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PubMed1988

Critical assessment of supraomohyoid neck dissection.

During a recent 5-year period, 115 patients had 131 supraomohyoid neck dissections. Eighty-one percent of these procedures were performed for squamous carcinoma. Seventy-nine percent of the primary tumors were located in the oral cavity and 16 percent arose in the oropharynx. Almost 80 percent of the necks dissected for primary squamous carcinoma were clinically N0, and occult nodal disease was discovered in 31 percent of these neck specimens. When the supraomohyoid neck dissection specimen showed no involvement, the overall incidence of treatment failure in the neck at 2-year follow-up was 5 percent. Almost all patients with occult squamous carcinoma in the supraomohyoid neck dissection specimen received postoperative radiotherapy, and the failure rate in the neck was 15 percent. When neck nodes were both clinically and pathologically involved, neck recurrence developed in 29 percent of the patients despite the addition of adequate postoperative radiotherapy. Among those patients with nonsquamous primary tumors and a pathologically negative supraomohyoid neck dissection specimen, there was only one subsequent treatment failure in the neck. Supraomohyoid neck dissection appears to be a valid staging procedure for clinically N0 patients with primary squamous carcinomas located in the oral cavity or oropharynx, with an appropriate yield of occult nodal disease, and infrequent treatment failure in the dissected neck when the supraomohyoid neck dissection specimen is pathologically uninvolved. When nodal disease is clinically obvious, treatment failure is more frequent, even with the addition of postoperative radiotherapy. The role of supraomohyoid neck dissection in this setting deserves further study.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Lipid and volume analysis of neck drainage in patients undergoing neck dissection.

PURPOSE: We seek to establish normative values for the volume of postoperative neck drainage from patients undergoing ablative oncologic procedures that include a neck dissection and to analyze neck drainage for lipid content to establish guidelines that may be helpful in identifying chylous fistula when this diagnosis is not clinically straightforward. PATIENTS AND MATERIALS: Neck drainage obtained through continuous suction percutaneous drainage catheters was evaluated following 23 neck dissections performed on 19 patients. In every case, either radicle or modified type I neck dissection was performed. The volume of drainage was quantitated on a day-to-day basis. In a separate group of 27 patients undergoing neck dissection, neck drainage was compared with serum levels of triglyceride, cholesterol, and chylomicron content. RESULTS: The mean duration of neck drainage was 5 days. Maximum drainage (160 mL) was noted on the first day and dropped daily to less than 10 mL by the fifth postoperative day. A statistically significant difference between serum and neck drainage triglyceride and cholesterol content was observed in nearly all cases. Neck drainage fat content was lower than that noted in serum in nearly all cases. Chylomicron content of 4% was encountered in neck drainage. CONCLUSIONS: This study provides normative data on lipid content of neck drainage. With only a rare exception, the triglyceride and cholesterol levels are higher in the serum than in the neck drainage. A triglyceride level of 100 mg/dL seems to be the upper limit of normal (mean plus 1 standard deviation). A low level of chylomicron (> 4%) is consistent with normal healing and may be due to breakdown of fatty tissue.

Aged↗
PubMed1977

The submandibular triangle in radical neck dissection.

Various modifications of the standard radical neck dissection operation have been advocated since its original description. An ideal operation would offer maximum cure rates with minimal cosmetic and functional disturbance. The validity of removing the submandibular triangle contents as part of radical neck dissection was studied by analyzing the involvement of this region by metastatic squamous cell carcinomas of the head and neck. Only three of the 51 neck-dissection specimens that were examined contained metastases to submandibular triangle lymph nodes. The primary sites were nose, floor of mouth, and retromolar trigone. None of the 26 laryngeal tumors in this series had spread to the submandibular triangle. In the absence of palpable submandibular or upper, deep cervical lymph nodes, the contents of the submandibular triangle can probably be left undisturbed in radical neck dissections for laryngeal cancer.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Blindness following bilateral radical neck dissection.

Blindness after bilateral radical neck dissection is a rare complication. A recent patient, who suffered total blindness after simultaneous bilateral radical neck dissection, is the fifth case reported. It is, however, the first with pathological study of the optic tracts. Detailed microscopic examination revealed bilateral intraorbital hemorrhagic optic nerve infarction without evidence of embolization or ophthalmic artery occlusion. The probable etiology of this event is an episode of prolonged hypotension. An additional etiologic factor may be increased resistance to blood flow caused by venous hypertension, resulting from bilateral internal jugular vein ligation.

Aged↗
PubMed1977

[Pain-sensation following classic neck-dissection (author's transl)].

Resulting neck-dissection surgery (including curative or conservative intervention) very complex pain-syndromes are next to losses of function at the top of complaints stated. The discussion of the case-reports of 242 patients with unilateral neck-dissection and the reexamination of 28 patients free of recurrence revealed several causes of head- and facial pain. The close relationship of functional disability and pain-sensation is discussed. The recommendation of elective neck-dissection - by critical indication - is supported. Resection of nervus accessorius may be necessary in some cases, immediate reconstruction by nerve sutures is recommended. By post-operative treatment the complaints often can be relieved.

Accessory Nerve↗
PubMed1991

Supraomohyoid neck dissection with frozen section biopsy as a staging procedure in the clinically node-negative neck in carcinoma of the oral cavity.

