Type Of Neck Dissection Research Articles

Preservation of the external jugular venous drainage system in neck dissection

Objective To investigate whether preserving the external jugular vein (EJV) in neck dissection reduces postoperative edema of the face and neck. Study Design A prospective, randomized controlled trial. Setting A tertiary hospital. Subjects and Methods Thirty-eight subjects were randomly assigned to two groups: EJV preservation versus sacrifice during neck dissection after stratification according to the neck dissection extent and type, the previous treatment, the primary site, and the reconstruction type. The relative soft-tissue thickness was evaluated by follow-up computed tomography (CT) scans at one week and four to five weeks postoperatively and compared with preoperative findings. The preserved EJV patency was also determined by contrast enhancement of EJV on follow-up CT scans. In addition, the scores for pain/discomfort on the upper neck/face and laryngeal edema were recorded at each time point. Results Relative soft-tissue thickness reached up to 160 percent of preoperative status at the hyoid and cricoid levels at one week postoperatively but resolved at four to five weeks. EJV preservation reduced the soft-tissue thickness significantly compared with EJV sacrifice ( P < 0.05) at one week postoperatively, particularly at the mandible and hyoid level. All preserved EJVs remained patent at one week, and 18 of 19 remained patent at four to five weeks. In addition, EJV preservation diminished the discomfort/pain of the upper neck/face compared with EJV sacrifice at one week ( P = 0.036). The extent of laryngeal edema did not differ between the two groups. Conclusion EJV preservation may reduce immediate postoperative neck edema and pain/discomfort related to neck dissection.

10-Year review of the cancer service in Cardiff

A 10-year retrospective review of Oral Cancer treatment at the maxillofacial unit Cardiff is presented. Utilising the Walton database, the stage of the disease at presentation, the resection and the type of neck dissection performed, the method of reconstruction and the primary site and neck recurrence as well as survival rates are presented. There is a follow up period of between 2 and 12 years. A previous presentation with a subsequent published paper by the senior author emphasised the shortcomings of the supraomohyoid neck dissection and the need for the inclusion of level IV and this presentation will support these views.

Prise en charge des curages ganglionnaires cervicaux en pathologie tumorale ORL

The presence of metastases in cervical lymph nodes (except distant metastasis) is the most significant independent prognostic factor in carcinoma of the head and neck. The purpose of this article is firstly to review the anatomy of the neck compartments, the types of neck dissection and secondly to describe recommendations for the technical procedures required and thus to provide a full informative report to optimise management by the clinician.

Regional Control of Melanoma Neck Node Metastasis After Selective Neck Dissection With or Without Adjuvant Radiotherapy

To examine the effect of adjuvant radiotherapy on regional control of melanoma neck node metastasis. A single-institution retrospective study. Tertiary care cancer center. The study included 64 patients with melanoma neck node metastasis who were treated with neck dissection between 1989 and 2004 in The Netherlands Cancer Institute, Amsterdam. Twenty-four patients were treated with surgery only (15 modified radical neck dissections [MRNDs] and 9 selective neck dissections [SNDs]) (S group), and 40 patients underwent surgery (28 MRNDs and 12 SNDs) and adjuvant radiotherapy (S+RT group). Prognostic factors, ie, number of nodes, size of nodes, and extracapsular extension, were worse in the S+RT group. With a median follow-up of 2.5 years, the 2-year ipsilateral regional recurrence (RR) rate was 18% in the S+RT group and 46% in the S group. This 28% difference in RR was not statistically significant (P = .16). However, evaluation of the effect of adjuvant RT in multivariate analysis revealed a significant reduction of the RR rate after correction for the number of involved nodes (P = .04). In the S group, SND was associated with a trend toward worse RR rate compared with MRND but was not statistically significant in univariate analysis (P = .08). The type of neck dissection did not influence the RR rate in the S+RT group (P = .60). Three of the 4 RRs occurred outside the dissected volume after SND in the S group. Based on our findings, we conclude that, compared with extended neck dissection, SND leads to inferior regional control in patients with melanoma neck node metastasis who are not treated with RT, even those with low-risk neck disease. Furthermore, our results suggest that adjuvant RT improves regional control in patients with 2 or more involved nodes.

