Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Neck Dissection”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Neck dissection after twice-a-day radiotherapy: morbidity and recurrence rates.

Between March 1978 and April 1986, 56 patients underwent planned unilateral, and five patients underwent planned bilateral, radical neck dissections following high-dose twice-a-day radiotherapy, usually with 60Co. Neck dissections were generally performed 6 weeks after radiotherapy. The overall rate of control of disease in the neck in all 61 patients was 81% at 5 years. Patients who underwent neck dissections following radiotherapy had significantly higher rates of neck-disease control than patients treated by radiotherapy alone during the same time period for stages N2A-N3A and N2B-N3B, but not for N1 disease. No carotid ruptures or fatal complications occurred. The rate of wound complications was judged to be acceptable.

Head and Neck Neoplasms↗
PubMed1986

Intracranial hypertension following neck dissection.

A 51-year-old man developed prolonged papilloedema as a result of increased cerebrospinal fluid pressure following staged bilateral radical neck dissection. The patient recovered completely with no further specific therapy. Although the prognosis for vision is usually good in patients with longstanding papilloedema due to raised cerebrospinal fluid pressure, permanent visual impairment remains a serious complication. In the presence of anatomical variations of the venous pathways by which the blood leaves the brain, a raised intracranial pressure may also develop following unilateral radical neck dissection. Nine cases of increased intracranial pressure following unilateral radical neck dissection reported in the literature until now are briefly reviewed.

Carcinoma, Squamous Cell↗
PubMed2007

Anatomical study of accessory nerve innervation relating to functional neck dissection.

PURPOSE: The present study sought to clarify correlations of accessory nerve innervation in the neck region and innervation of the sternocleidomastoid and trapezius muscles with postoperative dysfunction after functional neck dissection by macroscopic observation. MATERIALS AND METHODS: The materials used in this study were 35 cadavers provided for anatomical practice to the Department of Anatomy, Tokyo Dental College. The accessory nerve was identified at the anterior margin of the trapezius muscle, and its innervation in the posterior triangle of the neck was examined in detail. RESULTS: The superficial cervical vein vascularizes the anterior margin of the trapezius muscle near an area where the main trunk of the accessory nerve innervates the trapezius muscle. The results showed 3 types of accessory nerve innervation of the sternocleidomastoid muscle: Type A, the not penetrating type; Type B, the partially penetrating type; and Type C, the completely penetrating type. In addition, 5 types of innervation of the trapezius muscle by the main trunk and branches of the accessory nerve were apparent, with the number of branches innervating the muscle ranging from 0 to 4. CONCLUSIONS: Dysfunction after functional neck dissection can thus be avoided by paying attention to not only the main trunk of the accessory nerve, but also the branches. Moreover, when identifying accessory nerve innervation of the trapezius muscle, the superficial cervical vein may offer a useful surgical landmark.

Accessory Nerve↗
PubMed2005

Shoulder disability after different selective neck dissections (levels II-IV versus levels II-V): a comparative study.

OBJECTIVES/HYPOTHESIS: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. STUDY DESIGN: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. METHODS: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II-IV, and patients in group B had clearance of levels II-V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal-Wallis test. RESULTS: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case of total upper trapezius muscle denervation was observed in group B. In both groups, electroneurographic data from the side of the neck treated showed a statistically significant increase in latency (P = .001) and decrease in amplitude (P = .008) compared with the contralateral side. There was no significant difference in electroneurographic data from the side with and the side without dissection in either group. Even though a high number of abnormalities was found on electrophysiological testing, only a limited number of patients, mostly in group B, displayed shoulder function disability affecting daily activities. CONCLUSION: The study data confirm that clearance of the posterior triangle of the neck increases shoulder morbidity. However, subclinical nerve impairment can be observed even after selective neck dissection (levels II-IV) if the submuscular recess is routinely dissected.

Adult↗
PubMed2003

Who merits a neck dissection after definitive chemoradiotherapy for N2-N3 squamous cell head and neck cancer?

BACKGROUND: The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2-N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. METHOD: All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, > or =3 cm), primary tumor site, and radiation fractionation schedule. RESULTS: Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p =.019) and by largest lymph node size, <3 cm vs > or =3 cm (19 of 25 vs 46 of 84, p =.06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p =.33) and proved more likely only in the ND patients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p <.001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs <CCR-neck) did not predict either a PCR-neck (24 of 32 vs 27 of 44, p =.21) or regional failure (5 of 65 vs 4 of 44, p =.80). CONCLUSIONS: After chemoradiotherapy, clinical parameters do not identify those patients with residual neck node disease or those at risk for regional failure, suggesting that ND be considered for all N2-N3 patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Classification of neck dissection: current concepts and future considerations.

