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    Neck Dissection

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    Rakshith12
    A neck dissection is a surgical procedure to remove lymph nodes in the neck. There are several types including radical, modified radical, and selective neck dissections. A radical neck dissection removes all lymph nodes from levels I-V while preserving key structures like arteries and nerves. A modified radical neck dissection preserves one or more non-lymphatic structures like the spinal accessory nerve or internal jugular vein. Selective neck dissections only remove certain lymph node groups. The type of dissection depends on factors like cancer type and extent of spread. Neck dissections help stage and treat head and neck cancers.

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    Neck Dissection

    Uploaded by

    Rakshith12
    215 views51 pages
    A neck dissection is a surgical procedure to remove lymph nodes in the neck. There are several types including radical, modified radical, and selective neck dissections. A radical neck dissection removes all lymph nodes from levels I-V while preserving key structures like arteries and nerves. A modified radical neck dissection preserves one or more non-lymphatic structures like the spinal accessory nerve or internal jugular vein. Selective neck dissections only remove certain lymph node groups. The type of dissection depends on factors like cancer type and extent of spread. Neck dissections help stage and treat head and neck cancers.

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    A neck dissection is a surgical procedure to remove lymph nodes in the neck. There are several types including radical, modified radical, and selective neck dissections. A radical neck dissection removes all lymph nodes from levels I-V while preserving key structures like arteries and nerves. A modified radical neck dissection preserves one or more non-lymphatic structures like the spinal accessory nerve or internal jugular vein. Selective neck dissections only remove certain lymph node groups. The type of dissection depends on factors like cancer type and extent of spread. Neck dissections help stage and treat head and neck cancers.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    215 views51 pages

    Neck Dissection

    Uploaded by

    Rakshith12
    A neck dissection is a surgical procedure to remove lymph nodes in the neck. There are several types including radical, modified radical, and selective neck dissections. A radical neck dissection removes all lymph nodes from levels I-V while preserving key structures like arteries and nerves. A modified radical neck dissection preserves one or more non-lymphatic structures like the spinal accessory nerve or internal jugular vein. Selective neck dissections only remove certain lymph node groups. The type of dissection depends on factors like cancer type and extent of spread. Neck dissections help stage and treat head and neck cancers.

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    Download as ppt, pdf, or txt
    of 51

    Neck Dissection

    Definition
    It is a procedure to remove lymph nodes and surrounding fibro fatty tissues from neck to eradicate metastasis to cervical lymph nodes in cancer of aerodigestive tract.

    Fascial layers of the neck

    Superficial cervical fascia


    Deep cervical fascia Superficial layer SCM, strap muscles, trapezius

    Middle or Visceral Layer Thyroid Trachea esophagus Deep layer (also prevertebral fascia) Vertebral muscles Phrenic nerve

    Level I

    Submental triangle (Ia)


    Anterior digastric Hyoid Mylohyoid

    Submandibular triangle (Ib)


    Anterior and posterior digastric Mandible.

    Level I

    Ia
    Chin Lower lip Anterior floor of mouth Mandibular incisors Tip of tongue

    Ib
    Oral Cavity

    Floor of mouth
    Oral tongue Nasal cavity (anterior)

    Face

    Level II

    Upper Jugular Nodes

    Anterior Lateral border of sternohyoid, posterior digastric and stylohyoid Posterior Posterior border of SCM Skull base Hyoid bone (clinical landmark) Carotid bifurcation (surgical landmark)

    Level IIa anterior to XI

    Level IIb posterior to XI


    Submuscular recess Oropharynx > oral cavity and laryngeal mets

    Spinal Accessory Nerve

    CN XI Relationship with the IJV

    Level II

    Oral Cavity Nasal Cavity Nasopharynx Oropharynx Larynx Hypopharynx Parotid

    Level III

    Middle jugular nodes


    Anterior Lateral border of sternohyoid Posterior Posterior border of SCM Inferior border of level II Cricoid cartilage lower border (clinical landmark) Omohyoid muscle (surgical landmark)

