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At least 253 records · Page 14Linked to original sources
PubMed2005

Surgical technique--unwrapping the neck node levels around a sternocleidomastoid muscle bar: a systematic way of performing (modified) radical neck dissection.

AIM: Description of a systematic approach to the neck for removal of lymph node bearing tissues in levels I-V. METHOD: A (modified) radical neck dissection is divided in three steps: (1) Dissection of levels I-IV, (2) dissection of level V and (3) transection of SCM bar and finalisation of the dissection. The sternocleidomastoid muscle (SCM) is used as a "bar", around which the different neck levels can be systematically unwrapped, warranting permanent cranio-caudal tension of the neck specimen, while anatomical relations remain intact. RESULTS: In a group of 115 (modified) radical en bloc neck dissections with or without post-operative radiotherapy 10% regional recurrences, 2% post-operative chylous fistulas and < 5% post-operative wound infections occurred. The overall 5 years survival was 45% (95% confidence interval: 36-54%). CONCLUSION: A systematic unwrapping of lymph node levels around the sternocleidomastoid bar provides a reliable systematic method for performing (modified) radical neck dissections without a negative influence on clinical outcome.

Head and Neck Neoplasms↗
PubMed1982

[A proposition of uniform nomenclature of neck dissection (author's transl)].

There are difficulties in the interpretation of operative-surgical interventions (neck dissection), because the possibility to compare the basic disease is restricted and the operative-surgical procedures are described in a very different way. The neck dissection is carried out in different methods and that is why it must be arranged also in the treatment plan in a different way. Three important facts from the lots of information were used to get comparable informations: 1. The method of neck dissection (I-III), 2. the clinical palpation-statement of the lymphatic nodes of the neck (A, B) and 3. the histological statement of the lymphatic nodes of the neck (1-3). There will result a clear and also international comparable nomenclature of neck dissection. The problematic marking "prophylactic neck dissection" loses its purpose.

Head and Neck Neoplasms↗
PubMed1998

The effects of more conservative neck dissections and radiotherapy on nodal yields from the neck.

OBJECTIVE: To determine the effects of conservative neck dissections (NDs) and preoperative radiotherapy on the quantitative recovery of lymph nodes from the neck. DESIGN: Retrospective review of case series. Data were obtained for age, preoperative TNM staging, type of ND, preoperative radiotherapy, total nodal yield (tNY), and positive nodal yield (pNY). The tNY and pNY were analyzed with factorial analysis of variance (ANOVA) to determine differences among types of ND and the effect of radiotherapy. SETTING: Tertiary care center for head and neck cancer. PATIENTS: Consecutive sample of 135 NDs in 110 patients with cancer of the head and neck. RESULTS: A significant difference in tNY was found among dissections (P<.001, ANOVA). Supraomohyoid ND had a significantly lower mean tNY (9.9 nodes) than both radical ND and modified radical ND (21.8 and 26.3 nodes, respectively; P<.05). Functional ND also had a significantly lower tNY (16.1 nodes) than modified radical ND (P<.05); the differences between radical ND and both functional ND and modified radical ND were not statistically significant. Positive nodal yield was not different among the types of dissections (P=.62). Preoperative radiotherapy significantly decreased mean tNY from 22.0 to 17.1 nodes (P=.02) over all types of dissections. Differences in tNY among dissection types were independent of the effect of radiotherapy. The presence or absence of preoperative radiotherapy had no significant effect on pNY (P=.18). CONCLUSIONS: Conservative modifications of the classic radical ND differ with respect to the quantity of cervical lymph nodes excised, but survival may not be altered since the pNY is not significantly different. When compared with the radical ND, the modified radical ND and functional ND do not compromise the quantity of cervical nodes excised. Radiotherapy significantly reduces the quantity of cervical nodes, but a significant number of nodes will still remain.

Adult↗
PubMed2002

Role of planned neck dissection for advanced metastatic disease in tongue base or tonsil squamous cell carcinoma treated with radiotherapy.