Indications and extent of elective neck dissection in patients with early stage oral and oropharyngeal carcinoma: nationwide survey in The Netherlands

Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck. In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head and Neck Oncology Cooperative Group. This questionnaire covered: the factors influencing the decision to perform an elective neck dissection; the neck staging procedure; and the types of neck dissection undertaken. All eight questionnaires were returned completed. Respondents indicated that the site (n = 6), size (n = 7) and thickness (n = 6) of the primary tumour were important in decisions regarding elective neck dissection. Ultrasound-guided fine needle aspiration cytology was the most frequently used diagnostic technique (n = 7). Depending on the site and stage of the primary tumour presented, in the different cases 3-7 of the centres would perform an elective neck dissection. Selective neck dissections (i.e. levels I to III/IV) were more frequently performed than modified radical neck dissections. There was no uniformity regarding management of the clinically negative neck in patients with early stage oral and oropharyngeal carcinoma, within The Netherlands.

O90. What type of neck dissection should be performed after a positive sentinel node biopsy?

O90. What type of neck dissection should be performed after a positive sentinel node biopsy?

Management of the N0 neck in moderately advanced squamous carcinoma of the larynx

Objective To assess the oncological efficacy of selective neck dissection (SND) in patients with T3-4 N0 laryngeal squamous carcinoma. Subjects and Methods A total of 327 patients underwent 654 neck dissections; each side of the neck was individually evaluated. Results Three percent of patients who had SND developed regional recurrence (RR) in comparison with 11.7 percent of patients who underwent modified radical neck dissection (MRND) ( P = 0.005). Only 3 (0.9%) patients developed RR outside the field of SND. The presence of extracapsular extension ( P = 0.002) in node-positive (pN+) group and of microvascular invasion ( P = 0.007), together with the type of neck dissection (ND) ( P = 0.0003) in node-negative (pN0) group had statistical impact on RR. The development of RR significantly affected disease-specific survival ( P = 0.0001). Equivalent rates of RR were found in pN+ (2.6%) or pN0 (3.2%) patients treated with SND ( P = 0.98) as well as in pN+ patients who underwent SND (2.6%) or MRND (4.7%) ( P = 0.85). Conclusion This study confirmed the adequacy of SND as a satisfactory staging and therapeutic procedure, and suggests its use in the treatment of limited node-positive (N+) neck.

Metastatic Neck Disease Beyond the Limits of a Neck Dissection: Attention to the 'Para-hyoid' Area in T1/2 Oral Tongue Cancer

We evaluated patients with small oral tongue cancer suffering from recurrence, which develops in the intervening area between the primary site and the neck. Lesions in the area around the cornu of the hyoid bone ('para-hyoid' area) often involve the hypoglossal nerve and the root of the lingual artery, resulting in treatment failure and death. A 10-year retrospective chart review was conducted of 248 oral tongue cancer patients with small primary tumors (T1/2). No patients who underwent postoperative radiotherapy (PORT) were included. After excluding those who had local failure or developed new primary lesions, 6.3% of the patients were noted to have a para-hyoid lesion. A similar incidence was observed between the patients with and without previous neck dissection, 6.9% and 5.7%, respectively. All but one patient died due to uncontrolled neck disease. Recurrent para-hyoid lesions could occur, irrespective of a previous neck dissection. In other words, the para-hyoid area is beyond the limits of a neck dissection. Once a para-hyoid lesion becomes clinically evident, it seems difficult to salvage. Therefore, a careful inspection of the area should be included intraoperatively in any type of neck dissection (i.e. elective or therapeutic) for patients with oral tongue cancer. This may be the key to improving the regional control rate of patients with small oral tongue cancer. We believe that some patients will benefit from more aggressive treatment of the neck, although PORT seems unnecessary for the majority of the patients with limited neck disease.

Radial Forearm Flap for Tongue Reconstruction

Objective: To present a case of tongue reconstruction using radial forearm free flap.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary government hospital&#x0D; Patient: One&#x0D; Results: A 52-year- old female with a T3N2cM0 Stage IVa right tongue carcinoma underwent tracheotomy, right hemiglossectomy with modified radical neck dissection type III and extended supraomohyoid neck dissection on the left with radial forearm free flap reconstruction. After 1 month, the radial forearm free flap reconstruction in the tongue had acceptable appearance and good tongue mobility with intelligible speech. The patient did not complain about the appearance and function of the left forearm.&#x0D; Conclusion: The radial forearm free flap is a viable reconstructive option for tongue defects&#x0D; especially where a thin, pliable flap is needed. There is acceptable form and functional restoration with minimal donor site morbidity.&#x0D; Keywords: radial forearm free flap, tongue reconstruction

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.

