Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T14:01:46.962Z Has data issue: false hasContentIssue false
  • English
  • Français

The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review

Published online by Cambridge University Press:  08 January 2013

M E Smith ,
F Riffat  and
P Jani
M E Smith*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
F Riffat
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
P Jani
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
*
Address for correspondence: Mr Matthew Smith, Department of Otolaryngology and Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK Fax: +44 (0)1223 217 559 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The major lymphatic vessels may be damaged during neck dissection or other cervical surgery, resulting in chyloma or chyle fistula. While commonly considered to be predominantly a complication of left-sided surgery, the thoracic duct may be damaged on either side of the neck due to the extreme variability in the anatomy of the central lymphatic system.

Method and results:

This paper reviews the variable anatomy and embryology of the thoracic and right lymphatic ducts, particularly aspects relevant to head and neck surgery.

Keywords

Thoracic DuctLymphatic SystemAnatomy & HistologyChyleFistula
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 2 , February 2013 , pp. 128 - 133
Copyright
Copyright © JLO (1984) Limited 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Skandalakis, JE, Skandalakis, LJ, Skandalakis, PN. Anatomy of the lymphatics. Surg Oncol Clin N Am 2007;16:1–16CrossRefGoogle ScholarPubMed
2Agur, AMR, ed. Grant's Atlas of Anatomy, 10th edn.Philadelphia: Lippincott Williams and Wilkins, 1999Google Scholar
3Standring, S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice, 39th edn.New York: Churchill Livingstone, 2004Google Scholar
4Davis, HK. A statistical study of the thoracic duct in man. Am J Anat 1915;17:211–44CrossRefGoogle Scholar
5van der Putte, SC, van Limborgh, J. The embryonic development of the main lymphatics in man. Acta Morphol Neerl Scand 1980;18:323–35Google ScholarPubMed
6Kihara, T, Adachi, B, eds. The Lymphatic System of the Japanese [in German]. Kyoto: Kenkyusha: 1953Google Scholar
7Sabin, FR. The method of growth of the lymphatic system. Science 1916;44:145–58CrossRefGoogle ScholarPubMed
8Nathan, H, Seidel, MR. The association of a retroesophageal right subclavian artery, a right-sided terminating thoracic duct, and a left vertebral artery of aortic origin: anatomical and clinical considerations. Acta Anat (Basel) 1983;117:362–73CrossRefGoogle Scholar
9Yamada, G. A case of right sided aortic arch. Acta Anat Jpn 1932;5:783–93Google Scholar
10Epstein, DA, Debord, JR. Abnormalities associated with aberrant right subclavian arteries – a case report. Vasc Endovascular Surg 2002;36:297–303CrossRefGoogle ScholarPubMed
11Chen, H, Shoumura, S, Emura, S. Bilateral thoracic ducts with coexistent persistent left superior vena cava. Clin Anat 2006;19:350–3CrossRefGoogle ScholarPubMed
12Watson, M. Note on the termination of the thoracic duct on the right side. J Anat Physiol 1872;6:427–8Google ScholarPubMed
13Nathan, H, Gitlin, G. Thoracic duct terminating on the right side associated with aberrant retro-oesophagal right subclavian artery and truncus bicaroticus. Thorax 1968;23:266–70CrossRefGoogle ScholarPubMed
14Rouvière, H. Anatomy of the Lymphatics in Man [in French]. Paris: Masson, 1938;231–40Google Scholar
15Crumley, RL, Smith, JD. Postoperative chylous fistula prevention and management. Laryngoscope 1976;86:804–13CrossRefGoogle ScholarPubMed
16Jacobsson, SI. Clinical anatomy and pathology of the thoracic duct: an investigation of 122 cases. Stockholm: Almqvist & Wiksell: 1972Google Scholar
17Lane, S, Todd, RB, eds. The Cyclopaedia of Anatomy and Physiology. London: Sherwood, Gilbert & Piper, 1847;3Google Scholar
18Gottlieb, MI, Greenfield, J. Variations in the terminal portion of the human thoracic duct. AMA Arch Surg 1956;73:955–9Google ScholarPubMed
19Kausel, HW, Reeve, TS, Stein, AA, Alley, RD, Stranahan, A. Anatomic and pathologic studies of the thoracic duct. J Thorac Surg 1957;34:631–41CrossRefGoogle ScholarPubMed
20Van Pernis, PA. Variations of the thoracic duct. Surgery 1949;26:806–9Google ScholarPubMed
21Kinnaert, P. Anatomical variations of the cervical portion of the thoracic duct in man. J Anat 1973;115:45–52Google ScholarPubMed
22Peña, E, Zuñiga, J. An anatomical variation: the aberrant termination of the thoracic duct [in Spanish]. Biomedica 2009;29:204–8CrossRefGoogle ScholarPubMed
23Shimada, K, Sato, I. Morphological and histological analysis of the thoracic duct at the jugulo-subclavian junction in Japanese cadavers. Clin Anat 1997;10:163–723.0.CO;2-V>CrossRefGoogle ScholarPubMed
24Byers, RM. Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg 1985;150:414–21CrossRefGoogle ScholarPubMed
25Roh, JL, Kim, DH, Park, CI. Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer. Ann Surg Oncol 2008;15:424–9CrossRefGoogle ScholarPubMed
26Priego Jiménez, P, Collado Guirao, CMV, Rojo Blanco, R, Grajal Marino, R, Rodríguez Velasco, G, García Villanueva, GA. Chyle fistula in right cervical area after thyroid surgery. Clin Transl Oncol 2008;10:593–6CrossRefGoogle ScholarPubMed
27Santaolalla, F, Anta, JA, Zabala, A, Del Rey Sanchez, A, Martinez, A, Sanchez, JM. Management of chylous fistula as a complication of neck dissection: a 10-year retrospective review. Eur J Cancer Care (Engl) 2010;19:510–15CrossRefGoogle ScholarPubMed
28Halldorsson, A. Chylothorax after coronary artery bypass grafting. Int Surg 2009;94:119–29Google ScholarPubMed
29Erisen, L, Coskun, H, Basut, O. Objective and early diagnosis of chylous fistula in the postoperative period. Otolaryngol Head Neck Surg 2002;126:172–5CrossRefGoogle ScholarPubMed
30Nussenbaum, B, Liu, JH, Sinard, RJ. Systematic management of chyle fistula: the Southwestern experience and review of the literature. Otolaryngol Head Neck Surg 2000;122:31–8CrossRefGoogle ScholarPubMed