    Junction with IJV

    Level III

    Oral cavity Nasopharynx

    Oropharynx
    Hypopharynx Larynx

    Level IV

    Lower jugular nodes


    Anterior Lateral border of sternohyoid Posterior Posterior border of SCM Cricoid cartilage lower border (clinical landmark) Omohyoid muscle (surgical landmark)

    Junction with IJV

    Clavicle

    Level IV

    Hypopharynx Larynx Thyroid Cervical esophagus

    Level V

    Posterior triangle of neck


    Posterior border of SCM Clavicle Anterior border of trapezius Va Spinal accessory nodes Vb Transverse cervical artery nodes

    Radiologic landmark
    Inferior border of Cricoid

    Supraclavicular nodes

    Level V

    Nasopharynx Oropharynx Posterior neck and scalp

    Level VI
    Anterior Compartment Structures Boundaries Above by Hyoid bone Below by Suprasternal notch On either side by medial border of Carotid sheath

    Level VI
    Lymph Nodes
    Perithyroidal Pretracheal Precricoid Nodes (Delphian) Paratracheal nodes along recurrent laryngeal nerves

    Level VI

    Thyroid Larynx (glottic and subglottic) Pyriform sinus apex Cervical esophagus

    Subgroups

    Ia Ib IIa IIb III

    Submental Submandibular Upper jugular (Anterior to XI) Upper jugular (Posterior to XI) Middle jugular

    IVa Lower jugular (Clavicular) IVb Lower jugular (Sternal) Va Vb VI Posterior triangle (XI) Posterior triangle (Transverse cervical) Central compartment

    Common Nodal Drainage Patterns


    Face and Scalp Anterior Lateral Posterior Facial, Ib Parotid Occipital, V

    Eyelids
    Chin External Ear

    Medial
    Lateral Anterior Posterior

    Ib
    Parotid, II Ia, Ib, II Parotid, II Post auricular, II, V Parotid, II

    Middle Ear Floor of mouth Anterior

    Ia, Ib, IIa > IIb

    Lower incisors
    Lateral Teeth except incisors Nasal Cavity Anterior

    Ia, Ib, IIa > IIb


    Ib, IIa > IIb, III Ib, IIa > IIb, III Ib

    Common Nodal Drainage Patterns


    Nasal Cavity Nasopharynx Oropharynx Larynx Posterior Retropharyngeal, II, V Retropharyngeal, II, III, V IIb > IIa, III, IV, V Supraglott ic IIa > IIb, III, IV Subglottic VI, IV IV, VI

    Cervical esophagus Thyroid


    Tongue Tip Lateral

    VI, IV, V, Mediastinal


    Ia, Ib, IIa > IIb, III, IV Ib, IIa > IIb, III, IV

    Staging

    Nx: Regional lymph nodes cannot be assessed. N0: No regional lymph node metastases.

    N1: Single ipsilateral lymph node, < 3 cm

    Staging

    N2a: Single ipsilateral lymph node 3 to 6 cm N2b: Multiple ipsilateral lymph nodes < 6 cm N2c: Bilateral or contralateral nodes < 6cm

    N3: Metastases > 6 cm

    Staging

    Nasopharyngeal Carcinoma N1 Unilateral < 6cm N2 Bilateral < 6 cm N3a > 6 cm N3b Extension to supraclavicular fossa Thyroid N1 Regional node mets N1a - Ipsilateral N1b - Bilateral, midline, contralateral cervical or mediastinal LN

    Classification

    The RND is classified according to the Academys Committee for Head & Neck Surgery & Oncology into four major type: 1. Radical Neck Dissection (RND) 1. Modified Radical Neck Dissection (MRND)

    3. Selective Neck Dissection (SND)


    1.

    Supraomohyoid Posterolateral Lateral Anterior

    1.

    2.

    3.

