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At least 433 records · Page 24Linked to original sources
PubMed2005

High division of the accessory nerve: a rare anatomical variation as a possible pitfall during neck dissection surgery.

A rare clinical variant found during neck dissection surgery is reported in which the spinal accessory nerve divided at a high level in the neck, before entering the sternocleidomastoid muscle. This case documents the need for meticulous technique in identification and dissection of the spinal accessory nerve in order to reduce the risk of postoperative morbidity.

Accessory Nerve↗
PubMed2003

Regional tumor recurrence after supraomohyoid neck dissection.

OBJECTIVE: To evaluate the recurrence of lymphatic metastases in patients with squamous cell carcinoma of the oral cavity treated with supraomohyoid neck dissection with and without postoperative radiotherapy. DESIGN: A nonrandomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, State University of Campinas, São Paulo, Brazil, a tertiary referral center. PATIENTS: Thirty-two patients with squamous cell carcinoma of the oral cavity without previous treatment and a minimum follow-up period of 2 years were studied. There were 36 supraomohyoid neck dissections, of which 31 were elective (clinically negative nodes) and 5 therapeutic (clinically positive nodes). INTERVENTION: Resection of the primary tumor and supraomohyoid neck dissection, with or without postoperative radiotherapy. MAIN OUTCOME MEASURES: Evaluation of neck tumor recurrence according to clinical and histopathological findings in the neck and use of postoperative radiotherapy. RESULTS: The overall recurrence rate was 6% (2 patients). Recurrences were seen in 1 clinically negative neck (3%) and 1 clinically positive neck (20%). The presence of clinically or histopathologically positive nodes, number of positive nodes, and use of adjuvant radiotherapy did not influence the rate of neck tumor recurrence with a statistically significant difference. CONCLUSIONS: Neck tumor recurrence in procedures with clinically positive nodes was 6.3 times greater than in those with clinically negative nodes. There was no difference in regional recurrence of histopathologically positive node necks with or without the addition of postoperative radiotherapy. Neck tumor recurrence was not statistically influenced by clinically and histopathologically positive nodes, multiple positive nodes, and use of postoperative radiotherapy.

Carcinoma, Squamous Cell↗
PubMed2001

Value of neck dissection in patients with squamous cell carcinoma of unknown primary.

Lymph node metastases of cancer of an unknown primary (CUP syndrome) are responsible for 3-5% of the malignant diseases in the head and neck area. More than 70% of these patients show lymph node metastases of an unknown squamous cell carcinoma. The survival depends immediately on number and location of lymph node metastases. For a curative approach modified radical neck dissection combined with postoperative radiation therapy with or without chemotherapy should be considered in N1-N3 lymph node status. A radical neck dissection with postoperative radiation therapy should only be approved in cases of infiltration of the internal jugular vein, the accessory nerve and/or the sternocleidomastoid muscle. The different prognosis of patients with upper cervical and lower cervical lymph nodes should influence the indication and the extent of a neck dissection in the contralateral N0 neck.

Carcinoma, Squamous Cell↗
PubMed1985

Bony mass associated with hypertrophy of the sternohyoid muscle after radical neck dissection.

As a late complication after radical neck dissection, this paper reports a bony mass at the sternal end of the clavicle associated with hypertrophy of the sternohyoid muscle. The bony mass and hypertrophy of the muscle were considered due to continuous mechanical strain by the drooping of the shoulder caused by injury of the accessory and cervical nerves, left-handed physical labour, and the lack of the sternocleidomastoid muscle in rotating the head.

Adult↗
PubMed2000

Delayed anterior ischemic optic neuropathy after neck dissection.

There are only 2 published cases of anterior ischemic optic neuropathy (AION) occurring after neck dissection, to our knowledge. We report a case of bilateral AION following neck dissection, discuss the differential diagnoses, and compare the features of this case with those of previously described cases. There were none of the previously described risk factors for the development of AION after head and neck surgery (eg, hypotension, facial edema, or sudden massive hemorrhage) in this case, but there was prolonged diffuse postoperative bleeding. Also, the symptoms did not arise before the fifth postoperative day as they did in the other cases. Prolonged, mild postoperative bleeding is a risk factor for AION. Visual loss during the entire first postoperative week has to be regarded as a complication of surgery, requires the exclusion of several differential diagnoses, and must not be confounded with the patient's confusion or symptoms of withdrawal.

