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      Blindness after laryngectomy and bilateral neck dissection in a diabetic patient: case report

      case-report

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          Abstract

          CONTEXT: Neck dissection that accompanies resection of the primary lesion in malignant tumors of the upper aerodigestive tracts may cause complications inherent to the procedure or to prolongation of surgical time, increasing the risks for the patient. Among the complications that might 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 to total laryngectomy 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.

          Translated abstract

          CONTEXTO: O esvaziamento cervical que acompanha a ressecção da lesão primária no tratamento dos tumores malignos das vias aerodigestivas superiores possibilita o surgimento de complicações inerentes a ela ou ao prolongamento do tempo cirúrgico, aumentando os riscos para o paciente. Entre as complicações que podem ocorrer está a amaurose, de incidência rara. RELATO DO CASO: Um paciente submetido a laringectomia total e esvaziamento cervical seletivo à esquerda e radical modificado à direita, que evoluiu com amaurose, provavelmente decorrente de hipotensão intra-operatória, com contribuição dos Diabetes Mellitus descompensado e trombose da veia jugular interna à direita. Discutem as possíveis causas, os fatores de risco e os cuidados que devem ser tomados para evitar essa rara, mas tão debilitante complicação.

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          Most cited references7

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          Ischaemic optic neuropathy complicating cardiopulmonary bypass.

          Bilateral anterior ischaemic optic neuropathy occurred in two patients undergoing cardiopulmonary bypass grafting. The causes may have been vasoconstriction of the posterior ciliary arteries by increased circulating angiotensin and diminished ciliary blood flow in the setting of systemic hypotension and elevated intraocular pressure.
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            • Record: found
            • Abstract: not found
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            A study of spinal fluid pressures in operations requiring removal of both internal jugular veins.

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              The value of elective neck dissection in treatment of cancer of the tongue

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                spmj
                Sao Paulo Medical Journal
                Sao Paulo Med. J.
                Associação Paulista de Medicina - APM (São Paulo )
                1806-9460
                September 2001
                : 119
                : 5
                : 181-183
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                [2 ] Universidade de São Paulo Brazil
                [3 ] Universidade Estadual Paulista Brazil
                Article
                S1516-31802001000500006
                10.1590/S1516-31802001000500006
                bc88a8c1-ce5d-4050-8b4f-db6843a1a4df

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-3180&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Blindness,Neck dissection,Complications of neck dissection,Complications of Diabetes Mellitus,Amaurose,Esvaziamento Cervical,Complicações dos Esvaziamentos Cervicais,Complicações dos Diabetes Mellitus

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