Spinal Accessory Nerve Neuropathies Followng Neck Dissection

Objective To evaluate through electromyography (EMG) the injury to the 11th cranial nerve following neck dissection. Methods Prospective study with 60 patients submitted to neck dissection as part of treatment of head and neck tumors. All the cases underwent physiotherapic evaluation of shoulder dysfunction. Nerve integrity was evaluated pre- and postoperatively through surface EMG registering the electric activity of descendent fibers of trapezius muscle during maximal isometric voluntary contraction. The patients were grouped according the type of neck dissection, presence of shoulder pain, impairment during abduction movement, and hypotrophy or atrophy of trapezius muscle. Results The action potential had mean and standard deviation of 61,7±31,6mcV in preoperative evaluation and 15,6±12,4mcV in postoperative evaluation (p&lt;0.001). According to the neck dissection extension, there were mean values of 18,8±14,2mcV after dissection includiog level IIb and 18,8±14,2 mcV after dissection including levels IIb and V (p&lt;0.002). Conclusions Surface EMG is a sensitive and painless for 11th cranial nerve disfunction evaluation. In all cases, the superior fibers of trapezius muscle were affected with presence of pain and impairment abduction movement of the arm. The results suggest the benefit of trapezius muscle EMG to confirm the diagnosis and early physiotherapic intervention in neuropathies of the 11th cranial nerve.

Contralateral Lymph Neck Node Metastasis of Squamous Cell Carcinoma of the Oral Cavity: A Retrospective Analytic Study in 315 Patients

In relation to primary squamous cell carcinoma (SCC) of the oral cavity, many clinical and histopathologic factors have been reported to be predictive for lymph neck node relapse. However, few large studies concerning the association between clinical-histopathologic features and the development of contralateral lymph neck node relapse (CLNR) after surgical resection of primary SCC of the oral cavity are available. The purpose of this study was to analyze those factors related to the appearance of contralateral lymph neck node relapse in patients with SCC of the oral cavity primarily treated by means of surgery. This study was based on a series of 315 consecutive patients with primary SCC of the oral cavity treated between June 1979 and December 1999. All patients were treated primarily by means of surgery with or without adjuvant radiotherapy. The following data were analyzed for each patient: age, gender, habits, time to diagnosis, performance status, tumor clinical features, histologic grade, TNM staging, type of neck dissection, survival outcome, and functional/esthetic results at the end of the follow-up period. Histologic study included the pTNM classification, tumor size, surgical margins, extracapsular spread of lymph neck node metastasis, perineural infiltration, peritumoral inflammation, and bone involvement. Eighty-three patients eventually died of the disease (26.34%). A total of 177 patients were alive with no evidence of recurrence at the end of the study. The mean disease-specific survival rate was 147 +/- 6 months. Twenty-nine (9.1%) patients developed ipsilateral lymph neck node relapse (ILNR), whereas 18 (5.69%) patients developed CLNR. The mean period of time from surgery to the appearance of CLNR was 12.52 months (range, 3 to 49 months). Eighteen of 29 patients with ILNR finally died of the disease. Seven of 18 patients with CLNR died of the disease. Several clinical-pathologic features were predictive for CLNR in SCC of the oral cavity, such as the time to diagnosis, TNM staging, positive ipsilateral clinical N status, histopathologic differentiation, surgical margins of primary tumor resection, type of neck dissection, and perineural infiltration. Delay in diagnosis 12 or more months is associated with increased CLNR. Clinical and pathologic factors predictive for CLNR are TNM tumor staging IV, histopathologic poor-differentiation of the primary tumor, surgical margins less than 1 cm around the primary tumor, performance of isolated ipsilateral modified type III radical neck dissection, and perineural tumor involvement. Presence of ipsilateral neck metastasis at the time of diagnosis is associated with an augmented incidence of CLNR in SCC of the oral cavity.

