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Abstract Most head and neck cancer patients are first referred to an E. Oncological surgical interventions need to ensure clear resection margins; this means that whatever anatomic structures are involved in the tumor spread, need to be resected. The carotid artery is a vascular vessel system that provides blood supply for the head and neck region, the most important structure being the brain and its organs.
The ligation or the resection of the common carotid artery leads to an abrupt decrease of blood flow towards the brain, which can cause single sided paralysis, decreased cognitive functions, shock and even death. Common or internal carotid arteries ligatures or resections can be performed in patients with malignant tumors of the head and neck.
This is a synopsis of 2 successful cases of patients who underwent common and external carotid artery resection. Keywords: malignancy, chronic brain ischemia, oncological margin, neck dissection Introduction Head and neck cancer is one of the most important public health concerns worldwide because of the ever increasing number of tobacco and alcohol consumption, two of the major risk factors for this pathology.
This is the perfect example for a multidisciplinary patient approach in modern medicine in which case specialists of different areas of expertise need to collaborate. Most head and neck cancer patients are first referred to an E. The complex therapy of the head and neck cancer involves the presence of a vascular surgeon or an E.
Blog aimed at residents in surgery URL : www. Romeo Giuli MD, resident.
The vascular system of the head and neck is of outmost importance due to the implications on the local anatomy and on the cerebral functions. The lateral region of the neck, starting from the clavicle and ending at the base of the skull is the site of a possible malignant tumor, which may involve the carotid system.
Traducere "nodulilor limfatici" în engleză
The tumor spread explained by gastric cancer regional lymph nodes lymphatic and vascular spread in most cases finds its local development towards the large vessels of the head and neck. This metastasis process is to alter whatever anatomical elements of the neck may be in the pathway of the tumor. Lymph node metastasis is considered a loco-regional metastasis of the tumor process.
They are in direct relation to the large vessels of the neck, the internal jugular vein the carotid system, and also to the nerves of the neck, most important to the vagus nerve, hypoglossal nerve and the cervical sympathetic trunk. Oncological surgical interventions need to ensure clear resection margins; this means that whatever anatomic structures are involved in the tumor spread need to be resected.
The other organs, cancer malign la vezica urinara, nerves of the head and neck that are involved in the tumor process also need to be resected in order to ensure the surgical oncological effort. Background The carotid artery is a vascular vessel system that provides blood supply for the head and neck region, the most important structure being the brain and its organs. This procedure can be performed because of the presence of the collateral arterial vessels that can supply blood to the brain and organs through the arterial circle of Willis [ 2 ].
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This arterial anastomosis is the basis for performing such carotid resection or ligation. When the tumor process is slowly developing and affecting one or more carotid arteries common, internal or external carotid arteries there is an increased possibility of gastric cancer regional lymph nodes higher blood flow gastric cancer regional lymph nodes the contralateral carotid system and through the vertebral arteries.
This means that the tumor process acts like a trigger for the development of the collateral blood flow supply. When ligating the common carotid artery on one side of the neck there is the possibility that the patient will recover the entire brain and organ functions due to a retrograde blood flow through the external carotid artery and into the internal carotid artery, this being possible due to the Willis arterial circle.
Still, there is a possibility that the patient gastric cancer regional lymph nodes develop chronic brain ischemia or even die which makes this a high-risk procedure. In the 19th century, JA Wyeth performed some common artery ligations, of which resulted in the death of the patient. He realized that the supraomohyoid region of the common carotid artery is the best site to perform the surgical procedure.
The structure of the carotid systems gastric cancer regional lymph nodes the existence of baroreceptors, chemoreceptors and nerve plexus in the bifurcation region of the common carotid artery [ 3 ].
These essential anatomy data are the reason for light manipulation of the carotid system during surgical procedures at this site; otherwise, there is the possibility gastric cancer regional lymph nodes reflex bradycardia, drop in the arterial blood pressure, syncope, cardiac arrest or even death. Several studies made on young rat models have indicated that regions in the brain suffer from acute blood flow hypoperfusion following the ligation or resection of the carotid system common or internal carotid arterybut it is likely to have a quick self-recovery, within gastric cancer regional lymph nodes weeks time.
The results of the studies suggest that the blood vessels in young rat models have plasticity to external insult [ 4 ]. When analyzing our patients we found that all 5 had a full recovery, motor and cognitive functions, within a month after the surgery.
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There are other studies on rats that revealed the significant impairment in the eight-arm radial maze task in rats, following internal carotid artery ligation, only than in common carotid artery-ligated rats.
The impaired learning process of the young rats led to the conclusion that the reduction gastric cancer regional lymph nodes the blood flow might be an important risk factor for the appearance or the exacerbation of the cognitive decline in dementias [ 5 ]. There are no absolute contraindications when dealing with a life-threatening situation [ 8 ]. Still, there are situations when the ligation or the resection of the carotid system should better not be performed such as inoperable cases, life-threatening comorbidities, gastric cancer regional lymph nodes which increases the risk of an ischemic attack.
Case reports Case I A year-old, male, from the urban environment, heavy smoker — 1 pack of cigarettes per day for 25 years, alcohol consumer, referred to Coltea Clinical Hospital, E.
Department for dysphagia, odynophagia, left ear pain and the presence of a tumor mass of the neck, which he stated that appeared about 6 months prior to the examination, with a slow and progressive evolution. The patient is known to have high blood pressure, maximum value of mmHg, under treatment, and without any other significant pathology. When performing the clinical exam we found an ulcerated tumor mass in the hypopharynx, referring to the left lateral wall of the pharynx and to the root of the tongue.
Case reports – common and external carotid artery resection in head and neck cancer patients
The tumor process extended to the lateral region of the neck involving the submandibular gland, the levels II-V lymph nodes, large vessels of the neck and skin. Imaging studies confirmed the extension of the tumor process. The Doppler ultrasound examination showed a near to 0 blood flow through the external carotid artery and its branches. After performing a biopsy from the tumor under local anesthesia — invasive squamous cell carcinoma, we informed the patient about the choices of therapy and obtained his informed consent to perform the surgical intervention.
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We performed a tracheostomy in order to ensure a maximum access to the oro and hypopharynx, radical neck dissection with the resection of the internal jugular vein, accessory spinal nerve, sternocleidomastoid muscle, entire fatty tissue from the clavicle to the base of the skull.
In order to get the access to the entire tumor mass we needed to perform a lateral mandibulotomy Fig. The resection piece included the root of the tongue, lateral wall of the pharynx, the submandibular gland, lymph gastric cancer regional lymph nodes levels II to Va and skin.