In response to the increased number of neck dissection procedures and the lack of uniformity of terminology for describing these, several classification proposals have been made. The consensus report on neck dissection terminology by the American Academy of Otolaryngology-Head and Neck Surgery seems to have gained wide acceptance. This report outlines the Academy's classification system and its definitions for the lymph node groups. Other authors contributions are discussed and recommendations are suggested for future refinements to the classification system.

Head and Neck Neoplasms↗
PubMed2003

Ruptured internal jugular vein: a postoperative complication of modified/selected neck dissection.

BACKGROUND: Postoperative hemorrhage from the internal jugular vein after a modified or selective neck dissection is an infrequent, yet potentially life-threatening, complication. Despite the increasing frequency of modified or selective neck dissections, this complication has not been previously highlighted in the literature. SETTING: Tertiary referral academic center. MATERIAL AND METHODS: The records of six patients who experienced this complication were reviewed and analyzed for risk factors that might predict its occurrence. RESULTS: Common risk factors included postoperative pharyngeal fistula formation, significant tobacco history, and poor nutritional status. A more complete circumferential dissection of the vein low in the neck in the presence of hypopharyngeal fistula may place it at a higher risk for rupture. CONCLUSIONS: Patients who have a complete circumferential dissection of the internal jugular vein low in the neck and go on to have fistulas develop may be more prone to internal jugular vein rupture.

Aged↗
PubMed2006

A technique to identify and preserve the spinal accessory nerve during neck dissection.

INTRODUCTION: Preservation of the spinal accessory nerve during neck dissection should be the rule rather than the exception. Despite the presence of many described techniques to locate the nerve, a tedious dissection is often required; as a consequence, it remains vulnerable to damage. METHOD: We describe a novel method, not previously reported, based on identifying a constant vein which crosses the nerve. This aids in the nerve's early identification. CONCLUSION: Our method enables the surgeon to locate the nerve precisely and to avoid damage to it, thereby maximizing post-operative function.

Accessory Nerve↗
PubMed1980

Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial.

This study concerns 75 patients with squamous cell carcinoma of the oral cavity who were patients at the Gustave-Roussy Institute between December 1966 and July 1973. These patients were divided into two groups. The first group was comprised of 39 patients who underwent elective radical neck dissection; nodal involvement was present in 49% with capsular rupture in 13%. In the second group of 36, neck disease appeared during follow up in 19 cases. Therapeutic radical neck dissection was carried out in 17; the nodes were histologically positive in 15, 9 of which had a capsular rupture. In 2 cases, local or general conditions did not permit operative intervention. In this group, the involvement rate was 47% with a 25% capsular rupture rate. However, the comparison of the survival curves by the log-rank test did not reveal any differences, even though histologic prognostic factors were taken into account. These findings led to the conclusion that in squamous cell carcinoma of the oral cavity staged T1N0, T2N0, or T3N0 (from AJC's and UICC's clinical staging system), it seems possible, without risk, to delay neck dissection until a node is detectable, although it is reasonable to perform elective neck dissection in those cases in which the patient is unavailable for regular followup.

Carcinoma, Squamous Cell↗
PubMed1991

[Radical versus modified neck dissection. Cancer-related and functional viewpoints].

In a retrospective study 256 cases with curative or prophylactic neck dissection were evaluated with regard to neck recurrence and survival. In 173 cases the spinal accessory nerve had been preserved, in the remaining 86 cases it had been sacrificed. The results demonstrate that preservation of the accessory nerve has no influence on the regional recurrence rate and on survival if preservation of the nerve is possible without compromising the radicality of the neck dissection and if the patient is subjected to post-operative radiation.

Carcinoma, Squamous Cell↗
PubMed1998

Radiotherapeutic management of bulky cervical lymphadenopathy in squamous cell carcinoma of the head and neck: is postradiotherapy neck dissection necessary?

