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Web End = Oral Maxillofac Surg (2016) 20:431434 DOI 10.1007/s10006-016-0567-0
http://crossmark.crossref.org/dialog/?doi=10.1007/s10006-016-0567-0&domain=pdf
Web End = CASE REPORT
Sudden death after major head and neck cancer surgery due to undetected arrhythmogenic right ventricle cardiomyopathy (ARVC)
kos Bicsk1 & Alice Jellen1 & Herwig Tuppy2 & Wolfgang Paul Poeschl1
Received: 12 November 2015 /Accepted: 23 June 2016 /Published online: 29 June 2016 # Springer-Verlag Berlin Heidelberg 2016
AbstractBackground Oral squamous cell carcinoma is the sixth most frequent malignancy in Austria. The incidence of arrhythmogenic right ventricle dysplasia (ARVC), an important cause of sudden cardiac death, is estimated at 1:5000 to 1:1000.
Case report We present a case of a 75-year-old woman who underwent major oncologic surgery for T4aN0M0 maxillary squamous cell carcinoma and reconstruction with a scapularlatissimus dorsi microvascular flap. The patient died suddenly during her postoperative care. Autopsy revealed pericardiac tamponade due to rupture of the right ventricular wall. Histologic examination showed ARVC in a sample taken directly from the ruptured area. Cause of death was secondary arrhythmia originating from the ARVC. The arrhythmia had led to rupture of the right ventricular wall and sudden cardiac death.
Discussion As per our current knowledge, no cases of maxillary cancer and ARVC as co-morbidities have been reported in the literature. The patient had been given anti-arrhythmia treatment for previously detected atrial fibrillation, which could have been why the arrhythmia was not apparent on the electrocardiogram. Thus, although the appropriate preoperative diagnostics were performed according to current oncologic and anesthesiology guidelines, the potentially lethal cardiac condition of the patient could not be detected.
Keywords Arrhythmogenic right ventricle cardiomyopathy . ARVC . Major head and neck cancer surgery . Oral squamous cell carcinoma . Sudden cardiac death . Scapular-latissimus dorsi microvascular free flap
Background
Wound healing problems, wound infections, and bleeding are more or less expected complications after major surgical procedures, but sudden death is always a dramatic event. In such cases, the surgeon should investigate why a primarily successful surgical intervention resulted in a tragic outcome.
We present the case of a patient who was successfully operated on for squamous cell carcinoma of the maxilla. The surgery included secondary microvascular reconstruction. The patient died suddenly during her postoperative stay in the hospital. Autopsy revealed the cause of death as...