OBJECTIVE: At the conclusion of this article, the reader should be able to discuss the need for planned neck dissection for advanced cervical diseases in the tongue base and tonsil cancer after treatment with radiotherapy. BACKGROUND: In the past 5 years, we have treated patients with squamous cell carcinoma of the tonsil and tongue base with radiotherapy as the primary therapeutic modality. A planned complete neck dissection was performed on all patients with N2 or greater cervical disease regardless of response to radiotherapy. Composite resection was performed when there was persistent disease at the primary site. Although the "radiation-first" therapeutic approach for tongue base and tonsil cancer is widely accepted, the planned neck dissection for neck metastases remans controversial. The objective of the study was to determine the validity of planned neck dissection after radiotherapy for N2 disease. METHODS: Medical records of patients with primary squamous cell carcinoma of the tongue base and tonsil with neck metastasis staged N2 or greater were reviewed. Between 1994 and 1999, 36 such patients were treated with curative radiation therapy. Response was assessed 6 to 8 weeks after completion of treatment with clinical examination and CT imaging. All patients underwent planned neck dissection. We reviewed the clinical and radiographic response of neck disease to radiotherapy as it correlated with the histopathologic findings. RESULTS: Of the 36 patients, 17 had clinical and CT evidence of persistent disease. In this group, 65% had pathologically confirmed diseases at surgery. Of the 9 patients with no evidence of disease on clinical examination, negative biopsy at the primary site, and a negative CT scan, 33% (three of nine) still had residual disease in the neck dissection specimen. CONCLUSIONS: Positive findings on clinical examination and CT can predict the presence of malignancy after radiation therapy. However, a negative CT and clinical examination are limited in predicting a complete response. These data lend support to the role of planned neck dissection after radiotherapy of N2 neck disease.

Adult↗
PubMed1998

[Neck Dissection for salivary gland carcinoma].

Between 1986 and 1997, 18 patients with high-grade salivary gland malignancies were treated at our institution. Histologically, 7 of the 18 malignant tumors were adenoid cystic carcinomas. 4 were carcinoma in pleomorphic adenoma, 3 were undifferentiated carcinomas and 4 were others. For treatment of the neck, 11 patients underwent neck dissection, 1 received supraomohyoid neck dissection (SOMH) and 7 received no neck treatment. In our study, there was no difference according to local-regional control as to whether to use neck dissection or not. The result do not suggest that prophylactic total neck dissection for salivary gland carcinoma show an impressive degree of improvement in local-regional control. Total neck dissection should be performed when the neck is clinically positive for a tumor. Based on the above findings, we concluded that SOMH is feasible for submandibullar gland cancer without positive lymph nodes.

Adenocarcinoma↗
PubMedDate not supplied

Squamous cell carcinoma of the head and neck treated with radiotherapy: does planned neck dissection reduce the change for successful surgical management of subsequent local recurrence?

For patients with squamous cell carcinoma of the head and neck whose primary lesion is managed with radiotherapy, radiotherapy alone or in combination with neck dissection may be used to treat clinically positive neck nodes. Although these two treatment options produce similar control rates for small mobile nodes, it is our impression that radiotherapy plus neck dissection is the preferred treatment for more advanced neck disease. The question that arises is whether the addition of a neck dissection after radiotherapy will decrease the likelihood of successful surgical management of a subsequent recurrence at the primary site. In an effort to answer this question, the records of 227 patients with squamous cell carcinoma of the head and neck were reviewed. All patients had clinically positive neck nodes and were treated with radiotherapy alone to the primary lesion. There was no apparent difference in the rate of disease control at the primary site or in the ability to manage patients successfully who developed a local recurrence when comparing patients initially treated with radiotherapy alone to those managed by radiotherapy and neck dissection. We conclude that postradiotherapy neck dissection does not decrease the likelihood of successfully managing a recurrence at the primary site.

Carcinoma, Squamous Cell↗
PubMed2004

Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx.

OBJECTIVE/HYPOTHESIS: The utility of elective neck dissection in the management of patients with oral cavity and oropharyngeal cancer who present without neck metastases remains controversial. The study addressed the question of whether elective neck dissection improves regional control and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx presenting with T1/T2 node-negative disease. STUDY DESIGN: A nonrandomized, uncontrolled retrospective chart review. METHODS: A nonrandomized, uncontrolled retrospective chart review was performed. Resection of the primary tumor was performed in all patients. The neck was observed in one group, and elective neck dissection was performed for patients in another group. RESULTS: The study data indicated that elective neck dissection significantly improves regional control and regional recurrence-free survival. Elective neck dissection when compared with observation of the neck did not improve overall survival. CONCLUSION: Elective neck dissection reduces regional recurrence and may extend disease-free survival.

Adult↗
PubMed2006

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

Accessory Nerve Injuries↗
PubMed2000

Neck dissection for advanced lymph node metastasis before definitive radiotherapy for primary carcinoma of the head and neck.

