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PubMed1998

Long term results of primary radiotherapy with/without neck dissection for squamous cell cancer of the base of tongue.

BACKGROUND: There are several management options for patients with squamous cell cancer of the base of tongue. We have had an interest in using primary radiotherapy with or without neck dissection, in an effort to provide optimal oncologic as well as functional outcomes. METHODS: From 1981 to 1995, 68 patients with primary squamous cell cancer of the base of tongue were managed with primary radiotherapy, with neck dissection added for those who were initially seen with palpable lymph node metastases. Ages ranged from 35 to 77 years (median age, 55 years). There were 59 men and 9 women. T Stage distribution was: T1, 17; T2, 32; T3, 17; T4, 2. Fifty-eight patients (85%) were initially seen with nodal metastases. Initial treatment generally involved external-beam radiotherapy (EBRT) to the primary site and upper neck (54 Gy) and to the low neck (50 Gy). A 192-Ir brachytherapy boost (20-30 Gy) to the base of tongue was done about 3 weeks later, at the same anesthesia used for the neck dissection. All patients had temporary tracheostomy. Follow-up ranged from 1 month to 151 months (median, 36 months). Nine patients received neoadjuvant chemotherapy as part of a larynx-preservation protocol. RESULTS: Actuarial 5- and 10-year local control is 89% and 89%, distant metastasis free survival is 91% and 76%, disease-free survival is 80% and 67%, and overall survival is 86% and 52%, respectively. Complications occurred in 16%. CONCLUSIONS: Our long term data clearly demonstrate that primary radiotherapy produces excellent oncologic outcomes.

Adult↗
PubMed1987

An improved technique of radical neck dissection with an analysis of long-term results of 1,000 operated cases of head and neck cancer.

An improved technique of radical neck dissection is presented with a report of all 1,000 operated cases of the head and neck region from 1964 to 1980 at the Affiliated Tumor Hospital of Zhongshan Medical College, in Guangzhou, China. The practice has proved that our operative procedures are time-saving, with less blood loss during operation, fewer operative mortalities, fewer complications, better end results, better cosmetic effects, and that the techniques are easier to master.

Adolescent↗
PubMed2001

Surgical landmarks of the spinal accessory nerve in modified radical neck dissection.

We designed a study to identify useful landmarks for the preservation of the spinal accessory nerve during modified radical neck dissection (MRND). Eighteen consecutive patients undergoing 23 MRNDs were enrolled in the study. The distance of the accessory nerve from the greater auricular nerve, where it crosses the posterior edge of the sternocleidomastoid muscle (greater auricular point), was noted. The vertical distance between the point of entrance of the accessory nerve into the trapezius muscle and the clavicle was also measured. The mean distance between the greater auricular point and the accessory nerve was 10.7 mm, SD +/- 6.3. In all cases the accessory nerve was above the greater auricular point. The mean distance between the point of entrance of the nerve into the trapezius and the clavicle was 51.3 mm, SD +/- 17. The greater auricular point is a reliable landmark for the identification of the accessory nerve during modified radical neck dissection. Distance above the clavicle was less helpful.

Accessory Nerve↗
PubMed2006

Severe postextubation laryngeal obstruction: the role of prior neck dissection and radiation.

Aggressive treatment of advanced head and neck cancer may result in more patients undergoing surgery for unrelated illnesses. We present a case of a patient requiring emergency tracheostomy placement after a routine liver segment resection 10 yr after undergoing a bilateral modified radical neck dissection and radiation therapy. This type of patient may be at increased risk for both postoperative laryngeal edema and neuronal imbalance secondary to their preoperative condition.

Aged↗
PubMed1991

Stage I-II squamous cell carcinoma of the oral cavity treated by iridium-192: is elective neck dissection indicated?

