Classification Of Neck Dissections Research Articles

Levels of the Neck and Classification of Neck Dissection and Incisions

Neck dissection is a common procedure performed to remove lymph nodes in the neck that may contain cancer based on patterns of cervical metastases. Since the establishment of the radical neck dissection by Crile et al. in the early 20th century, modifications to this technique has been made. An understanding of lymphatic drainage patterns in the head and neck allowed for more limited dissections with reduced morbidity. This review discusses the history of neck dissection levels to its current accepted classification by the American Head and Neck Society, the evolving types of various neck dissections, and different incisions used to optimize resection and cosmetic outcomes.

Clinical study of lymph node metastasis without neck dissection classification in oral cancer

レベルシステムに含まれない口腔癌頸部リンパ節転移では，介在リンパ節である舌リンパ節あるいは外側咽頭後リンパ節が挙げられるが，発症頻度が低く，対応に苦慮することが多い。今回われわれは当科における口腔癌レベル外頸部リンパ節転移の治療法と予後について後ろ向きに検討を行い，今後の治療方針について考察した。 2008年6月から2021年12月までに当科で治療を行った口腔癌450例のうち，初回もしくは再発でレベル外頸部リンパ節のみられた17例を対象とし，転移リンパ節に対する治療，経過および予後について検討を行った。 初回治療時では外側咽頭後リンパ節転移が2例認め，副咽頭・咽頭後郭清術および超選択動注化学療法がそれぞれ施行されていた。再発時では後外側舌リンパ節1例，舌骨傍リンパ節7例，外側咽頭後リンパ節7例認めた。外側舌リンパ節転移は顎下リンパ節転移を伴っており，手術療法で救済可能であった。その他の14例はいずれも切除不能例で化学放射線療法，セツキシマブ併用放射線療法，免疫チェックポイント阻害薬あるいはベストサポーティブケアの治療方針となっていた。1年全生存率は舌骨傍リンパ節で25.0％，外側咽頭後リンパ節で33.3％と予後不良であった。 現在ではセツキシマブや免疫チェックポイント阻害薬が発達しており，生存期間を延長できる新たな治療方法として期待される。

Proposal for a rational classification of neck dissections

Alfio Ferlito, MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP, K. Thomas Robbins, MD, FRCSC, Jatin P. Shah, MD, PhD (Hon), MS, FRCSEd (Hon), FRACS (Hon), FDSRCS, Jesus E. Medina, MD, Carl E. Silver, MD, Shawkat Al-Tamimi, MD, Johannes J. Fagan, MBChB, FCS (SA) MMed, Vinidh Paleri, MS, FRCS (ORL-HNS), Robert P. Takes, MD, PhD, Carol R. Bradford, MD, Kenneth O. Devaney, MD, JD, FCAP, Sandro J. Stoeckli, MD, Randal S. Weber, MD, Patrick J. Bradley, MB, BCh, BAO, DCH, MBA, FRCS (Ed, Eng, Ir), FHKCORL, FRCSLT (Hon), FRACS (Hon), Carlos Suarez, MD, PhD, C. Rene Leemans, MD, PhD, H. Hakan Coskun, MD, Karen T. Pitman, MD, Ashok R. Shaha, MD, Remco de Bree, MD, PhD, Dana M. Hartl, MD, PhD, Missak Haigentz, Jr, MD, Juan P. Rodrigo, MD, PhD, Marc Hamoir, MD, Avi Khafif, MD, Johannes A. Langendijk, MD, PhD, Randall P. Owen, MD, MS, Alvaro Sanabria, MD, MSc, PhD, Primož Strojan, MD, PhD, Vincent Vander Poorten, MD, PhD, Jochen A. Werner, MD, Stanislaw Bien, MD, PhD, Julia A. Woolgar, FRCPath, PhD, Peter Zbaren, MD, Jan Betka, MD, PhD, FCMA, Benedikt J. Folz, MD, Eric M. Genden, MD, Yoav P. Talmi, MD, Marshall Strome, MD, MS, Jesus Herranz Gonzalez Botas, MD, Jan Olofsson, MD, Luiz P. Kowalski, MD, PhD, Jon D. Holmes, DMD, MD, Yasuo Hisa, MD, PhD, Alessandra Rinaldo, MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg

Neck Dissection in Oral Cavity Cancer

Lymph node status is the single most important prognostic factor in oral cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the oral cancer patients. The purposes of this article are to present the history of neck dissections, including current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of elective neck dissection and sentinel lymph node biopsy will be presented. It is necessary that dentists have to be interested in oral cancer and these interest will make it possible to prevent oral cancer, detect it earlier and also improve the prognosis, survival and the quality of life of survivors.