Adult↗
PubMed1991

[Clavicular fractures after radical neck dissection].

Fracture of the medial end of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4%-0.5%. Radical neck dissection alters the mechanics of the shoulder girdle, and distorts normal muscle forces acting on the clavicle. We present two patients to illustrate the problems of differential diagnosis and mechanism of fracture. Once the diagnosis has been made the fracture should be managed conservatively, although clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult. Biopsy is essential in doubtful cases.

Adult↗
PubMedDate not supplied

Rationale for elective modified neck dissection.

A retrospective study was conducted to give surgeons direction in deciding which type of modified neck dissection is proper elective treatment for the patient with a clinically negative neck. The medical records of 428 previously untreated patients (seen between January 1, 1970, and December 31, 1979) whose necks (i.e., NO) were electively dissected and who had had a primary squamous carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were included. The three major types of modified neck dissections studied were the supraomohyoid, the anterior, and the functional. Sixteen percent (70 of 428) of the patients had multiple positive nodes and 6% (28 of 428) had evidence of extracapsular invasion. A unilateral supraomohyoid dissection was most often used for primaries of the oral cavity. Bilateral anterior dissection was common for cancers of the larynx and hypopharynx, and functional neck dissection was equally distributed among the primary sites. None of the patients with primaries of the larynx or hypopharynx had pathologically positive nodes in the submental or submaxillary triangles. Advanced T-stage was generally associated with a greater incidence of subclinically positive nodes. Thirty percent of the patients received postoperative radiotherapy. The total number of nodes removed, the number of positive nodes with or without extracapsular invasion, and the anatomic location of the positive nodes were correlated with the type of dissection, the stage and site of the primary cancer, the use of postoperative radiotherapy, the regional (neck) failure, and survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed2000

[The influence of neck-dissection operations on cervical and cerebral blood circulation].

The authors conducted examination of blood flow velocity in medial cerebral artery using Trans Cranial Doppler method and calculated pulsatility index (PI) in 35 patients after neck dissection operation. Similarly 35 patients after neck dissection had duplex Doppler examination of common and internal carotid arteries performed. Pulsatility and resistance indexes and blood flow capacity were estimated. We compared the results with the control group consisted of 15 patients operated on because of chronic otitis. We confirmed a neck dissection operation influence into cranial and cervical blood flow disturbances as well as relationship between postoperative soft tissue oedema and hemodynamical changes. We didn't found connections between cervical and cerebral blood flow and postoperative complications.

Adolescent↗
PubMed1999

Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood.

OBJECTIVE: The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens. METHODS: We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure. RESULTS: We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results. CONCLUSION: An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.

Adolescent↗
PubMed1979

Incidence of lymph node metastasis in elective (prophylactic) neck dissection for oral carcinoma.

For cancers of the tongue, floor of mouth, mandibular gingiva and buccal mucosa, in which the widest diameter is greater than 2 cm, we perform neck dissection in continuity with resection of the primary growth as a part of the planned therapy,regardles of the clinical state of the cervical lymph nodes. Whenever the lesion is so situated that an in-continuity neck dissection cannot be performed (cancer of the palate) it may be wise to delay neck dissection until the lymph nodes become clinically apparent.

Adult↗
PubMed2002

[Level choice of the neck dissection in clinical N0 patients with supraglottic cancer].

OBJECTIVE: To study the characteristics of the cervical lymph node metastasis in negative node with clinically supraglottic cancer patients and decide which level should be dissected reasonably. METHODS: 57 modified neck dissection (MND) cases in the cN0 with supraglottic cancer were performed. Each lymph node in the 57 (63 sides) MND samples was studied pathologically in order to define the level of the lymph node metastasis. RESULTS: 1,877 lymph nodes were obtained in these MND samples; an average of 29.8 lymph nodes was obtained in one side. Among them 43 lymph nodes were metastasis nodes and 41 lymph nodes were located in the II, III level, 95.4% of metastasis cases. 15 cases (17 sides) in the 57 patients were metastasis (26.3%) and 14 cases of them were in the level of II and III (93.3%). Ipsilateral cervical recurrence occurred in the 3 of 57 cases in the II, III and IV level respectively. The recurrent rate was 5.3%, and 5-year survival rate was 80.7%. CONCLUSION: II and III levels should be dissected in the supraglottic cancer with cN0 and IV level should be included when III level was involved. I and V levels should not be included when the evidence of metastasis is not enough.

