Roentgen changes following radical neck dissection.

Abstract

We propose to describe and demonstrate the changes in the postero-anterior roentgenograms of the chest resulting from a relatively common surgical procedure, the radical neck dissection described by Crile. This problem first presented itself when we noted in one of our cases (Case 1) a calcific excrescence on the clavicle, the significance of which was not understood until we learned that the patient had been subjected to a radical neck dissection. We concluded that the calcific projection represented a spur consequent to surgical trauma to the clavicular periosteum. Subsequently we collected and analyzed all available cases of neck dissection performed in this hospital and observed other roentgenographic stigmata referable to the operation. It is well known that many surgical procedures are associated with characteristic roentgenographic manifestations and can thus be recognized by the radiologist with a high index of assurance, even in the absence of a clear history. Radical mastectomy provides the outstanding example of an operation which produces changes recognizable for what they are even in the absence of a history. Knowledge of previous surgery is often one of the important building blocks essential for correct interpretation of a roentgen study. Every roentgenologist is aware of the orientation of his thought processes following directly upon observation of the absence of the breast shadow. In the same way, he may recognize the presence of a radical neck dissection by the roentgen findings, even without prior knowledge of the procedure. The value of roentgenographic recognition of a previous surgical procedure may be threefold: (a) It may provide the radiologist, and even the clinician, with information which is not otherwise available to them, (b) Pursuant to the above, it will direct the radiologist's attention toward pathology of the type that may reasonably follow as a complication of the surgery or the underlying disease process. (c) It may assist the radiologist to avoid the pitfall of interpreting the changes resulting from surgery as a spontaneous pathologic process or an anatomic abnormality. Certainly, in most instances, this last consideration would be dominant. The Surgical Procedure The radical neck dissection done in the cases reported here conforms essentially to the procedure described by Crile. The accompanying diagram (Fig. 1) illustrates the appearance of the completed dissection prior to skin closure. The side operated upon presents salient anatomical features, important from a radiographic standpoint, as follows: 1. General soft-tissue deficiency. 2. Absence of the sternomastoid muscle. 3. Interruption of the eleventh cranial nerve, innervating the trapezius muscle. The nerve is frequently excised, although occasionally left intact.