Extended neck dissection

Abstract

The most important prognostic factor in the management of head and neck cancer is the presence of nodal metastasis. Nodal metastasis generally decreases survival by almost 50%. The classical surgical procedure for cervical metastasis has been radical neck dissection for almost 75 years. There has been a paradigm shift towards modified neck dissections and preserving vital structures, especially the accessory nerve. Occasionally, patients may present with advanced metastatic disease in the neck requiring extended neck dissection—removal of additional structures such as skin, platysma, hypoglossal nerve, posterior belly of the digastric muscle, vagus nerve, and occasionally carotid artery. There are select indications for extended neck dissection and with postoperative radiation therapy satisfactory local control can be achieved. Every surgeon involved in head and neck surgery should be familiar with the procedure of extended neck dissection, its operative technique and prognostic implications.