OBJECTIVE: To evaluate the outcome of neck dissection for advanced metastasis and subsequent planned radiotherapy to the neck and primary tumor. STUDY DESIGN: Single-center, retrospective case series. METHODS: From 1988 to 1998, 37 previously untreated patients were included into the study protocol. Two had a single tumor-positive neck node and the remaining 35 had multiple tumor-positive neck nodes (mean number, 6.0). Extranodal spread was reported in 35 cases (95%); mean nodal size was 5.7 cm (SD, 2.4 cm). Five patients (14%) were not irradiated or were irradiated with palliative intention. Of the remaining patients, 30 received irradiation of 60 Gy or more to the neck and the primary tumor (mean dose, 66.9 Gy; SD, 4.2 Gy). Cumulative survival distributions were estimated by the Kaplan-Meier method, and differences between groups were analyzed with the log-rank test. RESULTS: Treatment-related mortality was observed in three patients (8%). Disease-specific survival was 49% at 2 years and the overall locoregional control rate was 43% at 2 years. Patients with T1 to T2 primary lesions were compared with those with advanced primary disease, and the 2-year local control rates were 76% and 47%, respectively (P = .056). The following prognostic factors were identified for distant metastasis: three or more positive nodes (P = .037), positive surgical margins in the neck dissection specimen (P = .004), and time from diagnosis until neck dissection of 23 days or more (P = .043). The influence of distant metastasis on disease-specific survival was evident (P = .0003). CONCLUSION: Patients with low-T-stage tumors have a better local control rate with this regimen and survival depends on the status of the neck.

Adult↗
PubMed2006

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

OBJECTIVE: To compare the impact of various types of neck dissection on postoperative shoulder function. METHODS: 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. RESULTS: 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. CONCLUSIONS: The shoulder function after SND was superior to those after RND and MRND.

Adult↗
PubMed2006

Propofol lipemia mimicking chyle leak during neck dissection.

BACKGROUND: Propofol is an intravenous agent used in anesthesia. Lipemia is an uncommon adverse effect of propofol infusion. METHODS: A patient undergoing neck dissection for recurrent chordoma had intraoperative lipemia develop after prolonged propofol infusion. RESULTS: Lipemia gave blood in the surgical field a milky appearance resembling chyle, but no chyle leak was present. Lipemia was confirmed by drawing a sample of blood and leaving it to stand. Layering of the blood with a milky white upper layer was observed. Analysis of a second sample of blood revealed a high lipemic index. CONCLUSIONS: Lipemia is an uncommon adverse effect of propofol infusion, which may give blood a milky appearance and be confused for a chyle leak in a dissected neck. Identification of lipemia is also important because there is a risk of acute pancreatitis, and it may represent the early stage of propofol infusion syndrome.

Anesthetics, Intravenous↗
PubMed2001

Resection of the sternocleidomastoid muscle during radical neck dissection.

BACKGROUND: Surgical therapy of lymph node metastasis is based on accessibility for en bloc resection. First described as "radical neck dissection", this original approach has since undergone various modifications. This has produced controversy about the particular indications for the individual techniques. The aim of this study was to evaluate whether intraoperative macroscopic inspection of the sternocleidomastoid muscle (SCM) in regard to tumor infiltration is sufficient to decide about muscle resection and whether there are prognostic differences between patients undergoing radical-versus modified radical (selective) neck dissection. MATERIALS AND METHODS: In a retrospective study, data on the surgical treatment of cervical lymph nodes and survival rates from 438 patients with head and neck malignancies managed in our department between 1988 and 1994 were analyzed in 1994 and again in 1999. RESULTS: 337 patients (76.9%) underwent unilateral or bilateral selective neck dissection. In 101 patients (23.1%) a radical neck dissection was performed and the SCM was completely resected. Analysis of these cases showed intraoperative macroscopic tumor invasion of the SCM in 12 patients (11.9%), which could be confirmed histologically. In the remaining 89 cases (88.1%), a macroscopically intact muscle was resected; in none of these cases did histopathological examination show tumor infiltration of the SCM. Analysis of radically or selectively neck dissected stage III or IV patients with oral cavity, oropharyngeal, hypopharyngeal or laryngeal carcinomas did not show statistical differences in 2-, 5- and 10-year survival (54.8%, 23.7%, 18.7% versus 62.6%, 25.6%, 21.8%, respectively). CONCLUSIONS: (1) Intraoperative inspection of the SCM constitutes a valid parameter for deciding whether tumor infiltration is present or not. (2) There were no prognostic differences (2-year, 5-year and 10-year-survival) between stage III and IV patients with oral cavity, oropharyngeal, hypopharyngeal and laryngeal carcinomas treated by either radical or selective neck dissection.

