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PubMed1987

Is modified radical neck dissection only a staging procedure?

This retrospective study evaluates the clinical benefit of modified radical neck dissection among patients with squamous carcinoma of the upper aerodigestive tract. Ninety-eight modified neck dissections were performed in 86 patients over a 5-year period. The procedure entailed removal of the submaxillary and jugular chain nodes while the posterior triangle was not dissected. Thirty-two patients received postoperative radiotherapy. Lymph nodes were histologically positive in 55 of 98 dissections (56%). Among 72 determinate patients, recurrence in the dissected neck occurred in 8 of 38 with positive nodes and none of 34 with negative nodes (P less than 0.05). These recurrences occurred in patients who had clinically palpable nodes preoperatively. Postoperative radiotherapy did not significantly alter the overall recurrence rate or survival of patients with positive nodes. Cumulative disease-free survival at 5 years was 70% overall. It is concluded that the modified neck dissection described is appropriate in the clinically negative neck or when regional disease is early (i.e., N1) and located in the submandibular triangle. Postoperative radiotherapy should be given if more than one node is involved histologically or if extracapsular spread is present.

Adult↗
PubMedDate not supplied

Relative effect of surgery and radiotherapy on the internal jugular vein following functional neck dissection.

We examined the internal jugular veins in three groups of patients who had undergone (1) a functional neck dissection and radiotherapy, (2) a functional neck dissection alone, or (3) radiotherapy alone, using a noninvasive color Doppler ultrasound scan. The internal jugular veins were ultrasonically bilaterally normal in 18% of patients who had undergone a functional neck dissection and radiotherapy, in 88% of patients who had undergone a functional neck dissection alone, and in 57% of patients who had undergone radiotherapy alone. The combination of a functional neck dissection and radiotherapy significantly affected the internal jugular vein when compared with a functional neck dissection alone.

Adult↗
PubMed1991

Phrenic nerve paralysis following neck dissection.

One of the complications of neck dissection to control regional metastatic disease in cancer of the head and neck is phrenic nerve paralysis. The resulting elevation of the ipsilateral diaphragm can be diagnosed on a postoperative chest X-ray and confirmed by fluoroscopy. Symptoms can be respiratory, cardiac or gastrointestinal. In a retrospective study, unilateral phrenic nerve paralysis was observed in 14 (8%) of 176 consecutive neck dissections. None of the patients with postoperative phrenic nerve paralysis displayed severe symptoms, although a significantly higher number sustained atelectasis with or without pulmonary infiltrates to complicate the postoperative course.

Adult↗
PubMed2003

Patency and caliber of the internal jugular vein after neck dissection.

OBJECTIVE: To determine the incidence of thrombosis and change in caliber of the internal jugular vein after neck dissection. PATIENTS AND METHODS: Between September 1999 and December 2000, we studied 68 patients who underwent 76 neck dissection that spared the internal jugular vein. Thrombosis of the internal jugular vein was determined using duplex Doppler scans. The examination was performed about 10 days after the operation. Preoperative and postoperative imaging was available for 28 patients who underwent 32 neck dissections after April 2000. These 28 patients were divided into three groups. Group 1 consisted of 5 internal jugular veins which were treated with supraomohyoid neck dissection. Group 2 included 17 internal jugular veins which were treated with functional neck dissection. For group 3, ten patients underwent simultaneous bilateral neck dissections that spared the ipsilateral internal jugular vein with concurrent contralateral radical neck dissection. For each group, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was calculated. Measurements were planned for 7 days, 1 month, and 3 months postoperatively. RESULTS: The overall patency of the 76 internal jugular veins after neck dissection was 100%. In all groups, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was lowest during the early postoperative period, and gradually increased within 3 months after surgery. CONCLUSION: The caliber of the internal jugular veins decreased the most during the early postoperative period; however, internal jugular vein thrombosis is uncommon.

Aged↗
PubMedDate not supplied

A modified single flap for neck dissection in oral cancer.

Modification of the single flap for neck dissection is described and illustrated based on experience with 33 cases of squamous cell carcinoma of the oral cavity. The advantages of this modified incision are that there are no three-point junctions. Hence, it can be used after previous radiotherapy to the neck; the vertical limb is well posterior to the carotid artery, and the horizontal limb can be conveniently extended upward and forward to permit a combined resection of the jaw and/or tongue. To avoid necrosis at the apex of the skin flap, particularly after previous radiotherapy, a margin of about 1 cm can be removed prophylactically from the apex. This incision is recommended particularly for neck dissections in squamous cell carcinomas of the oral cavity in patients who have had previous radiotherapy and/or when resection of the mandible or the tongue is to be done at the same time. The incision is not recommended for bilateral neck dissections, nor for neck dissection combined with total laryngectomy or thyroidectomy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Tongue necrosis after radical neck dissection.

