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Case Reports
. 2018 Jan;10(1):E38-E41.
doi: 10.21037/jtd.2017.12.60.

Approach to resection of sternoclavicular tumor abutting the common carotid artery in irradiated field

Juan A Muñoz-Largacha  1 , Jaromir Slama  2 , Jeffrey Kalish  3 , Scharukh Jalisi  4 , Virginia R Litle  1 , Kei Suzuki  1
Affiliations
Case Reports

Approach to resection of sternoclavicular tumor abutting the common carotid artery in irradiated field

Juan A Muñoz-Largacha et al. J Thorac Dis. 2018 Jan.

Abstract

Head and neck cancer recurrence at the sternoclavicular junction (SCJ) in irradiated field poses a special challenge in terms of surgical planning. We herein present a case of tonsillar squamous cell cancer recurrence at the SCJ in a patient with history of tracheostomy and head and neck radiation. We describe our preoperative planning for vascular control and possible reconstruction as well as our approach for safe resection.

Keywords: Sternoclavicular tumor; head and neck cancer; sternotomy; vascular control.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Radiation planning imaging and computed tomography (CT) of sternoclavicular mass. (A) Radiation planning for adjuvant therapy after head and neck surgery. Red and orange fields indicate field of treatment; (B) chest CT angiogram showing the sternoclavicular mass (yellow arrow) abutting the right common carotid artery (red arrow) in transverse view and sagittal view (C).
Figure 2
Figure 2
3D reconstruction image showing the sternoclavicular mass (yellow arrow) and its relationship with the surrounding structures and right common carotid artery (red arrow).
Figure 3
Figure 3
Anterior view of the surgical field and macroscopic view of sternoclavicular mass after resection. (A) Surgical field after complete resection of tumor, manubrium, and bilateral sternoclavicular joints and first ribs (arrows showing medial edge of resected clavicles; dashed circle showing location of resected tumor; L, lung; T, trachea); (B) surgical view after complete resection and closure of the remaining sternum (S); (C) gross pathology specimen.
Figure 4
Figure 4
Postoperative view after chest wall reconstruction and skin graft.
See this image and copyright information in PMC

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