vein injuries (PJVIs), details pertaining to demographics, comorbidities, type of injury, mechanism and intent of injury, Injury Severity Score (ISS), vital signs, treatment, and outcome, were abstracted. Multivariate logistic regression was used to identify the risk factors of in-hospital mortality. A total of 548 patients with PJVIs were included in the final analysis. Patients with PEJVI were more likely to have a self-inflicted injury (p<.001) than those with PIJVI. In both groups, hemorrhage control surgery was performed in almost 60% of the patients within 24 hrs. of the injury (p=.767). Systolic blood pressure (OR 0.99, 95% CI: 0.98-1.00, p=.043), Glasgow coma scale (OR 0.88, 95% CI: 0.81-0.95, p<.001), ISS (OR 1.10, 95% CI: 1.06-1.14, p<.001), and the firearm as a mechanism of injury (OR 2.85, 95% CI: 1.19-6.79, p=.018) were found to be independently associated with the risk of in-hospital mortality. The injury severity, hemodynamic stability, comma scale, intent, and mechanism of injury differed significantly in PEJVI and PIJVI; however, the type of PJVI did not have an independent association with in-hospital mortality.

Transvenous embolisation via an occluded inferior petrosal sinus for cavernous sinus dural arteriovenous fistulas.

We retrospectively searched for cases of transvenous embolisation for cavernous sinus dural arteriovenous fistulas. Twenty-five cases underwent transvenous embolisation via the inferior petrosal sinus (IPS). IPS was probed using a standard 0.035-inch guidewire for microcatheter navigation, which was successful in all cases. IPS was occluded in 17 cases (68%). Only one case experienced a complication, where the approach was changed to the contralateral side because of internal jugular vein injury. The relationship between the external auditory canal and the IPS route was reviewed in 18 cases using digital angiography (lateral view). The guidewire passed across, above, or below the external auditory canal in 10 (56%), six (33%), and two (11%) cases, respectively. No previous reports have analysed the relationship between the external auditory canal and the IPS route. We present a safe and successful technique for approaching the cavernous sinus via the IPS.

Comparison of Nonoperative and Operative Management of Traumatic Penetrating Internal Jugular Vein Injury

Small case series have suggested that selective nonoperative management (NOM) of penetrating internal jugular vein (IJV) injuries is safe and feasible in select patients lacking "hard signs" mandating exploration. Therefore, we sought to compare NOM to operative management (OM) of penetrating IJV injury, hypothesizing that both strategies have similar patient outcomes and mortality when patients are appropriately selected. The Trauma Quality Improvement Program (2013-2016) was queried for patients with penetrating IJV injury with an abbreviated injury scale score of the neck ≥3. Demographics and patient outcomes were compared between patients undergoing NOM and patients undergoing OM, followed by a multivariable logistic regression model to analyze the risk of mortality. A penetrating IJV injury was identified in 188 (0.01%) patients meeting inclusion criteria, and OM was performed in 124 (66.0%) patients, whereas 64 (34.0%) patients underwent NOM. Although the OM group had a higher rate of pneumothorax (8.9% vs. 0.0%, P=0.01), there was no difference in any other concomitant injuries or demographic data (all P>0.05). The OM group had a higher rate of ventilator days (3 vs. 2days, P=0.01) but no other significant differences in morbidity or mortality (P>0.05). After controlling for covariates, OM was associated with similar risk of mortality compared with NOM of patients with penetrating IJV injury (odds ratio 1.05, confidence interval 0.23-4.83, P=0.95). The NOM of penetrating IJV injuries is associated with similar risk of morbidity and mortality compared with OM, suggesting that NOM may be used in appropriately selected patients. Future research is needed to determine the ideal patients suited for NOM and to identify risk factors and outcomes associated with failure of NOM.

Endoscopic selective lateral neck dissection via a chest-breast approach for papillary thyroid carcinoma: preliminary experience in 20 cases

Objective:To explore the feasibility of endoscopic selective lateral neck dissection(SLND) via a chest-breast approach.Method:We retrospectively reviewed 20 patients who underwent endoscopic total thyroidectomy along with SLND, between January 2017 and May 2018. Result: All the 20 patients underwent total thyroidectomy, central lymph nodes dissection and selective lateral lymph nodes dissection with endoscopic surgery via chest-breast approach. In this study, lymphatic leakage, transient voice hoarseness, internal jugular vein injury and external jugular vein injury were repectively found in one patient, and 4 patients suffered from transient parathyroid hypofunction, without other serious complications.Conclusion: Endoscopic lymph node dissection including levels Ⅱ,Ⅲ and Ⅳ is feasible. It has good cosmetic effect, and haven't serious adverse events.