This is a retrospective analysis of 233 evaluable patients with stage I-II squamous cell carcinoma of the oral cavity treated by definitive branchytherapy. Minimum follow-up is 3 years. Treatment of neck was chosen by a multidisciplinary team, according to age, medical status and availability for regular follow-up. One hundred and ten patients (47%) underwent elective neck dissection (END); 28 (25%) had positive nodes and received neck irradiation post-operatively. One hundred and twenty three patients (53%) were regularly followed up only, with therapeutic neck dissection (TND) reserved for cases of node relapses. In the END group, there were 19 neck relapses (17%): 12/60 (20%) in patients with mobile tongue carcinoma and 7/50 (14%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 9/19 (47%) cases. In the TND group, there were 21 neck relapses (17%): 16/82 (20%) in patients with mobile tongue carcinoma and 5/41 (10%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 13/21 (62%) cases. Ten-year survival is 37% for the END group and 31% for the TND group. Tumour stage and infiltration into underlying tissues increased the probability of neck relapse and death. Furthermore, a multivariate analysis showed that patients treated in the TND group had a higher probability of death than patients treated in the END group (p less than 0.04).

Adult↗
PubMed1990

Efficacy of radical neck dissection for the control of cervical metastasis after radiotherapy for nasopharyngeal carcinoma.

Fifty-one patients who had persistent or recurrent neck disease from nasopharyngeal carcinoma after radiotherapy underwent radical neck dissection. The follow-up period ranged from 0.5 to 9 years (median: 2 years). Multiple cervical lymph node involvement was present in 51% of the patients (26 of 51). Malignant cells were detected in 88% of the resected specimens (45 of 51). The clinical sign of fixation of lymph node is the only factor that affects the successful control of neck disease (p = 0.04). Extracapsular extension of the nodal disease was present, and 35% of the lymph nodes were adherent to surrounding structures at operation (18 of 51). There was one hospital mortality and the overall morbidity was minimal. The actuarial survival at 5 years was 38%, and the probability of control of neck disease was 66%. Radical neck dissection is effective in controlling post-irradiation cervical metastasis from nasopharyngeal carcinoma.

Adult↗
PubMed2005

Central neck dissection in the management of sporadic medullary thyroid microcarcinoma.

AIM: Treatment of medullary thyroid carcinoma (MTC) includes total thyroidectomy with at least bilateral central neck dissection. Systematic measurement of thyrocalcitonin (CT) levels in thyroid nodules allows for early diagnosis of MTC. As central neck dissection (CND) is associated with high morbidity, the aim of this study was to investigate the necessity of this procedure in the treatment of sporadic medullary thyroid microcarcinoma (S-mMTC). METHODS: Prospective multicentric study including 43 patients with sporadic micro-MTC who underwent CND between January 1991 and August 2001. RESULTS: 26 women and 17 men with sporadic micro-MTC, aged 28-87 (mean age was 58 years), without family history of multiple endocrine neoplasia, underwent surgery. Total thyroidectomy was performed in all patients and combined with 'picking' (n=7) or CND (n=36). Size of tumours ranged from 0.2 to 9mm (mean size was 4.1mm). Solitary (32/43 patients) and multiple S-mMTC lesions (11/43 patients) were seen. 601 lymph nodes from the 41 subclinical patients were analysed. Mean follow-up period for these patients was 32 months. No mutations in the RET oncogene were seen. CONCLUSION: As lymph node involvement is uncommon in S-mMTC, systematic CND is of questionable value.

Adult↗
PubMed1991

Nutritional support in patients with low volume chylous fistula following radical neck dissection.

One of the well known complications of radical neck dissection is a chylous fistula, which results from injury to the thoracic duct as it enters the left subclavian vein. Such fistulae may cause considerable increased morbidity to a patient who is already debilitated by malignancy and by the increased catabolic response to surgery. Further surgery may be appropriate for those with a high fistula output but conservative therapy is normally advocated for the remainder. Nutritional and electrolyte support for these patients is essential and poses potential problems in management. We present three such patients. One was fed parenterally and two enterally and in all cases the fistulae closed spontaneously. We examine the known physiological stimuli to chyle production and conclude that the enteral feedings of these patients with fat or an isomolar enteral feed does not, contrary to current belief, increase chyle flow or delay the healing of these fistulae.

