Axillary lymph node access: the alternative for lymphangiography and embolization for lymphatic leakage after total laryngectomy and radical neck dissection

Lymphatic leakage is an uncommon but significant complication following head and neck surgeries, potentially leading to malnutrition, electrolyte imbalances and prolonged hospitalization. We report a case of a 69-year-old male with hypopharyngeal carcinoma who developed right neck lymphatic leakage 2 weeks post total laryngectomy and bilateral radical neck dissection. Despite conservative management, including low fat diet, the leakage persisted. Lymphangiography via right axillary lymph node access using a 25-gauge spinal needle revealed lipiodol pooling at the right supraclavicular fossa, confirming the leakage site. Subsequent embolization with 2 mL of 33% N-butyl cyanoacrylate (NBCA) glue successfully resolved the leakage. This case highlights a novel approach in managing neck lymphatic leakage through axillary lymph node access, offering an effective alternative for patients who are unresponsive to conservative treatment and lack accessible cervical lymph nodes.