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At least 289 records · Page 16Linked to original sources
PubMed2004

The impact of neck dissection on health-related quality of life.

OBJECTIVE: To compare health-related quality of life in patients having no neck dissection and those having a selective dissection, with particular reference to shoulder dysfunction. DESIGN: Prospective study. SETTING: Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, England. PATIENTS: Two hundred seventy-eight consecutive patients undergoing primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma between January 1, 1995, and December 31, 1999. MAIN OUTCOME MEASURE: The University of Washington Quality of Life questionnaire, administered on the day before surgery and at 6 months, at 12 months, and more than 18 months after surgery. RESULTS: No neck dissection was performed in 58 patients (21%), a unilateral dissection in 181 (65%), and a bilateral dissection in 39 (14%). Patients with no neck dissection and those with unilateral level III or IV dissections had similar mean scores for shoulder dysfunction, whereas patients with unilateral level V and bilateral level III and IV dissections recorded much worse scores on average. CONCLUSIONS: There is little subjective morbidity associated with shoulder dysfunction after a unilateral level III or IV neck dissection compared with patients undergoing primary surgery without a neck dissection. More extensive surgery in the neck, whether bilaterally removing levels I to III or IV or extending posteriorly to include level V, is associated with statistically significantly worse shoulder dysfunction.

Aged↗
PubMedDate not supplied

A prospective study of shoulder disability resulting from radical and modified neck dissections.

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation.

Accessory Nerve↗
PubMed1987

Postoperative hypertension associated with radical neck dissection.

The incidence of hypertension following radical neck dissection was examined in 94 consecutive patients. Nine patients (9.6%) had postoperative blood pressure readings of 200/100 mm Hg or higher (n = 4) or of more than 40 mm Hg systolic and more than 20 mm Hg diastolic above preoperative levels (n = 5); ten patients (10.6%) had blood pressure readings of more than 40 mm Hg systolic or more than 20 mm Hg diastolic above preoperative levels. These elevations usually occurred in the first two postoperative hours and lasted approximately nine hours. Six patients required interventional therapy (intravenous nitroglycerin or sodium nitroprusside). No cardiac or central nervous system sequelae resulted, but two patients had postoperative hemorrhage and flap elevation by hematoma attributed to the hypertension. Carotid sinus denervation during radical neck dissection may be the cause of the reflex hypertension once general anesthesia-induced vasodilation has ended. Stripping of tumor from the carotid artery or placement of dermis grafts directly on the artery do not appear to influence postoperative development of hypertension.

Carotid Arteries↗
PubMed1993

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 DOSAK 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 DOSAK 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.

Carcinoma, Squamous Cell↗
PubMed1994

Unilateral hyperlucent thorax on plain chest radiographs after neck dissection: importance of atrophy of the trapezius muscle.

OBJECTIVE: A hyperlucent thorax on plain chest radiography indicates a decrease in the radiographic density of the thorax, which can be caused by intra- or extrapulmonary diseases. The purpose of this study was to assess the prevalence and mechanisms that may be responsible for unilateral hyperlucency of the thorax after neck dissection and to determine if atrophy of the trapezius due to the transection of the accessory nerve is a cause of hyperlucent thorax. MATERIALS AND METHODS: Differences in the radiographic density between the right and left lung were evaluated and correlated with transection of the accessory nerve in 21 patients who had had a radical or a modified neck dissection for a malignant tumor of the head and neck. Twenty-eight neck dissections were performed on these 21 patients (seven had a simultaneous bilateral neck dissection). In 14 of the 21 patients, the accessory nerve had been severed during the neck surgery. In six patients, mechanisms responsible for a hyperlucent thorax were investigated with follow-up thoracic CT scans. RESULTS: In the radiographs, eight patients had a hyperlucent thorax on the side of the neck dissection. In all of these cases, the accessory nerve on the side of this neck dissection had been severed during a radical or a modified neck dissection. Prior to surgery, no such hyperlucency was noted. CT scans showed atrophy of the denervated trapezius muscle. CONCLUSION: Our findings show that atrophy of the denervated trapezius muscle after neck dissection is a cause of unilateral hyperlucent thorax on plain chest radiographs. Therefore, this finding should be anticipated as a postoperative change in patients who have had this surgery.

