Internal Jugular Vein Reconstruction in Bilateral Radical Neck Dissection followed by Free Flap Reconstruction: A Case Report

Most clinics are currently trying to preserve the internal jugular vein (IJV) in the majority of cases of neck dissection. In a few cases, however, sacrifice of bilateral IJVs is inevitable. In radical neck dissection, removal of the sternocleidomastoid muscle, the spinal accessory nerve, and the IJV is performed. Bilateral radical neck dissection can be performed in one of the two ways as either simultaneous radical neck dissection or as a staged procedure with an interval period. Simultaneous sacrifice of the IJVs is known to cause critical complications, such as excessive postoperative head and facial edema,[ 1 ] facial cyanosis, increased intracranial pressure,[ 2 ] syndrome of inappropriate antidiuretic hormone secretion (SIADH),[ 3 ] blindness,[ 4 ] stroke, and even death.[ 2 ] Staged ligation of the IJVs with an interval of at least 1 month has been performed by many surgeons to avoid these postoperative complications. However, as reported by Dulguerov et al,[ 5 ] sacrifice of the IJV may still occasionally cause critical complications even when a staged procedure is performed, and sufficient collateral venous drainage may not be achieved. Moreover, despite recently improved radiological evaluations of the neck we occasionally are confronted with cases during which we must decide to sacrifice bilateral IJVs during planned modified radical neck dissection. IJV reconstruction for facial drainage during simultaneous bilateral radical neck dissection has been performed by many surgeons to prevent postoperative sequelae. We report our case of IJV reconstruction with the external jugular vein (EJV) in bilateral radical neck dissection followed by free flap reconstruction.