Classification of neck dissections: An evolving system

The authors review the evolving development of various types of neck dissections, and the resultant classification systems. The standard radical neck dissection, introduced at the turn of the 20th century, became the uniformly accepted treatment of cervical metastatic disease through the 1960s. The functional or modified radical neck dissection was developed in the 1950s and 1960s. This procedure became accepted treatment for suitable tumors by the 1970s. The concept of selective neck dissection, removal of only the node levels likely to be involved with tumor, gained acceptance by the late 1980s as definitive elective, and eventually, therapeutic neck dissection for suitable cases. In response to the increasing variations of neck dissection procedures, a number of classification systems were proposed and subsequently established. The system most often employed was published in 1991 by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. The system was revised in 2002 and 2008. These systems employ the American Joint Committee on Cancer staging system and traditionally established node levels. The neck dissections are grouped into four broad categories of radical neck dissection, modified radical neck dissection, selective neck dissection (this group is subclassified according to which node levels are removed) and extended neck dissection. Recently, the Japan Neck Dissection Study Group presented a new system for classification of neck dissections based on a system of letters and symbols. The system permits a comprehensive “shorthand” method of precise designation of the neck dissection procedure, but has the disadvantage of departing radically from previously employed systems by utilizing an entirely new terminology and designation of lymph node groups. This factor portends a lack of acceptance by surgeons long accustomed to conventional terminology. The abbreviated and tabular method of classifying neck dissections, however, is advantageous, and would be useful if integrated into the currently used terminology.

Consensus Statement on the Classification and Terminology of Neck Dissection

To update the guidelines for neck dissection terminology, as previously recommended by the American Head and Neck Society. Committee for Neck Dissection Classification, American Head and Neck Society; representation from the Committee for Head and Neck Surgery and Oncology, American Academy of Otolaryngology-Head and Neck Surgery (T.A.D.). Review of current literature on neck dissection classification. Semiannual face-to-face meetings of the Committee for Neck Dissection Terminology and e-mail correspondence. Standardization of terminology for neck dissection is important for communication among clinicians and researchers. New recommendations have been made regarding the following: boundaries between levels I and II and between levels III/IV and VI; terminology of the superior mediastinal nodes; and the method of submitting surgical specimens for pathologic analysis.

Discussion

Although the majority of maxillary sinus carcinomas certainly do not present with cervical nodal involvement, in those that do, the primary pathways of spread are represented by the lymphatic pathways along the facial artery (level IB), which are addressed by classic forms of neck dissection, as well as the retropharyngeal nodes, which are not. The management of malignancy of the posterior palate, posterior maxilla, and pharyngeal walls must, however, take into consideration these lymphatic pathways that traverse the retropharyngeal region. Classic anatomic descriptions suggest that these nodal stations drain the above-mentioned sites and drain into the nodes of the upper posterior cervical region, the level IIB lymph nodes, which sit above the accessory nerve in the substernocleidomastoid muscle recess. 1 Robbins KT Classification of neck dissection: Current concepts and future considerations. Otolaryngol Clin North Am. 1998; 31: 639 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar The presence of jugular lymph nodes in a patient with maxillary sinus cancer should therefore alert the clinician to this possibility and trigger a workup. This is exemplified by the cases reported in this article.