An unusual complication of radical neck dissection is presented. Necrosis of the anterior half of the tongue developed gradually within the first week of bilateral neck dissection. The patient had previously received radiotherapy.

Humans↗
PubMed1996

Selective neck dissection in the management of squamous cell carcinoma of the upper digestive tract.

Selective neck dissection has been used clinically in elective treatment of carcinoma, although many surgeons continue to advocate modified radical or radical neck dissection for therapeutic management of the neck. In a retrospective study 167 previously untreated patients were reviewed following curative laser microsurgical resections of oral or pharyngeal primary tumors and a unior bilateral selective neck dissection. In all, 221 (54 bilateral) neck dissections were performed. In patients with oral primary disease lymph nodes of levels I-III were removed, while nodes in levels II and III were removed in patients with pharyngeal tumors. Level IV was dissected when several metastases were suspected during operation. The posterior triangle was not dissected. Lymph nodes were histopathologically negative in 73 patients and positive in 94 patients. Twenty-five of these latter cases had pN1 disease, 55 had pN2b disease and 10 had bilateral lymph node metastases. Twenty patients in the pN0 group and 63 patients in the pN+ group received postoperative radiotherapy (to 56.7 Gy to the primary site and 52.5 Gy to the neck). With a median follow-up interval of 34 months, recurrence in the dissected neck occurred in 3 of 73 patients (4.1%) with pN0 disease and 6 of 90 patients (6.6%) with pN+ necks. Four patients with pN+ necks had simultaneous recurrences at the primary site. The addition of adjuvant radiotherapy seemed to improve disease control in the neck and improve overall survival in patients with an unfavorable prognosis due to multiple metastases or metastases with extracapsular spread.

Adult↗
PubMed2004

Shoulder complaints after nerve sparing neck dissections.

The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least 1 year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the shoulder disability questionnaire to evaluate shoulder disability in daily activities. In total 137 patients; 51 after modified radical neck dissection (MRND), 21 after postero-lateral neck dissection (PLND), and 65 after supraomohyoid neck dissection (SOHND) were analysed. After MRND 33.3% of the patients experienced shoulder complaints, after PLND 66.7%, and after SOHND 20% of the patients experienced shoulder complaints. Type of neck dissection was significantly (P < 0.001) related to shoulder complaints. Outcome on the shoulder disability questionnaire also showed a significant (P < 0.01) difference in outcome for type of neck dissection. The prevalence of shoulder complaints after SOHND are low, and reduce disability in daily activities. Radiation therapy does not have a significant effect on shoulder complaints and disability.

Accessory Nerve↗
PubMed1998

Papillary thyroid carcinoma: modified radical neck dissection improves prognosis.

OBJECTIVE: To ascertain whether modified radical neck dissection offers a survival advantage for some subsets of patients with papillary cancer of the thyroid. DESIGN: A retrospective cohort study of 2966 patients curatively treated at the Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan, between 1946 and 1991. SETTING: A center for the treatment of thyroid disease, where about 1400 thyroid operations are performed per year. PATIENTS: Between 1946 and 1991, patients with papillary cancer whose primary tumor was 1 cm or larger and who were curatively treated were studied. Of the 2859 patients, 72.1% underwent modified radical neck dissection, 8.5% underwent partial node excision, and 19.4% underwent no node excision. RESULTS: A univariate analysis revealed a subset of patients who benefited from modified radical neck dissection. A multivariate analysis revealed that sex (P<.001), age at the time of the operation (P<.001), size of the primary tumor (P<.001), extrathyroidal invasion (P<.001), and the presence of nodal metastasis (P<.01) are significant risk factors. CONCLUSION: Patients with nodal metastasis, patients in whom the primary tumor invades beyond the thyroid capsule, and women older than 60 years can benefit from modified radical neck dissection.

Adult↗
PubMed1998

Cable grafting of the spinal accessory nerve after radical neck dissection.

BACKGROUND: From January 1981 through March 1996, 20 patients with head and neck cancer underwent radical neck dissection with sacrifice of the spinal accessory nerve and immediate reconstruction of the nerve using a microsurgical technique and a cable graft of the great auricular nerve. METHODS: Postoperative shoulder function was assessed via a subjective questionnaire, objective strength testing, and/or postoperative electromyography. The latter was used to evaluate for the presence and amplitude of voluntary motor potentials, the presence of fibrillation potentials, and nerve conduction latency. The group of patients who underwent cable grafting of the spinal accessory nerve was compared with a group of patients who underwent modified radical neck dissection with preservation of the spinal accessory nerve and with another group of patients who underwent a classic neck dissection with sacrifice of the spinal accessory nerve and no reconstruction. RESULTS: In terms of shoulder function, the group of patients in whom the spinal accessory nerve was reconstructed occupied an intermediate position; ie, their postoperative shoulder function was better than that of the patients who underwent radical neck dissection without reconstruction but not as good as that of the patients who underwent modified neck dissection with preservation of the spinal accessory nerve. CONCLUSION: Cable grafting of the spinal accessory nerve that has been sacrificed during radical neck dissection results in improved shoulder function in the postoperative period.

