Duplex imaging and incidence of carotid radiation injury after high-dose radiotherapy for tumors of the head and neck.

Radiation-induced carotid artery disease following high-dose (greater than 50-Gy) radiotherapy for head and neck cancer may become more common as improved treatment results in longer survival. Duplex ultrasound scans were obtained in 91 consecutive patients to determine whether increased incidence and severity of extracranial carotid disease correlate with prior radiotherapy. Fifty-three patients who underwent radiotherapy an average of 28 months previously and 38 patients who received no radiotherapy were studied. Thirty percent of the irradiated group had lesions of the carotid arteries that were either moderate or severe vs only 6% of the control patients. Five patients were symptomatic; all had undergone radiotherapy. Long-term follow-up with sequential duplex ultrasound examinations is indicated in patients receiving high-dose radiotherapy for head and neck tumors, to detect radiation-induced carotid artery disease and prevent late sequelae.

[Bilateral carotid chemodectoma on the external carotid arteries. A case report]. / Quemodectoma carotídeo bilateral dependiente de la arteria carótida externa. A propósito de un caso.

Tumors of the carotid body are rare neoplasms that arise from neuroectodermic tissues. They are located in the fork of the primitive carotid artery. They are benign, slow-growing, and asymptomatic, and predominate in women. We present a case of bilateral carotid chemodectoma on the external carotids. These tumors were diagnosed by CT, MRI and superselective angiography. The treatment of choice is surgical after arteriographic embolization. Exeresis is curative in most cases, but some cases require radiotherapy.

Non-neoplastic process after neck dissection demonstrated on enhanced CT in patients with head and neck cancer.

OBJECTIVES: Head and neck radiologists should be familiar with typical post-therapeutic changes on enhanced CT after neck dissection because CT is widely used for the follow-up study in order to detect recurrent tumours at an early stage. The purpose of this study was to reveal post-therapeutic anatomical alterations and non-neoplastic processes demonstrated on enhanced CT. METHODS: Radical neck dissections were performed in 39 necks and modified radical neck dissections were performed in 8 necks. Post-operative radiotherapy was performed on 21 patients. Follow-up CT, studies were made within a period of 24 months. RESULTS: On enhanced CT, the densities of soft tissues replacing the resected structures were homogeneous in 44 necks and showed no contrast enhancement in 39 necks. During the 24 months after treatment, most of the soft tissues did not increase in size and the attenuation of the soft tissue remained unchanged. In 44 of 47 necks, lymphoedema (LE) was observed around the carotid artery at an early stage, and it converged into the space between internal carotid artery and external carotid artery gradually. In patients without post-operative radiotherapy, LE was observed around the carotid artery in 17 of 23 necks at 3 months after neck dissection and disappeared rapidly thereafter. In patients with post-operative radiotherapy, LE increased until 3 months after radiotherapy and decreased slowly thereafter. CONCLUSIONS: This is the first report of enhanced CT evaluation of LE around the carotid artery after neck dissection probably exacerbated by irradiation. Clinicians should be aware of LE around the carotid artery in patients with post-operative radiotherapy because of the possible risk of neck cellulitis at least 1 year after treatment.

Histopathologic damage to vessels in head and neck microsurgery.

PURPOSE: This study assessed the incidence of pre-existing damage in recipient arteries excised before the vessels were used for microvascular anastomoses between 1988 and 1999. PATIENTS AND METHODS: Recipient arteries of the head and neck region from 100 patients who had undergone ablative surgery requiring microvascular tissue reconstruction were examined histologically. Past illnesses believed to be risk factors included hypertension, myocardial disease, and diabetes. Blood vessels chosen for microsurgical anastomoses were examined using histological staining, scanning electron microscopy, and immunofluorescence. RESULTS: Of the patients undergoing microvascular surgery, 51% showed histologic vessel abnormalities. Marked thickening of the blood vessel wall and severe exfoliation of the endothelial cells were observed in most arteries. Thickening of the intima was evaluated using scanning electron microscopy (Friedman's method; Microvasc Res 3:416, 1971). Values higher than twice the ratio of wall thickness-to-lumen diameter were observed in 9 recipient arteries. Six graft failures were correlated with both technical errors and pre-existing vessel lesions. CONCLUSIONS: This study revealed that most patients undergoing microsurgery in the head and neck region had pre-existing damage to vessels that hindered anastomoses. Pre-existing changes in the recipient arteries may cause technical difficulties and must be regarded as additional factors contributing to graft failure.

[Microvascular anastomoses in irradiated blood vessels in the area of the mouth, jaw and face]. / Mikrovaskuläre Anastomosen an bestrahlten Gefässen im Mund-, Kiefer- und Gesichtsbereich.

Pedicle and free microsurgical reanastomized vascularised flaps are useful to cover defects in an irradiated area. In 51 patients microvascular anastomoses were performed on irradiated vessels in the neck area. Facial reconstruction was done after radiation by free flaps. Seventeen jejunum, 10 myocutaneous, 21 iliac crest and 3 fibula flaps were transplanted. The time between irradiation and reconstruction varied between 2 and 144 months. Four anastomoses had to be revised, two flaps were totally lost. Although the vessels were damaged by preoperative radiotherapy, 92 percent of the anastomoses were patent. This success rate is as high as in anastomoses on non-irradiated vessels.

[Emergency free microvascular flap transfer for repair of a pharyngeal defect manifesting as carotid artery erosion hemorrhage]. / Notfallmässiger freier mikrovaskulärer Lappentransfer zum Verschluss eines Pharynxdefektes nach akuter Arrosionsblutung der A. carotis.

We report on a case of an emergency free flap cover of a pharyngeal defect which was made necessary by aggressive digestive salivatory and radiation effects 3 weeks after neck-dissection and laser ablation of an epidermoid left tonsil carcinoma. Life threatening intraoral bleeding resulted from the erosion of branches of the external carotid artery. After management of the bleeding, massive blood transfusions and restoration of the patient's general condition, a sandwich patch cover of the transmural pharyngeal defect was achieved using a microvascular lateral arm flap. This aimed at preventing further digestive effects and bacterial colonisation of the neurovascular structures at the carotid triangle. Unfortunately, due to external mechanical forces, the flap became avascular and thus necrotic at the eighth postoperative day; however, until the successful replacement by a myocutaneous latissimus dorsi flap it remained water-tight and fulfilled its sealing task.