緊急輸血後にRh不適合輸血が判明した危機的大量出血の1症例(A case of critical bleeding with D–mismatched transfusion discovered after emergency transfusion)

要旨近年とくに外傷領域において，血液型判明前に緊急輸血が実施されることが増えている。しかし，本邦ではRh陰性の血液が不足しており，緊急輸血ではやむを得ずRh陽性の血液が用いられる。緊急輸血実施後に患者の血液型がRh陰性であることが判明する事例は一定の確率で起こると予測されるが，本邦ではほとんど報告されていない。症例は20歳代の女性，多部位刺創による出血性ショックのために，当院救命救急センターへ搬送された。主な損傷部位は，右顔面動脈損傷，右内頸静脈損傷，両肺損傷であった。血液型判明前にO型Rh陽性の濃厚赤血球，AB型Rh陽性の新鮮凍結血漿を急速投与したが，ショックから離脱できず，可及的速やかに止血術を実施した。術中に患者の血液型がO型Rh陰性であることが判明したが，出血が持続しており，十分な同型輸血を確保することは不可能と判断し，引き続きRh陽性の血液を投与した。手術終了までに，濃厚赤血球計70単位，新鮮凍結血漿計80単位，血小板計80単位を要した。術後は定期的な血液検査を行ったが，溶血を含む有害事象を呈することはなかった。第53病日に抗D抗体が陽性となった。Rh不適合輸血の安全性を検証した報告はいくつか見られるが，いずれも有害事象を認めていない。危機的大量出血に対してRh不適合輸血を実施することは許容される。不適合輸血実施後は，適切なフォローアップを行うべきである。

A Novel Method for Preventing Central Venous Air Embolism from Internal Jugular Vein Injury

A Novel Method for Preventing Central Venous Air Embolism from Internal Jugular Vein Injury

Temporal bone resection for patients with head and neck cancer: surgical modalities and techniques of reconstruction

ObjectiveThe aim of this article is to present authors’ experience of using different modalities of temporal bone resection (TBR) and methods of reconstruction in malignant tumor involving temporal bone.Patients and methodsFor 27 patients scheduled for TBR, computed tomography was done for all patients, whereas complementary MRI for 13 patients. Different indications, TBR types, reconstruction technique, complications, and outcome were documented and analyzed.ResultsThis study included 27 patients who had malignancy of or extend to temporal bone, including 11 (40.7%) external auditory canal, eight (29.6%) parotid gland, seven (26%) middle ears, and one (3.7%) lateral skull base tumors. The mean age of the patients was 57±10.4 years. Final histopathology was proved to be squamous cell carcinoma in 15 patients, adenoid cystic carcinoma in eight patients, and adenocarcinoma in four patients. Types of TBR were Lewis en-block technique in seven (26%) cases, lateral TBR in eight (29.6%) cases, modified lateral TBR in eight (29.6%) cases, and subtotal TBR in four cases (14.8%).Neck dissection (ND) was performed in all patients in the form of modified radical neck dissection (13 cases), radical neck dissection (five cases), supraomohyoid (three cases), and upper neck dissection (six cases).All preoperative clinicoradiological staging was upstaged postoperatively. Reconstruction of resulting defects was done using temporalis muscle flap (55.5%), pectoralis major myocutaneous flap (26%), latissimus dorsi myocutaneous flap (3.7%), trapezius myocutaneous flap (3.7%), and free flaps (14.8%). Reported complications were dural tears (22.2%), internal jugular vein injury (3.7%), transient vertigo (55.5%), complete facial nerve paralysis (33.3%), and hearing loss (14.8%). Postoperative adjuvant radiotherapy was given to 17 (62.9%) patients. The overall 3-year survival was 73%.ConclusionCommonest temporal bone involving malignancy was squamous cell carcinoma. TBR is integral part of radical resection for certain cancers involving temporal bone. Postoperative radiotherapy is usually needed. Operative tumor staging is more advanced than preoperative.

Transection of Sternocleidomastoid for Selective Neck Dissection in Recurrent Papillary Thyroid Cancers

ABSTRACT The surgical treatment of papillary thyroid carcinoma is the most frequent procedure in endocrine oncologic practice for endocrine surgeons. With the advent of positron emission tomography scan, many of these patients who had previous surgery in the form of total thyroidectomy with neck dissection present with recurrent nodal metastasis which is the cause of thyroglobulin increase. Reoperative surgery is fraught with increased incidence of complications mainly the internal jugular vein injury and nerve injuries. In this scenario, good exposure helps in avoiding these injuries, and also helps the surgeon. We describe the exposure of the posterior triangle by the division of sternocleidomastoid superiorly off the mastoid tip and retracting the muscle downward and suturing it back at the end of the procedure. How to cite this article Mayilvaganan S, Bothra S, Rashid M, Chekavar A, Vema AK, Agarwal A. Transection of Sternocleidomastoid for Selective Neck Dissection in Recurrent Papillary Thyroid Cancers. World J Endoc Surg 2017;9(1):32-34.

