Design, Setting and Participants
A retrospective analysis was performed on previously treated head and neck cancer patients who experienced CBS following tumor recurrence between 2015 and 2020. From medical records of 348 patients, 8 patients with CBS who had open approach surgical ligation of carotid artery were detected. Patients treated with endovascular intervention, untreated cancer patients and patients lost to follow-up were excluded. All of the patients had head and neck cancer with primary surgery and adjuvant treatment or salvage surgery and referred to our center with active bleeding due to CBS who were treated by open surgery with carotid ligation. CBS was classified as type I (threatened) CBS occurring when carotid artery was exposed through soft tissue breakdown, type II (impending) with limited, sentinel bleeding and type III (rupture) with active bleeding as suggested by Chaloupka et al(1) and Powitzky et al(12). Demographic data (age, sex), primary site of tumor, neck stage during primary treatment, type of surgery, radiotherapy history, predisposing factors (fistula, wound infection, necrosis), site of rupture, time to recurrence of tumor and time to CBS from exposure of neck soft tissues were obtained by a review of medical history. Variables were expressed as percentage, mean ± standard deviation. The reporting guideline of choice was STROBE (Strengthening the Reporting of Observational studies in Epidemiology) for this article. (13)