Blindness after laryngectomy and bilateral neck dissection in a diabetic patient
case report
Keywords:
Blindness, Neck dissection, Complications of neck dissection, Complications of Diabetes MellitusAbstract
CONTEXT: Neck dissection that accompanies resection of the primary lesion in malignant tumors of the upper aerodigestive tracts may cause com- plications inherent to the procedure or to prolongation of surgical time, increasing the risks forthepatient.Amongthecomplicationsthatmight occur is blindness, a rare complication with only 10 cases reported in the literature thus far. OBJECTIVE: To present the case of a diabetic patient submitted totota llaryngectomy and modified and selective neck dissection that resulted in blindness. CASE REPORT: The authors report on a patient submitted to total laryngectomy and selective neck dissection on the left side, and modified radical neck dissection on the right, who developed blindness. This was probably due to intraoperative hypotension plus the contribution of decompensated diabetes mellitus and thrombosis of the internal jugular vein on the right side. The possible causes, risk factors and care to be taken to prevent this rare but highly debilitating complication are discussed.
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References
Ferlito A, Devaney KO, Devaney SL, Rinaldo A. What is the incidence of metastasis in patients with stage N(0) cancers of the head and neck? ORL J Otorhinolaryngol Relat Spec 2001;63:1-5.
Kaya S, Yilmaz T, Gursel B, Sarac S, Sennaroglu L. The value of elective neck dissection in treatment of cancer of the tongue. Am J Otolaryngol 2001;22(1):59-64.
Pazos GA, Leonard DW, Blice J, Thompson DH. Blindness after bilateral neck dissection: case report and review. Am J Otolaryngol 1999;20:340-5.
Larkin DFP, Wood AE, Neligan M, Eustace P. Ischaemic optic neuropathy complicating cardiopulmonary bypass. Br J Ophthalmol 1987;71:344-7.
Schweizer O, Leak GH. A study of spinal fluid pressures in operations requiring the removal of both internal jugular veins. Ann Surg 1952;136:948-56.
Wilson JF, Freeman SB, Breene DP. Anterior ischemic optic neuropathy causing blindness in the head and neck surgery patient. Arch Otolaryngol Head Neck Surg 1991;117:1304-6.
Hayreh SS. Anterior ischemic optic neuropathy. I: Terminology and pathogenesis; II: Fundus on ophthalmoscopy and fluorescein angiography; III: Treatment, prophylaxis and differential diagnosis. Br J Ophthalmol 1974;58:955-89.