クロスボウによる内頸静脈損傷例

クロスボウによる内頸静脈損傷例

A Case of Penetrating Internal Jugular Vein Injury Caused by a Crossbow

A Case of Penetrating Internal Jugular Vein Injury Caused by a Crossbow

CASE 11–2014Successful Open Repair of an Extensive Descending Thoracic Aortic Aneurysm in a Complex Patient

The patient's additional past history included hypertension, a traumatic right internal jugular vein injury, and a 2010 Heller myotomy for achalasia of the esophagus. The patient reported no dysphagia for liquids and solids. His physical examination was consistent with his history and otherwise was within normal limits. His laboratory studies were all within normal limits, except for an elevated partial thrombo- plastin time (PTT). Recent transthoracic echocardiography revealed normal biventricular function and no significant valvular disease. A myocardial stress test was negative for ischemia. His carotid ultrasound studies revealed no significant disease. Review of his coagulation studies revealed a normal profile over time, except for an isolated chronically elevated PTT in the range of 36-41 seconds (normal range 20-34 seconds) with no clinical bleeding tendency or history of heparin exposure. There was no family history of a bleeding diathesis. There were no clinical features consistent with the antiphospholipid syndrome. Consultation with hematology confirmed no immediate contraindication to surgery and suggested elective investigation for an isolated mild clotting factor deficiency, if indicated, at a later time. Given that the patient was currently in the hospital with ongoing aortic pain despite strict blood pressure management, the decision was reached to proceed with definitive DTAA repair. Even though the bleeding risk posed by the elevated PTT was trivial to mild, this risk was still very relevant for possible neuraxial procedures such as a lumbar spinal catheter for CSF drainage and an epidural catheter for perioperative analgesia. After a team discus- sion and review of the benefits and risks of CSF drainage, a joint decision was reached to proceed with DTAA repair without a lumbar spinal catheter or an epidural catheter, given that the risk for spinal cord ischemia was low in this case and alternative analgesic options were available. Furthermore, the team opted for aortic repair under deep hypothermic circulatory arrest to maximize spinal cord protection in this unusual setting. 7 Given this decision about perfusion management after team discussion, intraoperative mon- itoring with transesophageal echocardiography (TEE) was deemed essential to guide perfusion management, including adequate vent- ing of the left ventricle from the left chest. 8 Because of his previous

Robotic‐Assisted Neck Dissection via Facelift Incision: Preliminary Findings in North American Patients

Objectives: Describe the technique and lymph node yield of robotic-assisted neck dissection (RAND) via facelift incision in a North American cohort. Methods: Patients with squamous cell carcinoma of the head and neck at a tertiary hospital in 2012 were offered selective neck dissection via facelift incision. Operative time, estimated blood loss, complications, and lymph node yield were collected. Additionally, seven sequential open selective neck dissections were retrospectively reviewed for lymph node yield. A two-tailed t-test was used to compare nodal yield between the two groups (RAND vs open). Results: Four patients underwent five RANDs, including a simultaneous transoral robotic surgery base of tongue resection and one partial glossectomy. Four lateral neck dissections and one supraomohyoid neck dissection were performed. Mean operative time for the cohort was 4:29 +/- 1:33 (including extirpation); the average time for the three RAND only was 3:29 +/- 0:55. Average blood loss was 77 +/- 68 ml. The only complication was an intraoperative internal jugular vein injury, which was repaired with surgical clipping and suturing. The average number of lymph nodes removed was 29 in patients undergoing level 2-4 RAND, compared to 35.9 in the open group ( P = 0.28). Conclusions: Our preliminary experience suggests that RAND is feasible and safe in the North American population. Our data is also the first to demonstrate that nodal yield is the same between robotic-assisted and open lymphadenectomy. Further study will determine the learning curve for the procedure, and long-term oncologic follow up is needed.

Transaxillary Robotic Thyroid Surgery: A Preliminary European Experience

Background: Robot-assisted endoscopic transaxillary thyroidectomy is an emerging surgical technique that needs to be evaluated in European patients. We evaluate the feasibility and preliminary results of our experience of this technique in a cohort of patients from within a single European university hospital (Nîmes, France). Methods: We performed a retrospective review of the first 23 patients, treated consecutively between September 2010 and June 2012. Results: Nine patients underwent total thyroidectomy and 14 patients lobectomies. All procedures were completed successfully with a mean total operative time of 134 min. We observed a single case of internal jugular vein injury during the console time. No instances of persistent complications were observed; however, minor postoperative events occurred in 5 patients. Pathological diagnoses included benign follicular adenoma in 18 patients, benign adenoma with lymphoid thyroiditis in 1 patient, and benign adenoma with Graves' disease in 4 patients. Conclusions: Robotic thyroid surgery is feasible in European patients and can be safely performed on selected patients. This technique has infrequent minor complications and provides a high level of satisfaction.

Management of Traumatic Vascular Injuries to the Neck: A 7-Year Experience at a Level I Trauma Center

Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.