Selective neck dissection iowa head and neck protocols. While the importance of treatment of the neck in clinically detected lymph nodes is beyond doubt, elective treatment of the clinically negative neck continues to bring controversy. Neck dissection is an important surgical procedure for the management of metastatic nodal disease in the neck. Thyroidectomies, glossectomies, and neck dissections. Proposal for a rational classification of neck dissections. It consists of removing lymph nodes from specific areas of the neck, and removing or not the sternocleidomastoid muscle, the internal jugular vein, and the accessory nerve. At that time, the technique of neck dissection included the en bloc resection of the spinal accessory nerve, the jugular vein, and the sternocleidomastoid muscle, and in some cases, the resection of the vagus nerve. Schobinger 1957 the use of a long anterior skin flap in radical neck dissections. Rather than use specific names for a particular neck dissection, it has become standard practice to call the neck dissection performed according to the levels of the neck dissected and the. Get a printable copy pdf file of the complete article 1. Functional and selective neck dissection begins with a full explanation of the fascial compartmentalization of the neck, and goes on to explain and illustrate the procedures. The functional neck dissection for lymph node neck metastasis.
On the pain sorry to say but it is there for life as part of our new normal. Apr 18, 2005 the selective neck dissection addresses a select group of lymph nodes based on the location of the highest incidence of metastatic disease, thus supraomohyoid neck dissection became very popular as a staging procedure for cancer of the oral cavity. Common types of neck dissection modified neck dissection. In certain situations, a neck dissection can also be performed prophylactically at the time of thyroidectomy to avoid a second operation due to recurrence. Neck dissection sankt gertraudenkrankenhaus gmbh, berlin. Operative steps the detailed stepbystep description of neck dissection that follows refers to a right sided mnd type i or ii. The gold standard of neck nodal management has been the radical neck dissection. The selective neck dissection addresses a select group of lymph nodes based on the location of the highest incidence of metastatic disease, thus supraomohyoid neck dissection became very popular as a staging procedure for cancer of the oral cavity.
This dissection video will show you the major steps of accomplishing the dissection of the posterior triangle of the neck. Radical neck dissection removes nearly all lymph nodes on one side of the neck as well as the internal jugular vein, sternocleidomastoid muscle and spinal accessory nerve. Classifications, indications, and techniques dr kuljinder sodhi. Tnm staging of head and neck cancer and neck dissection. Crile described the operation in 1906, and until recently, radical neck dissection was considered the standard procedure for management of both occult and clinically positive neck disease. The spinal accessory nerve and the internal jugu lar vein are preserved. This surgery is intended to remove lymph nodes or masses known or suspected to be harboring cancer cells. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most important factor in the spread. Great to have you with us, i did not do the neck dissection i just did the rad to the neck in hopes that it would kill the c, and it looked like it worked for me.
This article reflects the 2001 classification by the american head and neck society and the american academy of otolaryngologyhead and neck surgery 1, 2. This is a surgery to remove the lymph nodes in the neck area. The spinal accessory nerve, internal jugular vein and the sternocleidomastoid muscle are preserved. Carefully remove only the skin of the neck staying superficial to platysma muscle and ensure you leave it attached to the mandible 2. Selective neck dissection removes the cervical lymph nodes considered to be at high risk for metastasis from a given primary site.
Beginning with an introduction to the classification of neck dissections and incisions, the following chapters describe techniques for different sections and disorders of the neck. You may have felt swollen lymph nodes in your neck when you have had an infection such as a simple cold. Practical guide to neck dissection pdf arslan library. Neck dissection classification radiology reference article. After removing the lymph nodes, the surgeon places a small tube drain in the wound and closes the cut with stitches or staples.
Supraomohyoid neck dissection posterolateral neck dissection lateral neck dissection anterior neck dissection indication. Complete chapters are dedicated to selective neck dissection. Definition radical neck dissection is an operation used to remove cancerous tissue in the head and neck. Nerve damage can cause numbness temporary or permanent in different regions on the neck and create loss of function temporary or permanent. Selective supraomohyoid neck dissection, levels iiii. Rnd involved the same surgical steps, other than that the. Purpose the purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. My c started in 2002 and i been treated in 2004 and 2005 when it came back for a. Hockeystick incision for neck dissection combined with parotidectomy. Incisions for neck dissection combined with oral cavity cancer resection figure 4. Links to pubmed are also available for selected references.