Although traditional recommendations for the management of bulky cervical lymphadenopathy (AJCC categories N2-3) with definitive radiotherapy call for postradiotherapy neck dissection regardless of treatment response, recent data suggests that this policy can be modified on the basis of tumor regression rate. In a series of 130 patients with stage III-IV squamous cell carcinoma of the head and neck managed with a concomitant boost-accelerated hyperfractionated radiotherapy schedule, 81 cases had cervical lymphadenopathy at the time of referral. Patients were analyzed with respect to regional control outcomes for those having complete and incomplete clinical responses during the initial 3-month follow-up interval. The general management policy has been close observation of patients demonstrating complete clinical responses to radiation rather than postradiotherapy neck dissection. Failure patterns were examined in the 58 patients classified as complete responders. Failure occurred in the primary site in 16 (28%) of these patients, while isolated neck failure occurred in only 3 (5%). Neck recurrence rates for patients with maximum lymph node size < or = 3 cm vs. > 3 cm were not statistically different at 3-year follow-up (94% vs. 86%). Among the 23 incomplete clinical responders, 18 had incomplete neck responses. Five of these patients underwent salvage neck dissection; 4 remain clinically free of recurrence. The remaining 13 patients who either refused or were not eligible for salvage surgery ultimately succumbed with persistent loco-regional disease. The policy of observation after complete response to the radiotherapy schedule employed here was associated with a very low incidence of isolated neck failures and was safe and appropriate in patients who can be followed reliably. The prognosis for patients who failed to respond in the neck was poor except for those who underwent salvage surgery.

Carcinoma, Squamous Cell↗
PubMed2006

Botulinum toxin A for neuropathic pain after neck dissection: a dose-finding study.

OBJECTIVES: Botulinum toxin type A (BtxA) has been reported to be feasible in chronic neuropathic pain after neck dissection. The impact of the dose on the outcome has not been investigated yet. STUDY DESIGN: Twenty-three patients with neuropathic pain after neck dissection were selected for an open and prospective phase II trial. METHODS: In the low-dose group (n=13), a concentration of 10 mouse units (MU)/0.1 mL saline and in the high-dose-group (n=10), a concentration of 20 MU/0.1 mL saline were injected subcutaneously. Pain and quality of life were assessed at day 0 and day 28, respectively, by visual analog scales (VAS) and European Organization for Research and Treatment of Cancer (EORTC) quality-of-life core and EORTC quality-of-life head and neck module questionnaires. RESULTS: Patients in the low-dose group showed a significant pain reduction (VAS) from 4.3 at day 0 to 3.0 at day 28 (P<.05). The mean pain VAS values in the high-dose group did not improve significantly. No serious adverse events were observed. There were trends toward improvement in quality of life in the low-dose group. CONCLUSIONS: BtxA in a low concentration seems to be a useful therapeutic option in chronic neuropathic pain of the neck and shoulder after neck dissection.

Botulinum Toxins, Type A↗
PubMed2006

Level IIb lymph node metastasis in elective neck dissection of oropharyngeal squamous cell carcinoma.

This study investigated the oncologic safety of preserving level IIb lymph nodes in ipsilateral and/or contralateral elective neck dissection (END) in patients with oropharyngeal squamous cell carcinoma (SCC). Fifty-one oropharyngeal SCC patients who underwent surgery as an initial treatment were reviewed. Twenty-one patients had clinically node negative necks (cN0) while 30 patients had ipsilateral clinically node positive necks (cN+). Of the cN0 patients, bilateral or ipsilateral END was performed in 15 and six patients, respectively. For the cN+ cases, ipsilateral therapeutic neck dissection with contralateral END was performed in 24 of 30 patients. In the cN0 patients, nodal metastasis to level IIb lymph nodes was not observed in any ipsilateral (21) or contralateral necks (15). Of the 24 cN+ patients who underwent contralateral END, two cases (8.3%) showed contralateral occult level IIb lymph node metastasis. Our data suggest that in cN0 oropharyngeal cancer patients, level IIb lymph nodes may be preserved in ipsilateral and contralateral neck dissection. However, caution is advised when preserving contralateral level IIb nodes in ipsilateral cN+ cases.

Adult↗
PubMedDate not supplied

Spinal accessory nerve function following neck dissection.

Spinal accessory nerve (SAN) function was evaluated by electromyography (EMG) and muscle testing in 36 patients who underwent neck dissection with SAN preservation. The results emphasized that SAN function was relatively good after conservative neck surgery. Muscle testing findings showed better function than did EMG findings. After surgery the trapezius muscle functioned more efficiently than the sternocleidomastoid (SCM) muscle probably because of the more traumatic surgical handling of both the SCM muscle and its SAN branch. In order to obtain the functional advantages of SAN preservation, the authors suggest that the conservative procedure in radical neck dissection be used whenever warranted by oncologic diagnosis.

Accessory Nerve↗
PubMed1998

MR of denervated tongue: temporal changes after radical neck dissection.