    4. Extended Radical Neck Dissection (ERND)

    Classification

    Radical neck Dissection:


    Removing all lymphatic tissues in regions I - V Spinal Acessory Nerve Internal Jugular vein Sternocleidomastoid muscle Submandibular Salivary gland Tail of parotid Omohyoid muscle

    Classification

    Modified radical neck dissection:


    Excision of all lymph nodes removed with RND with preservation of one or more non-lymphatic structures, SAN, SCM and/or IJV

    Subtype I: Preserve SAN Subtype II: Preserve SAN & IJV Subtype III: preserve SAN, IJV and SCM
    Known as Functional neck dissection (Bocca)

    Classification

    Selective Neck dissection:


    Any type of cervical lymphadenectomy with preservation of one or more lymph node groups Four subtype:

    Supraomohyoid neck dissection Posterolateral neck dissection Lateral neck dissection Anterior neck dissection

    Classification
    Supraomohyoid neck dissection:

    Removal of lymph nodes in regions I III The posterior limit is the cutaneous branches of the cervical plexus and posterior border of SCM The inferior limit is the superior belly of the omohyoid where it cross IJN
    Removal of suboccipital, retroauricular, levels II V and level V Subtyped I III depending on the preservation of SAN, IJV and /or SCM

    Posterolateral neck dissection

    Classification
    Lateral neck dissection:

    Remove lymph nodes in levels II IV


    Require the removal of the lymph nodes surrounding the visceral structure in the anterior aspect of the neck, level VI Superior limit, hyoid bone Inferior limit, suprasternal notch Laterally, the carotid sheath

    Anterior neck dissection:

    Structures to be preserved
    Carotid artery Brachial Plexus, Phrenic & vagus nerve, cervical sympathetic chain, marginal mandibular, lingual and hypoglossal nerves

    Indications

    Radical Neck Dissection


    1. Multiple clinically obvious cervical lymph node metastasis particularly of posterior triangle and closely related to SAN 2. Large metastatic tumor mass or multiple matted in upper part of the neck

    Tumor should not be dissected to preserve Structures

    Classification

    Extended neck dissection:


    Any previous dissection and including one or more additional lymph node groups and/or non-lymphatic tissues

    Facts

    General nodal metastasis produce the following fact:


    The most important factor in prognosis of SCC of the upper aero-digestive tract is the status of cervical lymph nodes Cure rate drops 50% with involvement of the regional lymph nodes

    Indications

    Modified radical neck dissection


    MRND Type I:
    1.

    2.

    Clinically obvious neck lymph nodes metastasis and SAN not involved by tumor Intraoperative decision just like preservation of the facial nerve in parotid surgery

    Indications

    1. Rarely planned 2. Intra-operative decision for tumor found adherent to SCM but away from SAN & IJV

    MRND Type II:

    MRND Type III:


    1. 2.

    Depend on the autopsy reports

    Lymph nodes were in the fibrofatty and do not share the same adventitia with blood vessels They are not found within the aponeurosis or glandular capsule of the submandibular Functional neck dissection

    Indications

    MRND Type III:


    For treatment of N0 neck nodes Indicated for N1 mobile nodes and not greater than 2.5 3.0 cm

    Contra-indicated in the presence of node fixation Result is difficult to interpret because of the use of radiation therapy

    Indications

    Selective/elective neck dissection:


    For treatment of N0 neck nodes For N+ nodes when combined with radiotherapy Adjuvant radiotherapy for patient with 2 4 positive nodes or extra-capsular spread Upgrade intra-operatively following positive frozen section

    SND : Supra Omohyoid Type


    Oral cavity carcinoma with N0 Neck Hoffman oral cavity Level 1 30.1 % Level 2 35.7 % Level 3 22.8 % Level 4 9.1 % Level 5 2.2 %

    SND : Lateral Type


    N0 Neck in carcinomas of Oropharynx Hypopharynx Supraglottis Glottic Larynx

    SND : Posterolateral Type


    - Cutaneous malignancies

    Melanoma SCC Merkell cell Carcinoma

    - Soft tissue sarcomas of scalp and neck

    SND : Anterior Compartment

    Selected Cases of Thyroid Carcinoma Parathyroid Carcinoma Subglottic Carcinoma CA of Cervical Oesophagus

    Y Incision

    McFee Incision

    H Incision

    J Incision

    COMPLICATIONS

    Air embolus Pneumothorax Chyle leak & Chylus fistula Wry Neck (Torticollis Coli) Shoulder dysfunction Cerebral oedema

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