The book covers all techniques of neck dissection and the most recent advances in neck dissection by advocating better access to all techniques of neck dissection. Elective treatment of n0 neck with significant risk of regional metastasis. See table iiie1 pdf and cervical lymphadenectomy general considerations protocol of selected n1 neck dissection. Clinicalanatomy neck jan plzak department ofotorhinolaryngology andhead andnecksurgery institute ofanatomy 1st facultyofmedicine, charles univesity, prague. About your neck dissection surgery memorial sloan kettering. Because so much tissue is removed, one side of the neck may appear flatter than the other. Apr 18, 2005 neck dissection is an important surgical procedure for the management of metastatic nodal disease in the neck. Neck dissection, also known as cervical lymphadenectomy, is the surgical procedure for the management of metastatic cervical lymphadenopathy. Anatomy guy dissection sheet posterior triangle of neck dr. This operation may be carried out if there is evidence that there are one or more nodes affected with cancer in the neck. The objective of this study is to educate practitioners and trainees about surgical.
In your neck,your lymph nodes are organized into levels see figure 1. Neck dissection clinical application and recent advances is a leading book in neck surgery and represents the recent work and experiences of a number of top international scientists. Exercises following a neck dissection the following exercises have been developed to increase the movement and strength in your neck, arms and shoulders following a neck dissection. Neck dissection nd is a procedure for diagnosing staging and treating head and neck cancer. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Oct 04, 2018 radical neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. Selective neck dissection appears to be equally effective as modified comprehensive neck dissection for elective treatment of the neck. The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submental and submandibular triangles lymph node level i, the jugulodigastric and. It was bocca and pignataro who first described the functional neck dissection or mnd iii in their landmark paper in 1967. Selective neck dissections are generally performed on an elective basis. Neck dissection is usually performed to remove cancer that has spread to lymph nodes in the neck. Full text full text is available as a scanned copy of the original print version. Jan 21, 2016 the radical neck dissection was designed to ensure complete cancer removal in individuals with very advanced cancers in the neck. Brown 1970 horizontal incisions for radical neck dissections.
The more extensive the neck dissection, the more function the patient is likely to lose. Evaluation of four incisions used for radical neck. This article reflects the 2001 classification by the american head and neck society and the american academy of. Surgery is the oldest and continues to be the most reliable form of treatment of malignancy. Otolaryngology functional and selective neck dissection. Craig goodmurphy anatomy guy major dissection objectives 1. Anterior neck dissection thisincludeslevelvifigure6. Neck dissection classification radiology reference. Lymph nodes are small bean shaped glands scattered throughout the body that filter and process lymph fluid from other organs.
The first radical neck dissection was described and performed by. Neck lymph node excision not only helps stage the disease but also. Stepbystep descriptions of functional dissection surgeries, demonstrated with more than 200 highquality, sequential operative photographs and drawings, highlight and. Variations on neck dissections exist depending on the. Mar 03, 2015 selective neck dissection cervical lymphadenectomy with preservation of one or more lymph node groups four common subtypes. If your doctor thinks that theres a high risk that the cancer may have spread to the lymph nodes in your neck, or if it has already spread to those nodes, your treatment may include having a neck dissection. It is recommended that these exercises are started soon after your operation and should be carried out 2 or 3. Any modification in the neck dissection is always compared with this standard. It seeks to guide the reader presumably a neck surgeon wishing to improve his or her own technical skill through the various cervical structures in all their complexity. Radical neck dissection definition of radical neck. Know the levels of the neck and anatomic and radiographic borders. The term neck dissection has evolved to encompass several different operations that may be selected based on the nature of the disease.
A selective neck dissection, including levels i through iii, is typically used for malignancies of the oral cavity in patients with n0 disease. Dissection sheet 8222012 posterior triangle of neck. The definitions of types of neck dissection remain unchanged as previously outlined in the 1991 classification article. Radical neck dissectionremoves neck tissue, lymph nodes, muscle between the collarbone and jawbone, the internal jugular vein, and muscles and nerves that control speech, swallowing, and movement in the face, neck, and shoulder.
