Management and prevention of brachial plexus injury caused by surgical suture of neck dissection induced chylous fistula

• Published in: American journal of otolaryngology Vol. 43; no. 5; p. 103597
• Main Authors: Wang, Mei, Yuan, Xiaohui, Chen, Yongzheng, Wu, Jianfang, Tian, Shu, Wu, Chunping
• Format: Journal Article
• Language: English
• Published: Maryland Heights Elsevier Inc 01.09.2022; Elsevier Limited
• Subjects: Body fat; Brachial plexus; Brachial plexus injury; Chylous fistula; Dissection; Fistula; Fistulae; Hypopharyngeal cancer; Injury prevention; Laryngeal cancer; Muscles; Neck; Neck dissection; Nutrition research; Parenteral nutrition; Patients; Prevention; Software; Statistical analysis; Sutures; Throat cancer; Ultrasonic imaging; Veins & arteries; Laryngeal cancer; Hypopharyngeal cancer; Brachial plexus injury; Chylous fistula; Neck dissection
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2022.103597

The complication of brachial plexus injury (BPI) after surgical suture of chylous fistula caused by neck dissection is extremely rare. For the first time, we investigated the treatment and prevention strategy of BPI caused by surgical suture of neck dissection induced chylous fistula. Forty-two patients undergoing surgical suture of neck dissection induced chylous fistula were identified between January 2015 to March 2022 at a single tertiary academic center. All patients were divided into two groups, medial anterior scalene muscle (MASM) group (24 patients) and lateral anterior scalene muscle (LASM) group (18 patients), according to the location of fistula regarding scalene muscle described in the surgical records. The incidence of BPI between the two groups after surgical suture was summarized and compared. There was significant difference in the incidence of different degrees of BPI between the two groups. In the MASM group, the incidence of BPI was 0 % (0/24), while in the LASM group, 6 cases suffered different degrees of BPI immediately after operation and the incidence of BPI was 33.3 % (6/18) (p < 0.05). The neurological function of all BPI cases recovered within 1–3 months after the suture was removed in time. The incidence of BPI in patients of LASM group was significantly higher than that of MASM group. When suturing this kind of fistula, the depth of the needle should be properly controlled to avoid BPI. In case of BPI, the suture should be removed as soon as possible to promote the recovery of neurological function.