Chyle↗
PubMedDate not supplied

Increased intracranial pressure as a complication of unilateral radical neck dissection in a patient with congenital absence of the transverse sinus.

We report a patient with increased intracranial pressure occurring after unilateral neck dissection. Subsequent vascular studies reveal a hypoplastic contralateral transverse sinus drainage and occlusion of the ipsilateral jugular bulb. We review the literature on the etiology of this vascular malformation and conclude that vascular anomalies of the venous drainage of the head be considered whenever postoperative signs of increased intracranial pressure occur after unilateral radical neck dissection.

Carcinoma, Squamous Cell↗
PubMed1998

[Indications for elective neck dissection in malignant epithelial parotid tumors].

The purpose of the present study was to define the indications and extension for the treatment of lymph nodes in clinically NO patients with primary malignant epithelial parotid tumors. A retrospective analysis was performed on 46 cases with such tumor out of 307 parotid neoplasms (246 benign, 61 malignant) consecutively treated from 1985 to 1994. Lymph node metastases were present only in the histotypes with a high degree of malignancy (overall incidence, 24%). Two patients (5%) showed occult metastases. No correlation was found between the size of the neoplasm and the incidence of lymph node metastases. However, the latter were significantly more common in locally highly aggressive neoplasms (class "a"), 8%; class "b" 43%; P = 0.006). Due to the small number of cases, it was not possible to correlate the incidence of occult metastases with neoplasm size or local extension. As regards topographic distribution of lymph node metastases, level II was always involved, level V was never involved, and level i.v was involved only when metastases were found in the upper levels. Occult metastases were found only at level II. Over a follow-up period of 2 to 10 years, no cases were seen with cervical recurrences. Although drawn from a limited series, the results are similar to the data generally reported in the literature, showing that lymph node metastases are rare in neoplasms with a low grade of malignancy whereas there is a significant increase in the incidence of metastatic lymph nodes and occult metastases when the grade of malignancy is high. In conclusion, in clinically NO patients, a suprahomohyoid neck dissection (levels I-II-III) is indicated only when the neoplasm shows a high grade of malignancy or when it is a class "b" malignancy. In the other cases, neck dissection is determined by the clinical evidence of metastasis and can be extended to the lower levels. Neck dissection can be avoided in NO patients whenever ultrasound and fine needle biopsy are both routinely used in the preoperative evaluation of the cervical lymph nodes.

Epithelial Cells↗
PubMed2000

Combined use of endoscopic CO2 laser excision of a marginal laryngeal tumor, radical neck dissection, and perioperative laterofixation of the opposite vocal cord.

We report the use of endoscopic laser excision of a marginal laryngeal tumor, radical neck dissection, and laterofixation of a paralyzed vocal cord in a 66-year-old man who had an early-stage right supraglottic endolaryngeal tumor and ipsilateral neck metastasis. He had a left vocal cord paralysis after a left pneumonectomy that was performed 5 years previously. The primary laryngeal tumor was excised by endoscopic CO2 laser resection, and a simultaneous radical neck dissection was carried out. Postoperatively, severe inspiratory dyspnea developed because of the surgical intervention on the right side causing moderate laryngeal edema and limited movement of the right vocal cord in addition to the paralyzed left side. An endolaryngeal laterofixation of the paralyzed left vocal cord was performed to provide the patient with an adequate airway instead of tracheostomy. This patient had a 2 years' follow-up without recurrence of tumor. In the meantime movement of the right vocal cord has returned, so that the patient's voice was socially acceptable and he has a functioning larynx.

Aged↗
PubMed2004

Safety of modified radical neck dissection for differentiated thyroid carcinoma.

