Various Types Of Neck Dissections Research Articles

Lymph Node Dissection: Principles and Postoperative Imaging.

The management of neck nodes in head and neck cancer is critical, given a markedly increased poor prognosis in patients with nodal metastasis. The surgical management of neck nodes has undergone radical changes secondary to a paradigm shift from curative surgery to nonsurgical organ and function-preserving options, such as radiation therapy. In the neck after treatment, radiologists should be familiar with imaging findings in various types of neck dissections and post-chemoradiation changes, along with signs of residual or recurrent disease. A multidisciplinary approach is essential with well-designed evidence-based surveillance imaging protocols and standardized reporting.

Histological Assessment of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma

During surgical management of the neck using various types of neck dissection, the carotid sheath is removed, in particular, the part adjacent to the jugular lymph node chain, with the intention of preventing recurrence from the lymphatics present within it. The role of the carotid sheath as a potential origin for nodal recurrence has not been proved thus far. Working in a tissue plane between the carotid sheath and the neurovascular structures of the neck can lead to a greater chance of damage to these structures. Also, the carotid sheath is a strong fibroelastic tissue barrier that shields the internal jugular vein and carotid artery from saliva and local infection during the postoperative period. Thus, this study investigated the histopathology of the carotid sheath in patients with oral squamous cell carcinoma (OSCC) and assessed the pathologic infiltration of the carotid sheath when grossly uninvolved. Pathologic infiltration and histopathologic characteristics of the entire length of the carotid sheath were assessed in 30 biopsy-proved cases of OSCC; these patients underwent surgical excision of the lesion in addition to neck dissection from 2013 to 2015 in the craniofacial unit of the authors' institution. The carotid sheath consisted of fibrofatty tissue and interspersed nerve bundles. Neutrophilic infiltration and dilated lymphatic channels were seen in all 30 cases. Miniature lymph nodes adherent to the carotid sheath were seen in 5 cases and some lymphoid aggregates were seen in 15 cases. The carotid sheath in all 30 cases (metastatic and nonmetastatic) was free from tumor deposit and lymphatic tumor emboli, which are indicators of tumor cell infiltration. Indicators of tumor cell infiltration were not found in any of the 30 cases. The result did not vary with the age or gender of the patient, tumor size, location, staging or grading of the tumor, or even when there were metastatic lymph nodes in the gross specimen. Hence, the role of the carotid sheath as a potential origin for nodal recurrence is questionable and its removal needs reconsideration.

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.

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.

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.

The impacts of various types of neck dissection on postoperative shoulder function for patients with oral squamous cell carcinoma

To compare the impact of various types of neck dissection on postoperative shoulder function. The shoulder functions of 66 patients with oral squamous cell carcinoma (OSCC) and cN0 necks who underwent various types of neck dissection were evaluated by Constant's shoulder function test and neck dissection impairment index at least 12 months after surgery. The patients with accessory spinal nerve reserved had better shoulder function than those with accessory spinal nerve resected. In the group with accessory spinal nerve reserved, the patients receiving selective neck dissection (SND) showed better shoulder function than those with modified radical neck dissection (MRND). The shoulder dysfunction and pain arising from SND were minor in patients with selective neck dissection. The shoulder function after SND was superior to those after RND and MRND.

Évidements ganglionnaires cervicaux

One of the most important factors that affect prognosis in patients with squamous cell carcinoma of the upper aerodigestive tract is the nodal stage. Tumour dissemination to the lymph nodes of the neck is predictable and sequential. The therapeutic management of these lymph nodes must be adapted to the tumour stage. The “Union Internationale Contre le Cancer” (UICC) and the American Joint Committee on Cancer (AJCC) have adopted a common classification for lymph nodes of the neck. Two approaches based on different surgical concepts lead to the description of various neck dissections: the North American approach and the Latin approach. Many classifications are available, more or less complex and exhaustive. The goal of these classifications is to standardize the terminology of various types of neck dissections. The different techniques of neck dissection are described, peculiarly the functional neck dissection and the radical neck dissection ones.