PURPOSE: The purpose of this study was to evaluate the temporal changes of MR imaging in the denervated tongue after a radical neck dissection. METHODS: One hundred seventy-four consecutive MR studies in 116 patients with radical neck dissections for malignant tumors of the head and neck were evaluated retrospectively. Patients with tumors involving the tongue or hypoglossal nerve were not included in this study. RESULTS: Abnormal signal intensity and/or hemiatrophy on the side of the tongue operated on was seen in 22 patients who had hypoglossal paralysis after radical neck dissection. The denervated side of the tongue appeared hypointense to hyperintense relative to the normal side on T1-weighted images and hyperintense on T2-weighted images. Signal intensity ratios of the abnormal to normal muscles were 0.9-1.6 on T1-weighted images and 1.3-2.8 on T2-weighted images. High signal intensity on T1-weighted images appeared 5 months or more after the dissection, whereas on T2-weighted images, the most prominent increases in signal intensity appeared in the first several months after denervation. Hemiatrophy of the tongue was observed on MR images obtained more than 6 months after surgery. CONCLUSION: MR findings in the denervated tongue are compatible with histologic changes and are characterized by an enlarged extracellular fluid space or fatty infiltration. The pattern of signal intensity and the degree of hemiatrophy suggest the duration of denervation.

Adult↗
PubMed1986

Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection.

Disfiguring facial edema and elevated intracranial pressure often accompany ligation and excision of the internal jugular veins (IJV) during simultaneous or staged bilateral radical neck dissection. To minimize this morbidity, unilateral reconstruction of the IJV was undertaken at the time of second-side neck dissection in 11 patients. Five patients underwent reconstruction with the spiraled saphenous vein (SVG) and in six patients 10 mm externally supported polytetrafluoroethylene (e-PTFE) was used. Prebypass jugular venous stump pressures (JVPs) were measured and ranged from 28/17 to 75/54 mm Hg with mean pressures of 17 to 62 mm Hg. Two patients had simultaneous neck dissections and nine had staged dissections. The staged interval ranged from 0.3 to 33 months. Six of nine staged reconstructions were right-sided and three of nine were left-sided. Low molecular weight dextran was started intraoperatively, regional heparinization was used in all but two cases, and platelet inhibitors were continued postoperatively in all patients. Additional time in the operating room was 45 minutes (mean). All patients have been followed up 2 to 18 months postoperatively. B-mode ultrasonography, Doppler spectrum analysis, CT scan with contrast, and magnetic resonance imaging were used to assess patency. Four of five SVGs and three of six e-PTFE grafts have remained functional, which resulted in an overall patency rate of 64%. Four grafts (one SVG, three e-PTFE) failed in the immediate postoperative period. All grafts in patients who had a mean JVP greater than 30 mm Hg remained patent, whereas those in patients with lower stump pressures thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗
PubMed2001

Node counts in neck dissection: are they useful in outcomes research?

OBJECTIVES: We studied the unilateral nodal yields for procedures reported as standard or modified radical neck dissection (RND) to determine their applicability in outcomes research. METHODS: We analyzed the unilateral nodal yields for all procedures reported as RND for carcinoma of the oral cavity, pharynx, and larynx at our institution from 1985 to 1997 (n = 64, no prior treatment). These included both standard and modified techniques, encompassing levels I through V of the neck. Each side of a bilateral RND was treated as a separate case. This sample was compared with a similar population from the National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) registry. Nodal yield was obtained for RND alone and for unspecified neck dissection with primary excision for the same diseases and time period (n = 1499). RESULTS: The mean nodal yield from 64 RND was 30 vs 27 in the SEER data. The standard deviation was 14.7 compared with 17.2 in the SEER data. Values ranged from 7 to 66 nodes whereas the SEER range was from 1 to 97 nodes. Although the SEER data contain nodal yields from regional or selective neck dissection, we corroborate our findings of large variance in nodal yield from our RND sample. CONCLUSIONS: Large variance in nodal yields from RND may have undefined effects on quality of life, cure rate, and survival. Until correlation of nodal yields with outcomes is examined, we cannot know how to relate RND to outcomes.

Carcinoma, Squamous Cell↗
PubMed1980

Posterolateral neck dissection.

The charts of 17 patients who received postauricular, suboccipital, and posterior triangle neck dissection for primary malignant melanoma or squamous cell carcinoma of the posterior half of the scalp (behind the coronal plane of the tragus) or nape of the neck were reviewed. The regional procedure was applied bilaterally in five of these patients in whom the primary lesion was on or close to the midline. The low recurrence rate in the neck, in the absence of moderate or severe funtional and cosmetic sequelae, makes this regional neck dissection a sound procedure for selected patients.

Adult↗