European Journal of Cancer Care Volume 19 Issue 5 2010 [Doi 10.1111_j.1365-2354.2010.01208.x] PAUL LENNON; JOHN FENTON -- Review of the Management of Chylous Fistula as a Complication of Neck Dissection
We were very interested in an excellent review by Santa-
olalla et al. (2009), on chylous stula after neck dissec-
tion. We agree with the intra-operative management as outlined, although we do use tetracycline powder as an adjunct and we concur with their conservative manage- ment of two patients immediately post surgery for persis- tent leaks. However, the majority of leaks are not identied for 34 days post-operatively (Erisen et al. 2002) and they fail to present the timing of stula development in the remain- ing two patients in their cohort. It has been recommended that as leakages discovered and reported during surgery carry a high risk of chylous drainage post surgery, that the immediate post-operative use of low-fat medium chain triglycerides diet and other conservative measures should be utilised from the outset after surgery even in those patients deemed to have had a successful per-operative repair (De Gier et al. 1996). In our experience in the departments of Otolaryngology, Head and Neck Surgery at the Mid-Western Regional Hospital, Limerick, and the Aintree University Hospital, Liverpool, we have intro- duced this prophylactic approach in addition to an intra- operative repair in all patients noted to have chyle extravasations during surgery and thus far have not had a post-operative leak in those patients. In their conclusion, Santaolalla et al. state that all chyle leaks are on the left but this is somewhat ambiguous and it should have read that all of the stulae reported in their study were on the left as the right lymphatic duct can be also be damaged during surgery. PAUL LENNON Department of Otolaryngology, Head and Neck Surgery, Mid-Western Regional Hospital, Limerick, Ireland JOHN FENTON Department of Otolaryngology, Head and Neck Surgery, Mid-Western Regional Hospital, Limerick, Ireland REFERENCES De Gier H.H., Balm A.J., Bruning P.F., Gregor R.T. & Hilgers F.J. (1996) Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck 18, 347351. Erisen L., Coskun H. & Basut O. (2002) Objective and early diagnosis of chylous stula in the postoperative period. Oto- laryngology Head and Neck Surgery 126, 172175. Santaolalla F., Anta J.A., Zabala A., Del Rey Sanchez A., Martinez A. & Sanchez J.M. (2009) Management of chylous stula as a complication of neck dissection: a 10-year retrospective review. European Journal of Cancer Care Dec 17. [Epub ahead of print]. Correspondence address: Paul Lennon, Dooradoyle Limerick Munster Ireland L 1, Ireland (e-mail: paullennon81@gmail.com, paullennon81@ yahoo.ie). DOI: 10.1111/j.1365-2354.2010.01208.x European Journal of Cancer Care, 2010, 19, e11 Letter to the editor Review of the management of chylous stula as a complication of neck dissectionecc_1208 11 2010 Blackwell Publishing Ltd
Journal of Oral and Maxillofacial Surgery Volume 40 Issue 11 1982 [Doi 10.1016_0278-2391(82)90145-8] Troxell, James B.; Fonseca, Raymond J.; Osbon, Donald B. -- A Retrospective Study of Alveolar Cleft Grafting