In the human body, along the passage of the lymphatic vessels , nodes are located that are real filters, where filtering and neutralization of foreign substances takes place. If there is an increase in lymph nodes, and this can be detected by palpation or other types of studies, then it can be argued that there is an inflammatory process. Timely therapy leads to the normalization of their size, but there are situations when removal of the cervical lymph nodes is required. Consider in what cases this is required and what are the consequences.
Crail's operation
This surgery is the main way to remove the lymph nodes located on the neck. The technique has been developed for a long time, but is still used in surgery. The main task pursued by Crail's operation is to get rid of lymph nodes affected by cancer cells.
The fact is that chemotherapy and irradiation are not able to eliminate metastases that affect the lymph nodes, so you can not do without surgery. Lymph nodes under the jaw are removed if a neoplasm of the tongue or this area appears. Sometimes removal on both sides is necessary.
Location of the lymph nodes
It has already been said that an increase in lymph nodes indicates the presence of an inflammatory process in the body. Depending on where the lymph nodes on the neck are inflamed, we can conclude that the development of a particular pathology begins. Of course, only a specialist can do this.
An ordinary person should know that the lymphatic system plays a big role in protecting the body from foreign agents. Lymph nodes are a kind of filters that do not allow pathogenic bacteria and viruses to penetrate further into the body. Lymph nodes under the jaw or elsewhere in the neck can destroy the degenerated oncological cells, which are dangerous for humans.
Lymph nodes are located in many places of the body, but they can be divided into several groups:
- Located on the front of the neck and back.
- Ear
- Occipital.
- Chin and submandibular.
If the body is healthy, then it is quite difficult to probe the nodes, because these are small formations. They are slightly mobile, but when pressed, they do not cause discomfort. Inflammation of the submandibular lymph nodes may indicate a developing sore throat, and may be evidence of more serious pathologies. Only a specialist can determine this.
Causes of lymph node inflammation
The lymph nodes can begin to manifest themselves under different circumstances, most often the reason for their increase is:
- The penetration of an infectious agent into the body.
- Chronic alcoholism
- Injuries to the respiratory system or lesions in the oral cavity.
- Decreased immunity.
- Long stay in the cold.
- Lack of vitamins.
- Allergic reaction.
- Frequent stressful situations.
- Depression.
- The presence of AIDS or HIV.
- The development of the tumor process.
Thus, inflammation of the submandibular lymph nodes can occur for many reasons, so making a diagnosis is the prerogative of a specialist.
The reasons for the operation Crail
Doctors distinguish a number of indications for such an surgical intervention:
- Severe damage to the lymph nodes in the neck.
- Crail's operation is also indicated if some submandibular nodes are enlarged, the cervical nodes are not affected, but there is a suspicion that they also suffer.
- After examining the bifurcation of the carotid arteries.
It should be noted that the decision to conduct the operation is made only by the doctor, given that such surgery is rather complicated in terms of the technique and has a strong effect on the patient’s health.
That is why in some cases the doctor does not recommend it, because the harm will be greater than the expected benefit.
Contraindications for surgery
In which cases Crail's surgery is performed, we have examined it, but there are situations when it is better not to use such surgery:
- If metastases are in one place and are no longer spread.
- If the patient's body is severely depleted, that is, cachexia occurs.
- Young age can become an obstacle to such an operation. Severe surgical intervention can provoke serious complications that may not be possible for an elderly body.
Preparing the patient for surgery
Naturally, the operation is performed under general anesthesia. For convenient operation, the patient’s surgeon is placed on his back, a roller is placed under the neck.
The head is turned as far as possible in the direction opposite to surgery to create for the doctor the best overview of the place where the lymph nodes are on the neck. Hands must be locked in position at right angles to the body. After carrying out all the preparatory measures, the surgeon proceeds to the operation.
Crail operation: description
Surgery is carried out in stages. This is due to the fact that the removal of lymph nodes leads to disruption of the jugular veins, therefore, removal simultaneously from both sides will disturb cerebral circulation.
At the first stage, the lymph nodes are removed from the side where they are most damaged. For the incision, a scalpel is used, which is changed at each subsequent dissection. Simultaneously with the dissection of the skin, hemostasis is necessary. For its implementation, the nurse hands the clamps to one of the assistants, while the second carefully and thoroughly drains the surgical field.