Aged↗
PubMed2005

Neck dissection of level IIb: is it really necessary?

OBJECTIVES: To determine whether resection of level IIb is necessary in elective or therapeutic neck dissections. STUDY DESIGN: Prospective case series. METHODS: Level IIb nodes were analyzed for micrometastases as separate specimens in 160 neck dissections on 148 patients with squamous cell carcinoma of the head and neck. RESULTS: In 106 elective neck dissections (N0 necks) from upper aerodigestive tract (UADT) and skin/parotid squamous carcinoma primaries, level IIb was involved in 4.5% and 33%, respectively. In 54 therapeutic neck dissections (N+ necks) from UADT and skin/parotid squamous carcinoma primaries, level IIb was involved in 25% and 71%, respectively. Apart from skin/parotid squamous carcinoma primaries, level IIb was never involved unless level IIa was also involved. CONCLUSIONS: Level IIb nodes can be left in situ in UADT primary carcinomas in nontonsillar N0 necks without significantly compromising regional clearance of micrometastases.

Accessory Nerve Injuries↗
PubMed1997

Blindness as a rare complication of neck dissection.

Blindness is a rare and rather unexpected complication of neck dissection. There have been only a few cases reported to date, all following bilateral neck dissections. We present a case of blindness after one-sided neck dissection and an insidious finding of bilateral common carotid artery occlusion.

Blindness↗
PubMedDate not supplied

Bilateral chylothorax following neck dissection.

BACKGROUND: Bilateral chylothorax, as a complication of neck dissection, is extremely rare, and was first described in 1907. Ten cases are reported in the literature. METHODS: This presentation illustrates an additional case of bilateral chylothorax occurring after neck dissection. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed. RESULTS: Chylothorax has two major complications: respiratory and metabolic. The modern concepts of treatment are summarized. CONCLUSIONS: After neck dissection, the clinician should suspect chylothorax if the patient had respiratory embarrassment and an abnormal chest x-ray postoperatively.

Adult↗
PubMedDate not supplied

Elective neck dissection during salvage laryngectomy.

PURPOSE: To evaluate the rate of occult metastases detected with elective neck dissection during salvage laryngectomy for radiation failures. METHODS AND MATERIALS: Retrospective review of 63 patients failing radiation therapy treated with salvage surgery between 1970 and 1999. Charts were reviewed for tumor stage, neck treatment, complications, surgical time, and survival. Median follow-up for patients with glottic and supraglottic cancers was 7.8 and 4.5 years, respectively. RESULTS: Thirty-one of 41 glottic cancer patients received elective neck dissections. Three (10%) of 31 had occult metastases. Recurrent staged rT3 and greater tumors showed a 20% rate of occult metastases. No survival advantage was noted between patients treated with elective neck dissection and those followed expectantly (P = .87). Cartilage invasion and perineural invasion in the larynx were associated with a higher risk of occult metastases (P < .05). Ten of 22 supraglottic cancer patients received elective neck dissections. Two (20%) of 10 had occult metastases, and a statistically significant survival advantage was not noted (P = .49). CONCLUSIONS: We recommend bilateral neck dissection at the time of laryngectomy for recurrent staged rT3/4 tumors and all patients with recurrent supraglottic cancers because of the higher rate of occult metastases.

Adult↗
PubMed1994

Patency of the internal jugular vein following modified radical neck dissection.

Although the internal jugular vein is commonly preserved in modified radical neck dissections, the English literature contains only a single study assessing postoperative vein patency including only 13 patients. The present study was instituted to better determine the patency of the internal jugular vein following modified radical neck dissection and to identify factors associated with venous occlusion. Preoperative and postoperative computed tomography or magnetic resonance imaging was performed on 69 patients undergoing 79 vein sparing neck dissections. Sixty-eight veins (86%) were patent postoperatively. A retrospective chart review revealed that compression by either a musculocutaneous flap or recurrent carcinoma in the neck was associated with venous occlusion. We conclude that the internal jugular vein is likely to remain patent after modified radical neck dissection with vein preservation.

Combined Modality Therapy↗