Accessory Nerve↗
PubMed1978

Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival.

Two hundred sixty-one patients who underwent three types of neck dissection for cervical lymphadenopathy in association with squamous cell cancer of the head and neck are analyzed retrospectively. Patients were grouped into those with histologically negative nodes and those with histologically positive nodes. Statistical analyses for neck recurrence and survival rates were made using the sampled permutation method. The results show that suprahyoid neck dissection is associated with an unusually high recurrence rate in the neck in patients with histologically negative nodes. Modified radical neck dissection and standard radical neck dissection are equivalent with regard to recurrences in the neck and five year survival rates when the disease is above the juguloomohyoid lymph node group. The study suggests that simple upper neck dissection is contraindicated in patients with negative or positive nodes and that modified radical neck dissection can be used in selected patients instead of the formal radical neck operation.

Adult↗
PubMed1995

[Evaluation of the importance of systematic neck dissection in carcinoma of the oral cavity treated by brachytherapy alone for the primary lesion (apropos of a series of 346 patients)].

UNLABELLED: The study includes 346 carcinomas of the oral cavity (244 mobile tongues and 102 floors of mouth) treated by brachytherapy alone at primary tumor. We noted 199 T1, 131 T2, 14 T3 and 2 TxNx. Among T1, 36 patients had a neck dissection as well as 73 T2. Brachytherapy was performed according to the Paris system. In 59 cases, the curage on the lesion side was a radical neck dissection, in 14 cases a functional neck dissection and in 45 cases a submaxillary and submental dissection. A combined controlateral neck dissection was performed in 20 cases. A complementary irradiation of the node areas was given in 28 cases. RESULTS: for T1, the local control (LC) is 96%, the locoregional control (LRC) 83%, the specific survival (SS) 88%, and the overall survival (OS) 73%. For T2, LC 85%, LRC 70%, SS 75%, OS 52%. For T3, LC 64%, LRC 44%, SS 25%, OS 18%. The difference is very significant between T1 T2 T3 (p < 0.006) for results concerning N0, it is not significant between the N1 in each category, but their number is too low to reach a degree of significancy. In the 36 neck dissection specimens of T1, we found only in 7 cases positive nodes and in the 73 specimens of T2, 24 cases of positive nodes. A detailed study is reported. Tumoral, node or both recurrences are summarized (see table IV). Node recurrences are more frequent in patients without neck dissection than in those with neck dissection for T1, T2, N0, but this is significant only for LRC, SS and OS between patients with negative nodes on neck dissection and those with positive nodes (p < 0.0001). No significant difference was found between OS and SS for patients T1, T2, N0 with positive systematic neck dissection and those with a neck dissection differed until the node recurrence. Among T1, T2, T3, we noted more metastases in patients who presented a recurrence than in others. In conclusion, for patients treated by brachytherapy alone to the primary lesion, it seems desirable to perform a systematic neck dissection if there are adenopathies on initial examination. The dissection can be delayed for small tumors T1 N0 and low T2 N0 if the patients are followed-up regularly. However, a systematic dissection must be advised for high T2 N0 and T3 N0 given the frequency of the node involvement and the risk of metastases.

Brachytherapy↗
PubMed2001

Endoscopic neck dissection in human cadavers.

OBJECTIVE: To evaluate the feasibility and efficacy of endoscopic neck dissection (END) in human cadavers. STUDY DESIGN: Experimental self-controlled study. METHODS: END on five human cadavers through three openings: one for the camera, one for the dissecting instrument, and one for a grasping one. The tissue specimens removed were divided into traditional neck groups (I to V). After the completion of END, open neck dissection was performed using standard surgical techniques and the remaining tissue within each neck group was retrieved. The important neck structures (carotid artery, internal jugular vein, cranial nerves X, XI, and XII, phrenic nerve) were evaluated for lesions. A pathologist evaluated each specimen, without knowing its exact origin in terms of neck group or side, and type of surgical technique used. For each specimen, the number of retrieved lymph nodes and their anatomic integrity was analyzed. RESULTS: Ten neck dissections were performed on 5 cadavers, without any major difficulty. An injury of the internal jugular vein occurred twice and once the phrenic nerve was cut. Little tissue was usually left for open surgical dissection. The average number of retrieved lymph nodes by endoscopy was 4.9 +/- 2.7 (mean +/- standard deviation). Completion open neck dissection retrieved an additional 0.5 +/- 0.5 lymph nodes. Efficacy of END was 92 +/- 10%. The majority of retrieved lymph nodes were intact but exhibited important postmortem autolysis artifacts. CONCLUSIONS: Endoscopic neck dissection is possible in human cadavers and is free of lesions to major structures. The majority of neck lymph nodes can be removed endoscopically.