Adult↗
PubMed2006

Bilateral chylothorax following left-sided radical neck dissection.

Chylothorax is an extremely rare but potentially life-threatening complication of radical neck dissection. Its rarity makes surgeons unfamiliar with its management. We report the case of a bilateral chylothorax occurring after a left radical neck dissection and discuss its management. A multi-disciplinary approach is advocated, involving surgical, respiratory and dietetic input, and this led to a favourable outcome for our patient.

Adult↗
PubMed1989

GIA stapler in radical neck dissection.

I have used this procedure for over 7 years on approximately 150 radical neck dissections and have experienced no complications related to the use of this stapler, and operative time has been reduced. Approximately one third of these neck dissections have been done on patients who later received radiation therapy. In addition, approximately one third received preoperative radiation therapy. No problems with increased complications or recurrences in the area where the staples remain have been noted. This procedure has been discussed with radiation therapists at the University of Florida, where most of the patients received radiation therapy, and no increase in the complication rate or recurrence rate in this area of the neck was noted.

Humans↗
PubMed2000

Early fracture of clavicle following neck dissection.

Fracture of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4-0.5 per cent. We report a case where fracture occurred early following a selective neck dissection.

Aged↗
PubMed1999

[Lymphorrhea after neck dissection].

In this publication lymphorrhea was described as one of possible complications after the neck dissection surgery of Crile-Jawdyński procedurae. The matter of this complication is rise of pressure in lymph system. 4 women with this complication after neck dissection, the best treatment is drainage of the operated area. In one patient, because of the failure of conservative treatment, another surgical intervention was preformed. The full treatment of lymphorrhea was after 4-6 weeks.

Aged↗
PubMed1998

Selective lateral neck dissection for laryngeal cancer with limited metastatic disease: is it indicated?

The most important prognostic factor in cancer of the larynx is the presence of cervical metastatic disease, which is the most common type of recurrence in such patients. Because micrometastases cannot be detected pre-operatively at present, selective lateral neck dissection is increasingly recommended as the standard treatment for patients with a clinically negative neck in order to reduce the recurrence rate. In cases of N+ disease, selective lateral neck dissection can be as valid as modified radical neck dissection, providing patients have only limited, occult metastatic disease.

Humans↗
PubMed1994

Primary head and neck cancer. Histopathologic predictors of recurrence after neck dissection in patients with lymph node involvement.

OBJECTIVE: Retrospectively analyze several histopathologic variables that may predict neck recurrence after neck dissection. DESIGN: From 1970 through 1980, 284 patients with pathologically confirmed metastatic squamous cell carcinoma underwent neck dissection and received no adjuvant therapy. Kaplan-Meier evaluation estimated a 74% 2-year neck recurrence-free rate. After adjusting for the standard covariates of age, gender, neck stage, and tumor grade, we also controlled for the time-dependent covariates of primary recurrence, occurrence in the side of the neck not operated on, or development of new head and neck primary disease. SETTING: A large referral-based practice. RESULTS: The number of lymph nodes involved, invasion of vascular/lymphatic space, invasion of soft tissue, and desmoplastic lymph node pattern adversely affect neck recurrence. A desmoplastic stromal pattern was associated with almost a sevenfold increased risk of neck recurrence. To our knowledge, this finding has not been reported previously. CONCLUSION: Histopathologic evaluation of metastatically involved cervical nodes can identify patients with head and neck cancer who are at high risk for recurrence.

Adult↗
PubMed1986

[How important is preservation of the accessory nerve in neck dissection?].

Preservation of the spinal accessory nerve in radical or modified neck dissection is oncologically accepted in order to avoid the sequelae of the so called "shoulder syndrome". In 23 patients, on whom 29 neck dissections had been performed, the functional results were evaluated on an average 2.6 years postoperatively. 19 patients were radiated post surgery. Clinical and electromyographic examination revealed paresis of 62% of the preserved accessory nerves. Nevertheless, only 48% of the patients suffered from the shoulder syndrome, the remaining were able to innervate or compensate for the resulting deficit. Postoperative functional exercises are mandatory to prevent the shoulder syndrome and to make the preservation technique a worthwhile concept.

Accessory Nerve↗