Early history of neck dissection

With the exception of distant metastases, the presence of lymph node metastasis in the neck is accepted as the single most important adverse independent prognostic factor and an indicator of survival in squamous carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical, subclinical and subpathologic metastatic cancer to the neck. The pertinent literature from the beginning of the nineteenth century to the middle of the twentieth century was reviewed. The four giants of late nineteenth century surgery: von Langenbeck, Billroth, von Volkmann and Kocher developed and reported the early cases of different types of neck dissection. Butlin, in England, conceived and developed the concept of elective neck dissection. In 1888, the Polish surgeon Jawdyńsky reported and described in detail the first successful extended en bloc neck dissection. Crile, in 1905 and 1906, reported the first significant series of radical en bloc neck dissections, bringing this procedure to the attention of the medical world as an effective operation with reproducible technique and results. The greatest impetus to the status of this surgical procedure came from Martin and colleagues, who published a monumental report in 1951 of 1,450 cases that established the place and technique of radical neck dissection in the modern treatment of head and neck cancer. Neck dissection, for treatment of cervical lymph node metastases in head and neck cancer, was conceived and attempted in the nineteenth century, with some limited success reported by the end of that era. An effective operation was described and reported in the early twentieth century and evolved by the mid century into a fundamental tool in the management of patients with head and neck cancer.

Shoulder Function in Various Types of Neck Dissection. Role of Spinal Accessory Nerve and Cervical Plexus Preservation

The aim of this study is to determine the effects of two different types of nerve-sparing neck dissection on shoulder function. Even if the spinal accessory nerve is spared in functional neck dissection, some degree of shoulder syndrome may occur. The role of the cervical plexus in shoulder function and the effects of dissection of level 5 are emphasized. Twenty-six patients with laryngeal carcinoma were studied prospectively. Seventeen anterolateral and 15 functional neck dissections were performed. Electromyographic evaluation was carried out in all patients to assess spinal accessory nerve function preoperatively and at the sixth week and sixth month postoperatively. Shoulder disability was evaluated by a questionnaire (shoulder pain disability index) and goniometric measurements were done preoperatively and at the sixth postoperative month. In patients who underwent anterolateral neck dissection, the goniometric results were better than in the functional neck dissection group. The questionnaire results also showed better quality of life of patients who underwent anterolateral neck dissection. Electrophysiological evaluation of the trapezius muscles of both groups at the sixth week showed significant differences. The distal motor latency values of the anterolateral neck dissection group were shorter than those of the other group. Electrophysiological evaluation at the sixth postoperative month showed shorter distal latency values in the anterolateral dissection group, without statistical significance. Preservation of the cervical plexus and less disturbance of the spinal accessory nerve are important to diminish postoperative shoulder disability. The type of neck dissection has an important influence on shoulder function.

Editorial: Complications of Neck Dissection for Thyroid Cancer

There is a high incidence of nodal metastasis in well-differentiated and medullary thyroid carcinomas. With a diagnosis of papillary carcinoma, 40% to 60% will develop nodal metastasis.1 Elective nodal dissection is generally not indicated, however careful evaluation of the central compartment is essential in all patients undergoing thyroid surgery for suspected thyroid cancer.2 If the lymph nodes are clinically apparent at the time of thyroidectomy, central compartment clearance is usually considered. Neck dissection, though a reliably safe procedure, carries certain potential complications which are important to recognize. Roh et al.3 from Korea have mainly discussed the issue related to chyle leak after neck dissection for thyroid cancer. The purpose of this editorial is to discuss various types of neck dissections for thyroid cancer and routine complications, along with the techniques to avoid these complications.

Neck dissections: A practical guide for the reporting histopathologist

Summary This paper outlines types of surgical neck dissection and describes practical aspects of producing an accurate histopathological assessment and report.

Mandatory Indication for Neck Dissection Based on Long-Term Results

The cervical lymph node status is one of the most important prognostic factors in oral tongue SCC. To assess the nodal status, CT, MRI, ultrasonography, and PET have been used, and currently good quality of CT is the imaging study of choice for nodal stage. However, even these imaging modalities hardly detect micrometastases. When a “wait and see” policy is used for the neck at risk for metastases, patients tend to fail with advanced nodal disease, even with close follow-up. So in light of the tumor characteristics influencing the propensity for nodal metastases, it has been suggested that if the probability of metastases to cervical lymph nodes exceeds 20%, then neck dissection is warranted. However, the probability of metastases is hardly determined. In general, for clinically N- patients with T1 or early T2 tumor, “wait and see” is adopted. For clinically N- patients with late T2 or more disease, supraomohyoid neck dissection (SOHND) is recommended, and extended SOHND clearing nodal level IV in addition to levels I, II and III is indicated in selected patients. Sentinel lymph node biopsy is under investigation in clinically N- patients. In clinically N+ patients, neck dissection is the most widely accepted treatment. Various types of neck dissection are performed depending on the nodal stage and minimizing the morbidity of the procedure. In this setting, radical neck dissection (RND) or modified RND sparing the SAN, IJV or SCM is indicated. SOHND in clinically N+ patients is controversial, however, it is often advocated in N1 patients whose metastasis involves the level I node without evidence of extracapsular spread (ECS) of tumor. Lingual lymph nodes, small, interrupting nodules located deeply above the suprahyoid region along the course of the lymphatic vessels draining the tongue are infrequently involved, so they should be included in dissection in selected patients. Risk factors for failure in the neck or distant sites are the presence of ECS of tumor, and presence of multiple nodes involved at multiple levels of the neck. In patients with such advanced neck disease, postoperative chemoradiotherapy may decrease the rate of failure.

