Abstract It has long been known that neck surgery following radiation therapy for primary and metastatic carcinomas is fraught with complications. These complications include necrosis of the skin flaps, oral and pharyngeal fistulas, and necrosis and rupture of the common carotid artery. Since the carotid artery derives 80% of its blood supply from its adventitia, and the adventitia is removed in the course of radical neck dissection, the artery is dependent upon the skin flaps for its future nourishment. Irradiated tissues with their decreased vascularity do not heal well after surgery, and no other region is more in need of adequate vascularity than the tissues of the neck. Failure of the flaps to heal predisposes to oral and pharyngeal fistulas and necrosis and rupture of the common carotid artery. While flap necrosis and fistulas can be treated with deliberation, rupture of the common carotid artery is a dire emergency demanding immediate References 1. Wyeth, J. A.: Essays in Surgical Anatomy and Surgery , New York, Williams & Wood Co., 1879. 2. de Fourmestraux, J. J.: Les accidents cerebraux et oculaires consécutifs á la ligature de la carotide primitive: Etude experimentale et clinique, Thesis No. 292, Paris, 1906. 3. Matas, R.: Personal Experiences in Vascular Surgery , Ann. Sur. 112:802-839 ( (Nov.) ) 1940.Crossref 4. Dandy, W. E.: The Treatment of Carotid Cavernous Arteriovenous Aneurysms , Ann. Surg. 102:916-920 ( (Nov.) ) 1935.Crossref 5. Schorstein, J.: Carotid Ligation in Saccular Intracranial Aneurysms , Brit. J. Surg. 28:50-70 ( (July) ) 1940.Crossref 6. Gurdjian, E. S.; Webster, J. E.; Martin, F. A., and Hardy, W. G.: Carotid Compressions in the Neck: Results and Significance in Carotid Ligation , J. A. M. A. 163:1030-1036 ( (March 23) ) 1957.Crossref 7. Watson, W. L., and Silverstone, S. M.: Ligation of the Common Carotid Artery in Cancer of the Head and Neck , Ann. Surg. 109:1-27 ( (Jan.) ) 1939.Crossref 8. Martin, H.; Del Valle, B.; Ehrlich, H., and Cahan, W. G.: Neck Dissection , Cancer 4:441-499 ( (May) ) 1951.Crossref 9. Lill, H.: Über die Gefährlicheit der Karotisligatur , Klin. Med. , Wien 12:49-56 ( (Feb.) ) 1957. 10. Dandy, W. E.: Results Following Ligation of the Internal Carotid Artery , Arch. Surg. 45:521-533 ( (Oct.) ) 1942.Crossref 11. Conley, J.: Carotid Artery Surgery in the Treatment of Tumors of the Neck , A. M. A. Arch. Otolaryng. 65:437-448 ( (May) ) 1957.Crossref 12. Grady, E. D.; Robinson, J. S.; White, J. B., and Krantz, S.: Technical Suggestions for Cancer of the Tongue and Floor of the Mouth , North Carolina M. J. 17:466-470 ( (Oct.) ) 1956. 13. Zovickian, A.: Pharyngeal Fistulas: Repair and Prevention, Using Mastoid-Occiput Based Shoulder Flaps , Plast. & Reconstruct. Surg. 19:355-372 ( (May) ) 1957. 14. Castigliano, S. G., and Rominger, C. J.: Dissection of the Neck after Intensive Irradiation to the Neck , Am. J. Roentgenol. 69:771-788 ( (May) ) 1953.
A.M.A. Archives of Otolaryngology – American Medical Association
Published: Apr 1, 1959