A retrospective analysis was performed to evaluate the efficacy of elective supraomohyoid neck dissection in 57 newly diagnosed patients with squamous cell carcinoma of the oral cavity. The protocol included sampling of both the most suspicious and the largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present) for frozen section examination. In 10 cases, frozen section biopsy revealed metastatic disease, and surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In another 10 cases, histologic examination of the supraomohyoid neck dissection specimens revealed occult nodal disease at other sites. In the histologically proven absence of metastatic disease in the supraomohyoid neck dissection specimens, disease recurrence in the neck occurred in only three cases (7%), all in the presence of local failure. The results of our analysis support the conclusion that elective supraomohyoid neck dissection with frozen section biopsy appears to be a valid staging procedure and a valuable approach to the management of the clinically node-negative neck in squamous cell carcinoma of the oral cavity.

Biopsy↗
PubMed1987

Current status of neck dissection in the management of squamous carcinoma of the head and neck.

Classical radical neck dissection (RND) remains the primary treatment for clinically positive lymph nodes among patients with squamous carcinoma of the upper aerodigestive tract. Recurrence rates following RND range from 20 to 70% depending on the number of nodes involved and the extent of extracapsular spread. Modified radical neck dissection (MRND) is associated with less cosmetic and functional morbidity than RND but, used alone, MRND is only appropriate when clinical neck disease is absent or minimal. Both RND and MRND should be combined with adjuvant postoperative radiotherapy when more than one node is positive or extracapsular spread is present. This approach will significantly decrease regional failure, but may not improve survival because of an increased incidence of distant metastases. MRND is especially useful as an elective procedure to stage the clinically negative neck. A survival benefit from elective neck dissection, however, remains to be demonstrated.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Rehabilitation of the shoulder after radical neck dissection.

After classical radical neck dissection with removal of the sternocleidomastoid muscle and division of the spinal accessory nerve, there are certain disabling or disagreeable musculoskeletal defects. This paper describes the muscular deficiencies and gives a set of exercises which can be counted on to minimize the problems.

Humans↗
PubMed1991

Second radical neck dissection.

We report a series of 96 patients (62 men and 34 women) undergoing a second radical neck dissection for enlarged contralateral cervical nodes after primary treatment of a squamous cell carcinoma of the head and neck, including an ipsilateral radical neck dissection. The proportion of patients requiring a second later neck dissection varied from 0% for tumours of the nasopharynx, nasal cavity and paranasal sinuses, to 5% for tumours of the hypopharynx. The incidence of second neck dissection was not determined by the original T stage of the primary tumour, but patients with enlarged nodes at presentation were 5 times more likely to need a second neck dissection than those with no palpable nodes at presentation. Also, patients with a poorly differentiated tumour were twice as likely to need a second neck dissection as those with a well differentiated tumour. The overall 5-year survival after second neck dissection was 35% and the perioperative mortality 1.92%. Significant factors predicting survival after a second neck dissection were the time to recurrence, the clinical neck node status at recurrence, the number of histologically invaded nodes in the neck and the presence of extra-nodal disease.

Carcinoma, Squamous Cell↗
PubMed1991

Venous drainage of free flaps following radical neck dissection.

Large tissue defects may occur following head and neck surgery. When combined with ipsilateral radical neck dissection the venous drainage of a free flap used to cover the defect may be compromised. Twelve patients having radical neck dissections underwent on-table venography to study the pattern of venous drainage of these flaps. The predominant drainage pattern is initially in a cephalic direction, then across the midline and finally in a caudal direction on the contralateral side of the neck. Venous drainage to the contralateral side of the neck may be a determinant of flap survival. In order to facilitate venous drainage following free flap procedures, patients should be positioned so that the contralateral internal jugular vein is not compressed. Drains should be placed caudal to the microvascular anastomoses in order to minimize interference with the cephalic direction of venous drainage. Any patient having a radical neck dissection requiring a central venous catheter should have it placed ipsilateral to the neck dissection. Thrombosis around a contralaterally placed cannula may significantly increase head and neck venous pressure.

Catheterization, Central Venous↗
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↗
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↗
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↗
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↗
PubMed1992

Neck dissection for non-squamous malignancy.

Of 1030 patients who underwent neck dissection (radical, modified or selective) in a 27-year period 103 had malignant neck nodes from a primary site in the head and neck with a histological diagnosis other than squamous carcinoma. There were 71 men and 32 women in this group with a mean age of 55 years. 28 patients had neck dissection as part of their initial treatment and 75 for later nodal recurrence. Five-year survival was 52% (40-63%). Survival was site dependent, best for thyroid tumours and worst for tumours of the major salivary glands (chi 1(2) = 6.52, P < 0.05). Histology significantly affected survival, best for papillary tumours and worst for melanoma and undifferentiated tumours (chi 1(2) = 3.85, P < 0.05). Survival was worse with advanced N stage but varied little with node level. The number of nodes invaded had a highly significant effect on survival (chi 4(2) = 23.94, P < 0.001), but extracapsular rupture had no effect. Advanced T stage at the time of surgery had a significant adverse effect on survival using univariate analysis, but this effect disappeared using multivariate analysis. In the 75 patients who had neck dissections for nodal recurrence the presence of a simultaneous recurrence at the primary site had no significant effect on survival. These patients had a better 5-year survival than patients having neck dissection for squamous disease, but the usual predictors of survival in squamous carcinoma do not always apply to non-squamous malignancy.

Female↗
PubMed1978

Indications for radical neck dissection following radiation therapy.

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.

Evaluation Studies as Topic↗
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↗