Accessory Nerve↗
PubMed1983

Value of contralateral supraomohyoid neck dissections.

This study was carried out to determine the merit of contralateral supraomohyoid neck dissection in the clinically negative neck. When performed in conjunction with a standard radical neck dissection on the ipsilateral side, a yield of 2.8 percent pathologically positive nodes (5 of 177) was obtained in the contralateral neck. Little difference was noted in the yield of midline lesions versus unilateral lesions which approached the midline (3 and 2.6 percent, respectively). Similarly, the yield with preoperative radiation was close to that of the nonradiated group (3 and 2.7 percent, respectively). Additionally, in 1.7 percent of patients (3 of 177) with both clinically and pathologically negative nodes, metastases later developed in the contralateral neck, which indicates that the dissection is not necessarily effective in preventing future disease. The contralateral supraomohyoid neck dissection in the treatment of malignancies of the oral cavity, pharynx, and larynx does not appear to be of significant therapeutic value.

Head and Neck Neoplasms↗
PubMed2006

Elective neck dissection for carcinomas of the oral cavity: occult metastases, neck recurrences, and adjuvant treatment of pathologically positive necks.

BACKGROUND: Supraomohyoid neck dissection (SOHND) is currently performed in patients with carcinoma of the oral cavity with clinically negative neck. Most investigators consider SOHND as a staging procedure. METHODS: Records of 100 patients with cancer of the oral cavity and clinically negative neck undergoing SOHND were reviewed. The rate and significance of occult metastases are evaluated, the neck recurrences are analyzed and the indication of adjuvant radiation of pN+ necks is discussed. RESULTS: In 34 of 1814 of analyzed lymph nodes, metastatic disease was detected as follows: 30 macrometastases and 4 micrometastases. In 13 of 34 metastases (38%), extracapsular spread was observed. Twenty of 100 patients (20%) had to be upstaged. In 9 of 87 (10%) patients without local recurrence and with a minimal follow-up of 24 months, 5 ipsilateral (4 within the dissection field) and 5 contralateral neck recurrences were observed. Regional recurrence developed in 4% and 35% of patients with pN0 and pN+ necks, respectively. CONCLUSIONS: In 20% of patients with oral cavity tumors and pN0 neck, occult metastases were disclosed. Neck recurrences developed significantly more often in patients with pN+ than in those with pN0 necks. To evaluate the exact indication for an adjuvant treatment of patients with cN0/pN+ necks, prospective studies should be performed.

Adult↗
PubMed1989

Five-year results of functional neck dissection for cancer of the larynx.

Two hundred forty-two patients with a diagnosis of epidermoid carcinoma of the larynx were studied. All of them underwent surgery. One hundred sixty-one patients underwent functional neck dissection, with a total of 206 performed. Thirty-three patients underwent classic radical neck dissection, with a total of 35 performed. The overall 5-year neck tumor recurrence rate in the necks with functional neck dissection was 3.4%. Recurrences developed in 5.7% of fields protected by radical neck dissection. The overall recurrence rate in the surgically unprotected necks was 6.2%. Our results confirm that functional neck dissection is the procedure of choice in cases with NO disease and in cases with mobile nodes. From the oncologic viewpoint, functional neck dissection is a safe technique to treat the cervical spread from cancer of the larynx as long as its indications and technical characteristics are carefully observed.

Adult↗
PubMed1985

Radical neck dissection for squamous cell carcinoma of the head and neck: early and long-term results of treatment.

An account is given of the use of radical neck dissection in a consecutive series of 147 patients treated during the years 1967-76 in the Head and Neck Unit of the Royal Marsden Hospital. The majority had received previous treatment principally by irradiation to full dosage, some by previous surgery, and a minority by induction cytotoxic chemotherapy. The 5-year determinate survival results for surgical salvage are 28.03%, and 20.5% at 10 years. Prevention of recurrent cancer in the neck was achieved in 70% of all those who later succumbed to their disease.

Adult↗
PubMed2001

Squamous cell carcinomas of the soft palate treated with radiation therapy alone or followed by planned neck dissection.