Historical outline on the nomenclature of neck lymph nodes as a basis of neck dissection classification

The neck dissection classification is based considerably on the organization of the lymph nodes of the neck. Terminology and anatomical allocation of nearly 300 cervicofacial lymph nodes repeatedly changed since the beginning of the 20th century. Analysis of the literature on neck lymph node organization with reference to the development of the neck dissection classification. The first fundamental nomenclature of the neck lymph nodes is founded on the work of Rouviére (1932). Suárez (1963) described the functional neck dissection on the basis of the fascial compartmentalization of the neck. Lindberg (1972) left the predominantly anatomically correlated grouping of the cervical lymph nodes as described by Rouviére and divided the lymphatic system of the neck on basis of pathophysiological mechanisms. The attention regarding the location of occult metastases led to the description of the selective neck dissection. Since the fundamental work of Shah et al. (1981) there was a multiplicity of more or less slight changes of the neck node regions. These changes were again basis for new neck dissection terminologies. A new classification was introduced in the year 2000 as the revised version of the American Head and Neck Society. The revised version of the neck dissection classification can reduce former controversies, particularly regarding an optimized intraoperative allocation of the lymph nodes and a simplified terminology of the selective neck dissection. With the goal of a standardization of the neck dissection forms it remains to be seen if the proponents of the functional neck dissection after Suárez consider the extent of the neck dissection in patients with N0 neck in favor of the selective neck dissection.

CLASSIFICATION OF NECK DISSECTION: Current Concepts and Future Considerations

In response to the increased number of neck dissection procedures and the lack of uniformity of terminology for describing these, several classification proposals have been made. The consensus report on neck dissection terminology by the American Academy of Otolaryngology-Head and Neck Surgery seems to have gained wide acceptance. This report outlines the Academy's classification system and its definitions for the lymph node groups. Other authors contributions are discussed and recommendations are suggested for future refinements to the classification system.

Possible Implications of Neck Lymphovenous Shunts-Reply

Thank you for sharing your experience with lymphoscintigraphy of the cervical pathways and bringing to our attention the possibility of lymphovenous shunting of head and neck malignancies. The lymph nodes along the internal jugular vein are usually considered to represent a downward pathway of lymphatic spread for tumor emboli and the lower jugular lymph nodes represent the inferior extent of this route. Your work with lymphoscintigraphic tracers suggests that this is not always the case and there is shunting from the upper jugular lymph nodes directly into the venous circulation. I will attempt to respond to your question on whether the distribution of pathologic lymph nodes in the neck outlined in our previous article on the classification of neck dissection is related to preferential pathways of drainage, retrograde lymphatic spread, or early lymphovenous shunting. In the neck dissection classification article, we defined the names and surgical boundaries of six regions

Classification of neck dissection: Variations on a new theme

Commencing in 1984, we initiated a head and neck service surgical database that included a classification system for neck dissection. The aim was to reduce the confusion in terminology resulting from growing interest in modifications of conventional radical neck dissection. We considered a neck dissection as radical when four or five lymph node levels were excised; this included patients who had an otherwise classical neck dissection for supraglottic larynx or hypopharyngeal cancer sparing level 1. Lymph-node levels removed, nonlymphatic structures preserved, and excised nonlymphatic structures not ordinarily included in a classical radical neck dissection were all specified by the operating surgeon. We defined as a selective neck dissection any lymphadenectomy that encompassed no more than three nodal levels, usually supraomohyoid (levels 1, 2, 3), or jugular (levels 2, 3, 4). We defined as a limited neck dissection any lymphadenectomy that involved removal of no more than two nodal levels. At the 10-year mark, this database of 10,650 patients now includes 2,635 lymphadenectomies in 2,426 patients, the precise extent of which is accurately described in each patient. The current classification of neck dissection does not cover all possibilities. If we define as radical those lymphadenectomies that resect four or five nodal levels and specify structures preserved or additional nonlymphatic structures sacrificed, we allow for the possibility that some procedures may be both modified and extended. Selective would describe the standard, three-level dissections (eg, supraomohyoid or jugular node dissections), and the term limited would be introduced to indicate a neck dissection that involves removal of no more than two nodal levels. Such a three-tiered classification would more accurately reflect the time and effort involved and provide a more equitable basis for reimbursement.

A rational classification of neck dissections (editorial): Jesus E. MedinaOtolaryngol Head Neck Surg. 1989: 100: 169-76

A rational classification of neck dissections (editorial): Jesus E. MedinaOtolaryngol Head Neck Surg. 1989: 100: 169-76

A Rational Classification of Neck Dissections

A Rational Classification of Neck Dissections