The idea of an illustrated manual on neck dissection, which dates back roughly 2 years, was based on this philosophy. There is also a dissection steps pdf file attached so you can print the worksheets and make any notes you wish to take to lab with you as a reminder of the steps. If sutures or staples are still in place, clean incision twice a day with hydrogen peroxide followed by saline solution. Neck dissection technique commonality and variance. Jun 14, 20 i had a neck dissection on both sides of my neck just before easter. See table iiie1 pdf and cervical lymphadenectomy general considerations protocol of. Neck dissection hull university teaching hospitals nhs trust. Cervical lymphadenectomy, or neck dissection, is the treatment of choice when there is evidence of lymph node metastasis from thyroid cancer. The functional neck dissection for lymph node neck. The treatment of the neck in patients with squamous cell carcinoma of the upper aerodigestive tract and other neoplasms of the head and neck region continues to be one of the most controversial issues in head and neck oncology. I had a neck dissection on both sides of my neck just before easter. Neck dissection classification update article pdf available in archives of otolaryngology head and neck surgery 1287.
Head and neck dissection lecture johns hopkins hospital. This book is a concise guide to neck dissection procedures for practising and trainee otolaryngologists. Original article neck dissection classification update. Neck dissection nd technique preferences are not well reported. The greatest risk in a neck dissection is damage to the nerves, muscles, and veins in the neck. Cut both clavicles in the middle third without removing the manubrium 3. Oppenheimer md division of otolaryngologyhead and neck surgery, department of surgery, university of california, san diego, school of medicine, ucsd cancer center. Selective neck dissection cancer survivors network. Neck dissection is surgery to remove the lymph nodes and surrounding tissue in the neck. Neck dissection clinical application and recent advances.
The university of tennessee, department of otolaryngologyhead and neck surgery, 956 court ave. Terms based on the intent or purpose of the neck dissection include planned neck dissection, therapeutic neck dissection, elective neck dissection, prophylactic neck dissection, salvage neck dissection, and others, depending on the vocabulary and. Hence, this study compared the results of these commonly used incisions for radical neck dissection on the basis of their accessibility to operation site, duration of operation, postoperative wound healing, damage to vital structures and scar cosmesis developing a standardized outcome, which will form the basis of the selection of the most suitable incision for a given case of neck metastasis. A neck dissection is an operation to remove lymph nodes from the neck on one or both sides. I had both a tonsillectomy, a small tongue dissection and the dual selective neck dissections at the same surgery. When a larger nodal burden is present, an extended levels iiv selective neck dissection or a modified radical neck dissection levels iv is indicated.
Stell 1969 transverse incisions for radical neck dissection. I only had a modified neck dissection, 23 lymph nodes and my left salivary gland, i still have daily pain, and stiffness in my neck, as well as issues with my left arm, so i imagine with as extensive as your husbands surgery was, i makes sense that he would still have pain. There is good information by searching the discussion board, and everyones treatment and experiences are different, but here are some of mine. Carcinoma of the oral cavity has a great potential for metastatic spread to neck lymph nodes, with the incidence reported to be 3450%. Early identi fication of the phrenic nerve to keep it visualized. Interest developed in understanding the prognostic factors of metastatic disease in the neck. Neck dissection was originally based on halsteads principles of en bloc removal of lymph nodes in the neck for the management of patients with head and neck tumors. Codes 415 glossectomy, partial, with unilateral radical neck dissection and 41145 complete or total, with or without tracheostomy, with unilateral radical neck dissection refer to glossectomies with radical neck dissection. These procedures sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles so the surgeon. The immune cells in the lymph nodes help the body fight infection.
The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck. This technique avoids the inadvertent elevation of the plexus and its contribution to the phrenic nerve. The radical neck dissection is effective but produces characteristic cosmetic changes. Radical neck dissection association of surgical technologists. Selective neck dissection a supraomohyoid b lateral c posterolateral d anterior 3.
There are multiple types of neck dissection that vary by the structures removed 1. With laryngectomy patients, mnd can be done either via a wide apron flap, or by lateral extensions from the apron flap. The modifications to the radical neck dissection are as follows. Marginal mandibular nerve weakness ramus mandibularis level i neck dissection extended recurrent pleomorphic adenoma. Neck dissection discharge instructions a neck dissection may be performed alone to further evaluate a neck mass, to biopsy lymph nodes, or in addition to another procedure being performed on the head and neck. As performed by dr crile, the radical neck dissection called for the removal of all the. It has been proposed that neck dissections be more logically and precisely described and classified by naming the structures and the nodal levels that have been resected.