OBJECTIVES/HYPOTHESIS: The management of cervical metastases from differentiated thyroid carcinoma (DTC) remains controversial. Most surgeons perform a neck dissection (ND) for clinically apparent disease. The extent of nodal dissection varies from regional to comprehensive. Morbidity from ND in the setting of DTC remains high, particularly when performed in the setting of a thyroidectomy (TT). To determine complications from ND for DTC, we retrospectively reviewed our surgical experience of modified radical neck dissection for nodal metastases. STUDY DESIGN: Retrospective chart review. METHODS: Between 1997 and 2002, 39 consecutive patients (31 females and 8 males) underwent 44 comprehensive NDs of levels II-V for DTC. Central compartment dissection (CCD) (levels VI and VII) was also performed during 23 of these procedures. Twenty (45.5%) patients had prior treatment elsewhere. Preoperative pathology revealed papillary carcinoma in 22 patients (56.4%), tall cell variant in 11 (28.2%), and follicular variant in 6 (15.4%). RESULTS: Ten patients (20%) underwent ND alone, whereas 6 (14%) underwent simultaneous ND and TT. Fifteen patients underwent simultaneous ND, TT, and CCD (30%). Temporary hypocalcemia occurred after 21% of NDs that were performed in the setting of either TT or CCD or both. There were no cases of permanent hypoparathyroidism. Transient regional lymph node (RLN) paresis occurred in two patients and was associated with a concomitant central compartment nodal dissection; there were no permanent RLN palsies. Transient spinal accessory nerve paresis developed after 27% of NDs performed. Two patients developed chyle leaks. CONCLUSIONS: When ND is necessary for the treatment of thyroid malignancies, the procedure can be performed safely with acceptable morbidity.

Adolescent↗
PubMed1998

A study of sternocleidomastoid muscular atrophy after modified neck dissection.

To elucidate the conditions of atrophy in the sternocleidomastoid muscle (SCM) after modified neck dissection (MND), we tried to scrutinize the atrophic regions in the SCM and determine the cause of atrophy, by electromyography in 40 patients with SCM atrophy following MND. We also examined the detailed anatomy of the SCM in 40 cadavers. Atrophy was observed in the caudal portion in the SCM in 90% of the patients. Electromyographic examination revealed neurogenic atrophy in 24 patients, ischemic atrophy in 11, and a mixing of both types in 5. The SCM was found to be innervated by the spinal accessory nerve (SAN) and the SCM branch of the cervical nerve. The main artery feeding the cranial half of the SCM was a branch of the occipital artery (Oc) or the external carotid artery (Ex), and the auxiliary artery was a branch of the posterior auricular artery (Ap). The main artery feeding the caudal half of the SCM was a branch of the superior thyroidal artery (St), and the auxiliary artery was a branch of the subclavian artery (Sc). Postoperative SCM atrophy is attributed to damage of the feeding artery in the SCM caudal portion and local damage in the nerve fibers running through the SCM. To prevent this type of atrophy, it is important to carefully handle this muscle itself and protect the nerve fibers running through it, as well as to conserve the SCM branches of the St and Sc.

Aged↗
PubMed1991

Discontinuous vs in-continuity neck dissection in carcinoma of the oral cavity.

We compared the results of transoral excision of the primary tumor with discontinuous neck dissection with the results of in-continuity dissection of primary tumor and neck nodes in anteriorly localized squamous cell carcinoma of the oral cavity. We analyzed 27 patients who underwent 28 discontinuous dissections and 34 patients who underwent 40 in-continuity dissections for T2 anterior tongue or floor-of-mouth carcinoma. The overall ipsilateral neck recurrence rate was 11%. The discontinuous dissection group did significantly worse than the in-continuity dissection group, with a neck recurrence rate of 19%. Consequently, the actuarial 5-year survival of patients who underwent a discontinuous dissection was substantially decreased (63%) compared with patients who were treated by an in-continuity dissection (80%). Discontinuous neck dissection, thus, is not to be recommended in oral cancer.