PURPOSE: The present study presents the experience at the University of Florida with treatment of unselected patients with carcinomas of the soft palate with radiation therapy (RT) alone or followed by planned neck dissection. METHODS AND MATERIALS: One hundred seven patients treated with curative intent with RT alone or followed by neck dissection from 1965 to 1996 were included in the study. All patients had follow-up for at least 2 years. No patients were lost to follow-up. RESULTS: Local control rates at 5 years were 86% for T1, 91% for T2, 67% for T3, and 36% for T4 carcinomas. T-stage and overall treatment time significantly affected local control in multivariate analysis. Nodal control rates at 5 years were 86% for NO, 76% for N1, 61% for N2, and 67% for N3 carcinomas. Overall treatment time and planned neck dissection significantly affected nodal control in multivariate analysis. Ultimate local-regional control rates at 5 years were 90% for Stage I, 92% for Stage II, 84% for Stage III, and 60% for Stage IV disease. Overall treatment time and planned neck dissection significantly affected ultimate local-regional control in multivariate analysis. The overall survival rate at 5 years was 42% for all patients. Overall stage, overall treatment time, and planned neck dissection significantly affected overall survival in multivariate analysis. The cause-specific survival rate at 5 years was 70% for all patients. Overall treatment time and planned neck dissection significantly affected cause-specific survival in multivariate analysis. Three patients sustained severe postoperative complications and 3 patients sustained severe late complications. Sixteen patients had synchronous and 14 patients had metachronous carcinomas of the head and neck mucosal sites. CONCLUSION: For limited carcinomas of the soft palate, RT (alone or followed by planned neck dissection) results in relatively high local-regional control and survival rates. For advanced carcinomas of the soft palate, local-regional control and survival rates are relatively low and local-regional recurrence rates are substantial. Advanced carcinomas of the soft palate may be better treated with RT and concomitant chemotherapy.

Adult↗
PubMed1993

A technique for diagnosing the individual patterns of innervation of the trapezius muscle prior to neck dissection.

Based on the techniques of regional anaesthesia, a method for simulating the effects of radical neck dissection on the innervation of the trapezius muscle by selectively and reversibly blocking the accessory nerve and its superficial cervical anastomoses, was developed and tested on 40 patients who were due to undergo radical neck dissection. Action potentials of the three portions of the muscle were recorded after this blockade as well as after radical neck dissection, and compared. It was found that the electromyograms were congruent in 92.5% of the cases. Four patterns of innervation were demonstrated, ranging from complete substitution of the resected or blocked nerves to a remaining muscle activity of less than 20% after blockade or radical neck dissection.

Accessory Nerve↗
PubMedDate not supplied

Neck dissection for cutaneous malignant melanoma.

This retrospective study examines the experience of the Sydney Melanoma Unit in the management of cervical lymph nodes among patients with cutaneous melanoma of the head and neck. From 1960 to 1990, 397 patients had neck dissections for cutaneous malignant melanoma of the head and neck. This number represents 40% of all patients treated for head and neck melanoma at the Sydney Melanoma Unit during this period. Neck dissections were therapeutic in 152 patients, elective in 234 patients and for an unknown indication in 11 patients. Lymph nodes were histologically positive in 39% of operations overall and in 7% of elective neck dissections. The incidence of recurrence in the neck after dissection was 24% overall, 28% when nodes were histologically positive and 13% when nodes were histologically negative. Patients who developed recurrent neck disease after neck dissection had a worse prognosis than those with positive nodes who did not recur, but the difference in survival was not statistically significant. Patients with histologically positive nodes had a significantly worse survival than those with negative nodes, 34% vs 67% respectively at 10 years (p less than 0.001). Elective neck dissection was associated with a significant improvement in survival for patients with melanomas 1.5-3.9 mm thick, using univariate analysis. This apparent benefit was lost when multivariate analysis was carried out. Patients having elective neck dissection currently have selective modified radical dissections depending upon the anatomic site of the primary melanoma. Postoperative radiotherapy is used for multiple positive nodes or extracapsular spread.

Female↗
PubMed1985

Modified neck dissection. A study of 967 cases from 1970 to 1980.

