RESUMEN
The management of chylous fistulae remains controversial. A detailed conservative protocol and guidelines regarding surgical intervention are lacking in the literature. This paper presents our experience in the management of two cases of persistent chylous fistulae by successfully employing topical tetracycline. Our regimen of management is discussed and illustrated with the above two cases. An updated review of the pertinent anatomy, physiology, and literature is presented.
Asunto(s)
Fístula/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/cirugía , Cuello/cirugía , Complicaciones Posoperatorias , Tetraciclina/uso terapéutico , Administración Tópica , Quilo/fisiología , Femenino , Fístula/etiología , Humanos , Laringe/cirugía , Masculino , Persona de Mediana Edad , Faringe/cirugía , Conducto Torácico/anatomía & histologíaRESUMEN
Two hundred neck dissections performed at Toronto General Hospital over a 3 year period are reviewed. There were six intra-operative lymph leaks and five postoperative chylous fistulae. The postoperative chylous fistulae are analysed in detail and the approach to conservative management of lymph leaks is discussed. Two cases required re-exploration of the neck; difficulty in identifying the site of leakage and of sealing lymph channels is discussed. Also reported is the successful use of topical tetracycline powder in two cases and a review of the various treatment modalities advocated in the literature.
Asunto(s)
Quilo , Fístula/epidemiología , Enfermedades Linfáticas/epidemiología , Cuello/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Fístula/cirugía , Fístula/terapia , Humanos , Linfa/metabolismo , Enfermedades Linfáticas/cirugía , Enfermedades Linfáticas/terapia , Masculino , Persona de Mediana Edad , Necesidades Nutricionales , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Tetraciclina/uso terapéuticoRESUMEN
CT demonstrates nasal anatomy extremely well. The intimate relationship of the nasal cavity to the cerebral, orbital, paranasal sinus, nasopharyngeal, and oral tissues is noted. Examples of benign and malignant neoplasms, inflammatory processes, including intrinsic and extrinsic mass lesions are utilized to demonstrate the value of CT in assessing the nasal cavity in conjunction with its surrounding tissues. Congenital and traumatic lesions also are demonstrated to the same advantage.