Adult↗
PubMed1994

Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity.

BACKGROUND: Recent studies in patients with previously untreated T1 and T2 squamous cell carcinoma (SCC) of the tongue and floor of the mouth have shown a relationship between tumor thickness, neck metastasis, and survival. Our study was conducted to determine the indication of elective neck dissection in patients with early oral cavity SCC. PATIENTS AND METHODS: Sixty-seven patients were stratified by stage (T1 and T2 NO), and those in each stage were randomized to receive one of two types of treatment; resection alone (RA) or resection plus elective supraomohyoid neck dissection (RSOND). Fifty-two patients (78%) were men and 15 (22%) were women. The median age was 57 years old (range 34 to 95). RESULTS: Twenty-six (39%) patients had tumor in the floor of the mouth and 41 (61%), in the tongue. Using the criteria of the Union Internationale Contre le Cancer (UICC), 1987, we classified 31 tumors (46%) as T1 lesions and 36 (54%) as T2 lesions. Thirty patients had a tumor thickness < or = 4 mm and 37 had a tumor thickness > 4 mm. Thirty-three (49%) patients were treated with RA, and 34 patients (51%) were treated with RSOND. Seven (21%) patients of the RSOND group had occult cervical metastasis. There were recurrences in 14 (42%) patients of the RA group and 8 (24%) patients of the RSOND group. The disease-free survival rates at 3.5 years for RA and RSOND patients were 49%, and 72%, respectively. The impact of sex, age, site, cancer stage, and tumor thickness was assessed by the Mantel-Haenszel chi-square procedure. Later stage (P = 0.05) and increased tumor thickness (P = 0.005) were significantly associated with treatment failures. CONCLUSION: Neck dissection remains mandatory in the early stage of oral SCC, because of better survival rates compared to RA and the poor salvage rate. In particular, patients with tumor thickness > 4 mm treated with RSOND had significant benefit on disease-free survival.

Adult↗
PubMed2006

Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings.

Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.

Aged↗
PubMedDate not supplied

Functional neck dissection. Anatomical grounds, surgical technique, clinical observations.

The anatomical grounds of and surgical technique for functional neck dissection are described in detail in order to demonstrate that the radicalism of this procedure, from the viewpoint of surgical anatomy, is by no means less than that of the classical (so-called radical) neck dissection. From 1972 to 1978, 476 operations were performed (211 patients treated bilaterally and 54 unilaterally). The percentage of false negatives (ie, histologically proven metastases in clinically unsuspected nodes) was 14%, while the percentage of false positives (histological negativity in clinically suspected nodes) reached 53%. The total number of local recurrences in a three-year follow-up was nine (3.5%).

Fascia↗
PubMed1980

The incidence of vasovagal reflex activity during radical neck dissection.

Pressure receptors exist within the walls of the carotid bulb which are responsible for maintaining the balance between blood volume, vascular tone, and cardiac output. When these receptors are manipulated during neck surgery the result may be bradycardia, hypotension or cardiac arrythmia. Such events occur sporatically during head and neck surgery and occasionally may prove fatal. While many surgeons advocate anesthetizing the carotid bulb prophylactically, this practice is not universally accepted. A retrospective appraisal of 76 radical neck dissections demonstrated an incidence of clear cut vasovagal reflex activity of 10%. Thirty-one radical neck procedures were then randomized into treatment and control groups in a prospective fashion. The treatment group (12 patients) had 5 cc. of 2% lidocaine applied topically to the carotid bifurcation. Nineteen controls had normal saline applied to the same site. The incidence of vasovagal reflexes in the control group was 10% and 16% in the treatment group. The similarity of these treatment groups is highly significant. It is concluded that topical 2% lidocaine is not an adequate prophylaxis for vasovagal reflexes during radical neck dissection.

Anesthesia, Local↗