In a 60-year-old male, bilateral radical neck dissection and resection of bilateral internal jugular veins were carried out in two stages for metastasis of carcinoma of the larynx to bilateral submandibular lymph nodes following irradiation.
Postoperatively, sequelae of operative insult such as facial edema, edema of thehypopharynx and larynx, difficulty in swallowing due to motor nerve paralysis, paralysis of bilateral hypoglossal nerve, and left Horner's syndrome were noted. On the 20th postoperative day, pneumonia due to swallowing occurred, leading to shock-like symptom accompanied by transient disturbance of consciousness. Recoverry was seen through maintenance of the airway. Such complication was considered to be due to anoxemia on account of insufficient gas exchange in the lung, in view of the complete absence of symptoms referrable to intracranial cerebral nerves following recovery from the shock. Subsequently, metastasis to lymph node above the left scapula was noted and this was removed. After the operation, patient fell into shock, without recovery of consciousness, and died on the 11th postoperative day.
Among cases subjected to bilateral radical neck dissection, resection of bilateral internal jugular vein is only rarely necessary. According to the statistics of our Department during the part 5 years, this was performed only in 1 case.
As regards the justification of the resection of internal jugular vein in bilateral radical neck dissection, various complications due to resection of bilateral jugular vein are discussed through a review of literature.