Is the type of dissection in lateral neck metastasis for differentiated thyroid carcinoma important?

This study was to compare the types of therapeutic neck dissection in patients with differentiated thyroid carcinoma. Sixty-one patients with lymph node metastasis in the neck, treated between 1997 and 2001, were studied retrospectively. A comparative study was made of a selective lateral neck dissection group and a radical or modified radical neck dissection group for recurrence, disease free survival (DFS), and overall survival (OS). Type of dissection was not related to DFS (P=0.92), OS (P=0.33), and local recurrence ratio (P=0.56). The factors affecting local recurrence were the age over 45 years (P=0.02), tumor size (0.005), and the presence of distant metastasis (P=0.04). The factors affecting DFS and OS were tumor size (0.003), thyroid capsule invasion (0.004). Determination of the type of therapeutic neck dissection depends on patient and tumor characteristics. Selective lateral neck dissection can be applied safely in selected cases.

Planned Postradiotherapy Neck Dissection: Rationale and Clinical Outcomes

In this study, we examine pathology results and clinical outcome for patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) who present with advanced neck disease and undergo planned postradiotherapy neck dissection. Review of all patients with SCCHN treated with primary radiation (or chemoradiation) and postradiotherapy neck dissection at the University of Wisconsin between 1992 to 2005 was performed. One hundred seven neck dissections were identified in 93 patients, 79 unilateral and 14 bilateral. All major treatment and outcome parameters were examined with particular emphasis on the postradiotherapy neck dissection. Thirty of 107 neck dissection specimens (28%) showed evidence of residual carcinoma on pathologic review. The mean number of lymph nodes identified at neck dissection for the entire cohort was 21 per specimen (range, 1-60) with 1.3 nodes per positive neck dissection demonstrating residual carcinoma. No correlation was found between the type of neck dissection performed and the presence of residual nodal disease. Eighty-two evaluated patients (93%) remain free of regional disease recurrence, whereas six patients have subsequently manifested neck recurrence. Four of the six patients who developed regional recurrence showed residual carcinoma in their neck dissection specimen. Five of these patients underwent comprehensive neck dissection (levels I-V); one underwent selective neck dissection (<levels I-V). Approximately one-fourth of the patients in this series showed pathologic evidence of residual carcinoma in the neck at the time of postradiotherapy neck dissection. The majority of these cases showed microscopic residual carcinoma in a single lymph node. Although in the early postradiotherapy setting, we cannot accurately predict the viability and growth potential of microscopic residual carcinoma in lymph nodes, these findings, combined with the modest overall morbidity of selective neck dissection, suggest that planned postradiotherapy neck dissection should be strongly considered for patients presenting with advanced neck disease. This remains a prevailing clinical practice at our institution.

An evaluation of the shoulder domain of the University of Washington quality of life scale

The aim of this study was to compare the shoulder domain in the University of Washington quality of life (UW-QoL) scale with two shoulder-specific questionnaires. Methods We did a cross-sectional survey of 100 consecutive outpatients who had had operations on the head and neck for cancer using the UW-QoL, the neck dissection impairment index, and the shoulder disability questionnaire. Results The types of neck dissection were none ( n = 12), unilateral selective ( n = 63), bilateral selective ( n = 17), and radical or modified radical ( n = 8). There were significant correlations among the three questionnaires. The worst scores were found in the group who had modified radical or radical neck dissection. Although responses were similar between those who had no neck dissection and those who had unilateral level 3 neck dissection, a few patients reported considerable dysfunction after selective neck dissection. Conclusion Although the UW-QoL shoulder domain is limited to one of four responses, our results support the conclusion that it is sufficiently sensitive to screen for dysfunction of the shoulder.