Shoulder function after accessory nerve-sparing neck dissections.

This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

Evolution of neck dissection for improved functional outcome.

Neck dissection plays a crucial role in the management of metastatic neck disease. Until recently, radical neck dissection has been the standard treatment for malignant cervical adenopathy irrespective of the nodal staging. However, in recent years, there has been a trend toward the development of more conservative operations, wherein certain nonlymphatic structures and lymph node groups can be selectively preserved. Radical neck dissection still remains the surgical standard against which various modifications must be compared. The need to perform more conservative surgery comes from the realization that the radical operation is attended by significant postoperative morbidity, and that some of the structures removed in the course of this operation can actually be preserved without any compromise in oncologic safety. The purpose of this article is to discuss the evolution of conservation surgery in the management of metastatic neck disease, define the clinical applications of various types of neck dissection, and evaluate the implications of these conservation approaches on preservation of function.

Shoulder function and patient well-being after various types of neck dissections.

Preserving the accessory nerve results in a better outcome of the shoulder function after neck dissection. However, little is known about the impact of preserving a cervical contribution to the accessory nerve. This study describes the shoulder function after different types of neck dissections, with the emphasis on the significance of the cervical contribution to the accessory nerve. Fifty-nine patients who underwent neck dissections of various types were included. Thirty-eight patients underwent unilateral radical or modified radical neck dissections, and 21 patients underwent bilateral neck dissections. All the patients were assessed subjectively and objectively, using a questionnaire and an inclinometer. Radical neck dissections inflicted significantly more morbidity than modified radical neck dissections. Preserving a cervical contribution to the accessory nerve did not decrease pain complaints or functional impairment. However, there might be some improvement in range of motion, especially exorotation and anteflexion. Preserving the accessory nerve has a positive influence on shoulder function and complaints. Preserving a cervical contribution does not decrease morbidity significantly.

Neck dissections: Its anatomy, indications, history and current terminology

This paper provides an overview of the anatomy of the neck lymph node distribution; indications, history and current terminology of various types of neck dissections and the therapeutic applications for different primary head and neck malignancy.

A comparison of radical and conservative neck dissection

A review is presented of the confusing terminology applied to the various types of neck dissection. It is recommended that the terms “conservative” and “radical” be based on clear definitions. The fourth prospective, randomized DÖSAK therapy study deals with the controversial issue of radical as compared with conservative neck dissection. Patients with squamous cell carcinoma (SCC) of the oral cavity who had not been treated before were randomized and stratified according to the DÖSAK treatment-dependent prognostic index (TPI). At present, 104 patients have been evaluated, of whom 48 had radical neck dissection, and 56 conservative neck dissection. Tumor location and patient age and sex are equally divided in both therapy groups. After an average follow-up time of 460 days, the relative mortality for both therapy groups is 23%. At this stage, there is no difference between the two groups in the percentage of patients with complete remission or in the percentage of patients alive. At this stage, there appears to be no difference between the two groups with regard to patient survival or recurrent disease.

Neck dessection: Concepts, Controversies, and Technique

The various types of neck dissections are described. The indications for each type of neck dissection are discussed for patients with necks staged N0, N+, for the patient with an unknown primary and for the patient whose neck dissection is in conjunction with radiation. The technical aspects of modified neck dissections are addressed but not in great detail. The indications for the use of postoperative radiation are emphasized. The nodal groups at risk for metastases from various primary sites are identified and a terminology for neck dissection is suggested.

A complication related to a central venous catheter in head and neck surgery

Various types of neck dissections are commonly performed by the otolaryngologist. The following complication of a transected central venous pressure (CVP) catheter within the internal jugular vein was encountered during a radical neck dissection. The method by which this complication was managed shows an alternative means for handling this problem that might not have been previously realized.