After the first stage of the operation, a break is made for two to three weeks, and then lymph nodes are removed on the other hand.
Complications of the operation
Any operation is a gross and cardinal intervention in the body, therefore undesirable consequences are possible. Any surgeon should set himself up for a positive outcome, but everything can be unpredictable. If Crail’s surgery is performed, complications occur and can be divided into two groups:
- Complications that appeared directly during the operation.
- Delayed complications that appear already in the postoperative period.
In each group, local and general complications can be distinguished.
The problems that arose during surgical intervention include:
- Damage to nerve trunks. This can subsequently lead to hoarseness, the development of tachycardia, pneumonia.
- Due to emphysema, pneumothorax can develop.
- If large vessels are damaged, an embolism occurs with air.
- Heavy bleeding; a blood transfusion may even be required.
- Some other difficulties during the operation that cannot be predicted in advance.
It should be noted that a competent surgeon will overcome all these complications by timely prophylaxis or by changing the technique of the operation.
The consequences of surgery
The consequences after surgery include:
- The breathing problems that most often develop due to laryngeal edema.
- Aspiration pneumonia. It can develop due to the accumulation in the lungs of foreign substances, such as vomit.
- Bleeding, in this case, the doctor is most often to blame, who did not thoroughly stitch the tissues.
- Swelling of the face.
- Cyanosis of the skin, especially in the mouth.
- Other consequences, upon the appearance of which it is necessary to consult a doctor.
Actions after surgery
Performing surgery is another half of the story, it is important that the patient tolerates the postoperative period well, and it is rather complicated if Crail’s operation was performed.
The patient from the operating department must be transferred to intensive care, where he is constantly monitored. During this period, it is very important to take all measures to prevent the development of postoperative complications.
The patient must prescribe the following groups of drugs to the patient in order to accelerate the process of recovery of the body after such a rough intervention:
- Analgesics to relieve pain.
- Soothing drugs to relieve nervous agitation and anxiety.
- Be sure to take antibacterial agents to prevent bacterial infection.
- Glucose injections will not interfere with the maintenance of the body.
- The body faster to cope with the consequences of the operation, if you take fortifying drugs.
After the operation is completed and transferred to the intensive care unit, anti-shock therapy is first performed. The patient is placed in a bed, which is preheated to room temperature, heating pads that are applied to the arms and legs can be used as an addition.
After surgery to remove lymph nodes against the background of oncology, radiotherapy is mandatory.
Medical personnel must timely treat the wound after surgery with antiseptic solutions in order to prevent the development of the inflammatory process and accumulation of pus. The dressing must be changed several times a day.
After the operation, the following activities are also required:
- Do everything possible to prevent a cerebrovascular accident.
- To perform splinting.
- Take all measures to prevent swelling of the larynx.
- If the patient lost a lot of blood during surgery, then a transfusion is needed.
- After the operation, the patient is prescribed special dietary nutrition.
- The doctor usually recommends that the patient do breathing exercises, this should be given at least 5 minutes three times a day.
It should also be noted that the patient in bed should be in a half-sitting position. This improves the process of ventilation. To improve breathing, an additional supply of oxygen through the nasal tube is indicated.
After the patient's condition stabilizes, he is transferred to a regular ward, where he is still under medical supervision for several days. Only when the patient’s condition does not cause fear among doctors, he will be discharged home, but the course of therapy can be continued, as a rule, the attending doctor gives important recommendations on observing the work and rest regimen, on nutrition, and the dosage of physical activity, which are generally excluded for the first time. It is possible that the doctor will prescribe some medications that must be taken.
Conclusion
In conclusion, it must be said that Crail’s operation has very different reviews. This is understandable, the body of each is individual and in its own way reacts to cardinal interventions in its work. So it turns out, there are patients who quickly recover after removal of the lymph nodes. But there is such a group that comes to life for a very long time. They need much more time to recover. Even after discharge, they are largely forced to limit themselves, strictly adhere to all the recommendations of the doctor.
I must also say that many patients who underwent surgery confirm that even after the end of inpatient treatment, it is necessary to take medications prescribed by a doctor, observe the regimen, and eat right. Of course, this operation is a gross intervention, but even after it there is an opportunity to recover and lead a familiar lifestyle.