The medical records of 967 patients treated with a modified neck dissection were carefully reviewed, and the data were collected and statistically analyzed. For a primary tumor in the oral cavity or oropharynx, a supraomohyoid neck dissection was adequate treatment for the neck that was both clinically staged N0 or N1 and pathologically staged N1 without evidence of extracapsular invasion. For primary tumors in the larynx and hypopharynx, an elective bilateral anterior neck dissection is considered proper treatment if the nodes are not multiple or if connective tissue disease is not present. A functional neck dissection is effective neck treatment regardless of the primary site or stage of the disease. The selective use of postoperative radiotherapy can more effectively decrease the incidence of neck recurrence compared with surgery alone in patients with multiple positive nodes, a node more than 3 cm in size, or nodes with extracapsular invasion.

Adult↗
PubMedDate not supplied

Neck dissection: radical or conservative.

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.

Carcinoma, Squamous Cell↗
PubMed1992

Functional neck dissection: three decades of controversy.

Functional neck dissection (FND) is a neck-functional, tumor-radical approach for the management of the neck in patients with head and neck cancer. Based on the anatomic knowledge of the lymphatic compartments of the neck, FND is a different surgical technique rather than a modification of the classic procedure described by Crile. From an oncologic viewpoint, FND is a relatively safe operation to treat the cervical spread from head and neck cancer as long as the indications and technical details are carefully followed. In this report, based on our experience with more than 1,000 FNDs, we analyze the history and the philosophy of the operation.

Argentina↗
PubMed2004

Efficacy of routine bilateral neck dissection in the management of supraglottic cancer.

OBJECTIVE: In a previous study, we reported that the contralateral undissected neck was the most common site of failure in patients treated for squamous cell carcinoma of the supraglottic larynx. Since then, we have altered our treatment of all patients with T2-T4 supraglottic cancer and selective T1 cases to include routine bilateral neck dissection. In the present study, we compare the long-term efficacy of routine bilateral neck dissections to historic controls in the treatment of patients with supraglottic cancer. STUDY DESIGN AND SETTING: A retrospective chart review on all patients undergoing primary surgery for supraglottic carcinoma between 1989 and 2000 was performed. All had undergone routine bilateral neck dissection. The most proximal area of recurrent disease was identified as the site of recurrence. Rates of recurrence, 2-year overall survival, and 2-year disease-specific survival were calculated. Results were compared to historical data using Fisher's exact test. RESULTS: Of 180 patients identified, 115 patients with minimum 2-year follow-up and meeting exclusion criteria were included in the analysis. Four patients (3.5%) experienced local recurrence, 9 patients (7.8%) had cervical recurrence, and 8 patients had distant spread (7.0%). Recurrence in the neck (7.8%) has been significantly reduced from the historical recurrence rate (20%) prior to instituting routine bilateral neck dissections ( P = 0.009). The 2-year survival increased from 72% to 82.6% ( P = 0.0408). CONCLUSION AND SIGNIFICANCE: Routine bilateral neck dissection decreases cervical recurrence and appears to improve survival in the management of supraglottic cancer.

Adult↗
PubMed1999

A safe and rapid technique for modified neck dissection.

The technique of modified neck dissection presented here, by the very limited anatomic area it addresses of necessity shares aspects of techniques described by other authors. Developed over many years of teaching residents, it provides, if carefully followed, a simple, safe, and relatively rapid method of carrying out the procedure, having been used by the senior author and his residents in scores of patients both at our institution and in many overseas operations under rather primitive conditions without modification. It is not a new way of doing the procedure, but rather a combination of some of the simplest approaches and aspects which may be especially helpful to those without wide experience.

Developing Countries↗
PubMed1990

Accessory nerve conduction in neck dissection subjects.

Evaluation of the accessory nerve and trapezius muscle was performed on eight subjects with neck dissection secondary to oropharyngeal/laryngeal cancer. The latencies and amplitudes of the upper, middle, and lower trapezius muscle in neck dissection subjects were compared to those in healthy subjects similar in age. Subjects after neck dissection showed abnormalities of evoked responses and abnormal spontaneous discharges in electromyographic studies of the upper trapezius. Future serial studies that seek prognostic indicators of shoulder dysfunction common to neck dissection patients are warranted.

Accessory Nerve↗