Aged↗
PubMed1998

Anatomical variants of the cervical sympathetic chain to be considered during neck dissection.

Horner's syndrome, as a complication of radical neck dissection, is given little attention in textbooks of head and neck surgery. To investigate which topographical anatomic factors, if any, might influence damage to the sympathetic chain during neck dissection, we undertook a series of 12 cadaveric neck dissections. The axial position of the cervical sympathetic chain varied. The chain could be clearly delineated from the carotid sheath except in two cadavers, in which it was found within the sheath. The presence of cervical ganglia also varied. We suggest that if the chain is within the sheath, it may be more likely to be injured during operation.

Cadaver↗
PubMedDate not supplied

Nonsimultaneous bilateral radical neck dissection.

From January 1963 to December 1977, 63 patients underwent a therapeutic second (staged) neck dissection at our institute. The mean interval between the first neck dissection and the second neck dissection was 13.2 months; 58.7% of the second neck dissections were performed between 6 and 12 months after the first. Forty-six patients had histologically positive and 17 patients had histologically negative nodes in the first neck clearance; 57 patients had histologically positive and 6 patients had histologically negative nodes in the second neck clearance. Forty-two of the 63 patients had bilateral nodal disease, while 2 patients had no disease in either side of the neck. Fifty-four percent of the patients had postoperative complications; 30% developed immediate postoperative edema, and 14% had wound infection. The overall three-year and five-year survival rates were 60% and 38%, respectively. Patients who had bilateral histologically positive nodes had a 16% five-year survival rate, while those who had histologically positive nodes in one side of the neck only had a 26% five-year survival rate.

Adult↗
PubMed1975

Conservative neck dissection.

The areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses. These are derived from the embryonal mesenchyme, surrounding muscles and vessels, giving origin to a series of compartments which are in continuity with each other. These compartments, which contain the lymphatic structures, may be entirely removed en bloc including their limiting aponeurotical membranes, as long as the latter are carefully stripped from the muscular and vascular structures. This technique of neck dissection originating with O. Suarez in Argentina, is as radical as any traditional neck dissection, providing that some technical details are respected and that the nodes are still mobile. By preserving many useful or necessary structures of the neck, which themselves are unrelated to the lymphatic spread of cancer, conservative neck dissection presents important functional and cosmetic advantages as compared with traditional neck dissection.

Humans↗
PubMed1994

A selective approach to neck dissection for mucosal squamous cell carcinoma.

A personal series of 189 neck dissections performed over 6 years among 154 patients with mucosal squamous cell carcinoma is presented. The most common primary sites were the oral cavity (66), oropharynx (38) and hypopharynx (17). There were 104 therapeutic and 85 elective neck dissections. Over 40% of therapeutic dissections were modified or selective procedures. Radical neck dissection was never used electively. Seventy-eight patients (50%) had postoperative radiotherapy to the neck. Nodes were histologically positive in 110 dissections overall (58%); 92% of therapeutic dissections and 17% of elective dissections. Extracapsular spread was present in 65% of positive dissections. Ipsilateral neck recurrence developed in 10 of 60 patients who had therapeutic radical dissections (17%) and in 2 of 44 patients who had therapeutic, modified or selective dissections (5%). Recurrence after elective dissection occurred in only one patient (1.2%). It is concluded that modified and selective neck dissection are safe and oncologically effective when used among selected patients and combined with adjuvant radiotherapy. Neck recurrence may still occur among patients with advanced and biologically aggressive disease despite radical therapy.

Adult↗
PubMed1995

Internal jugular vein thrombosis following functional neck dissection.

Twenty-five patients on whom 27 functional neck dissections were performed for upper aerodigestive tract squamous carcinoma were prospectively investigated to determine the frequency of venous thrombosis on the side of the neck dissection. Retrograde venography, performed within 1 month postoperatively, was used to determine the status of the internal jugular vein. Nineteen veins were patent at venography, but ipsilateral occlusion was demonstrated in 8. In 5 of the 8 patients, venous thrombosis followed major wound sepsis or fistula formation. No causes for the remaining 3 cases of internal jugular vein thromboses were identified. Possible mechanisms for "spontaneous" internal jugular vein occlusion following functional neck dissection are endothelial trauma, reduction in venous flow during anesthesia, and the altered coagulability profile of some cancer patients. The finding that functional neck dissection does not always maintain patency of the internal jugular vein is especially important when surgical treatment to the opposite side of the neck is planned, as the surgeon may be faced with an unexpectedly complicated postoperative course.

Adult↗