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PubMed2002

[Bilateral neck dissection and venous reconstruction with internal saphenous vein in cancer of the larynx].

Radical neck dissection (RND) is a surgical procedure for treating patients with cervical metastatic adenopathies generally dues to head and neck tumours. Since Crile, in 1906, began this technique, because of the important postoperative complications noticed, related to disturbances of the venous return when the dissection was bilateral, was suggested a 15 days-term between the two operations. We have verified that it is much better to reconstruct the blood drainage through a venous graft simultaneously. This is a useful technique already described in the literature. We contribute with one case.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Innervation of the trapezius muscle: a study in patients undergoing neck dissections.

Twenty-four patients with surgical section of the accessory nerve and/or its cervical contribution(s) were examined from 1 to 156 months after surgery, and compared to twenty controls. Thirteen patients had a classical neck dissection; seven had the whole length of the accessory nerve preserved but not the cervical plexus contributions. Four had the upper half of the accessory nerve sectioned, but with preservation of both the lower half and its cervical contributions. Clinical and electrophysiological studies of the three portions of the trapezius suggested the existence of an undescribed motor nerve supply to the trapezius and of a motor input from the cervical plexus contributions via the accessory nerve. The former is also supported by an anatomical study.

Accessory Nerve↗
PubMed1994

Reinnervation of the trapezius muscle after radical neck dissection.

Based on the observation, that the caudal parts of the trapezius muscle after radical neck dissection with complete loss of the spinal accessory nerve, are still innervated to an individually varying degree, and on recent anatomical findings relating to this fact, a method for completely reinnervating the trapezius muscle, despite uncompromising radicality of the dissection, is introduced. This procedure consists of identifying and dislodging a subfascial branch of the deep cervical plexus running to the caudal parts of the trapezius muscle in the lateral cervical triangle and anastomosing it to the distal stump of the accessory nerve, using microsurgical techniques, thereby connecting it to the whole innervation system of the muscle. Clinical and electromyographical examinations showed very good recovery of all three portions of the muscle, 15 months after the procedure, in 46 of 52 patients (85%), although these patients were preselected by temporarily blocking the accessory nerve prior to operation, as possessing very little additional nerve supply.

Accessory Nerve↗
PubMedDate not supplied

Platysma myocutaneous flap including the external jugular vein with special reference to neck dissection.

Although platysma myocutaneous flap (PTMCF) is suitable for a small intraoral defect, combination with neck dissection (ND) decreases the viability. Therefore, a version of PTMCF was devised to increase the viability. This version consists of three points: preservation of the external jugular vein (EJV), preservation of the facial artery after skeletonization from the submandibular gland, and a new incision around the flap. This procedure was applied to 21 patients with intraoral cancer. All 21 patients underwent some kind of ND. The average viable area of transferred skin was 80%. This rate was significantly better than that for 46 previous cases using Farr's modification with ND, in which the facial artery was divided. Viability of the flaps was analyzed by the vessels preserved, especially by EJV. ND is not a contraindication with this version.

Humans↗
PubMed2006

Accessory nerve function in lateral selective neck dissection with undissected level IIb.

BACKGROUND: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. METHODS: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. RESULTS: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. CONCLUSIONS: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.

Accessory Nerve↗
PubMed2004

Minimally invasive parathyroidectomy by unilateral neck dissection--experience in a regional hospital in Hong Kong.

OBJECTIVE: To compare the efficacy and safety of minimally invasive open parathyroidectomy with localised unilateral neck dissection to the conventional method of bilateral neck exploration and parathyroidectomy as a surgical treatment for primary hyperparathyroidism. PATIENTS AND METHODS: Eleven patients diagnosed with primary hyperparathyroidism at Queen Elizabeth Hospital from 1 January 2002 to 31 December 2002 were treated surgically with minimally invasive open parathyroidectomy. Their results were compared to a retrospective series of 15 patients treated by conventional bilateral neck exploration and parathyroidectomy between 1 January 2001 and 31 December 2001. Demographic data; cure, recurrence, and complication rates; operating time; and hospital stay were analysed. RESULTS: The cure rate was 100% in both groups. There was no recurrence in either group. Minor complication rates were 9% and 20% in the minimally invasive open parathyroidectomy and the control groups, respectively. Mean operating time was 63 minutes in the minimally invasive open parathyroidectomy group, and 92 minutes in the control group. The mean postoperative hospital stay for the minimally invasive open parathyroidectomy group was 1.36 days. Three of these procedures were performed as day surgery. The mean hospital stay for the control group was 2.93 days. The operating time and hospital stay were significantly shorter in the minimally invasive open parathyroidectomy group. CONCLUSION: Minimally invasive open parathyroidectomy is a viable alternative treatment method for primary hyperparathyroidism. It has comparable cure and recurrence rates to the conventional approach. It is safe, with a lower complication rate, and has the benefits of being a shorter procedure and allowing a shorter hospital stay. It can be performed as day surgery, further reducing hospital costs.

Adult↗
PubMedDate not supplied

Modified radical neck dissection in cancer of the mouth, pharynx, and larynx.

A retrospective analysis of 390 determinate radical neck dissections (RND) performed for cancers of the mouth, pharynx, and larynx was carried out. There were 75 patients (19%) who had a modified RND. These were separately analyzed and the outcome was compared to those who had a standard total RND. Our goal was to assess the effectiveness of modified RND in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified RND group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified RND for N0 and N1 cases, but increased significantly (as compared to the group of patients with standard RND) in the N2 and N3 cases (52% vs. 33%). Treatment of neck recurrences following modified RND was primarily by surgery, with a 48% 3-year disease-free survival. Overall survival was the same for modified RND (68%) and for standard total RND (63%). This was true for all N stages individually. The morbidity of standard total RND is discussed and the goals of modified RND are analyzed. Definitions and a standardized nomenclature for the various types of modified RND are suggested for uniformity of reporting.

Carcinoma, Squamous Cell↗
PubMed1977

A physiologic approach to the problems of simutaneous bilateral neck dissection.

A number of physiologic derangements have been observed resulting from the management of head and neck cancer with resection and simultaneous bilateral neck dissection. A protocol evolved to minimize morbidity from these complications was used on seventeen patients. Eleven are alive and free of disease and there was no mortality.

Animals↗
PubMed2004

Shoulder function after accessory nerve-sparing neck dissections.

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

Accessory Nerve↗
PubMed1995

Amputation neuroma following radical neck dissection--report of 3 cases.

Amputation neuroma occurred in three cases among 111 cases of oral cancer patients after radical neck dissection. All of three cases appeared as a small nodule at superior neck around the carotid artery with accompanying tenderness. The lesions were located in continuity with the proximal end of nerve at excision. Although the incidence of amputation neuroma is low, critical examination is required to distinguish this from recurrent tumor after cancer surgery.

Adult↗
PubMed2004

Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer.

PURPOSE: To assess the impact of a diagnostic ladder including [(18)F]fluorodeoxyglucose positron emission tomography (PET) and lymphoscintigraphy guided sentinel node biopsy (LS/SNB) on neck treatment in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). PATIENTS AND METHODS: Prospectively, 62 patients with resectable T1-3 OOSCC underwent computed tomography (CT) and PET. Patients without neck uptake in PET were defined as cN0 and were accrued for LS/SNB. Results were correlated with histopathology. The traditional guidelines according to CT findings were compared to the actual regimen and the outcome. RESULTS: Sensitivity, specificity, validity, and positive and negative predictive value of PET versus CT were 72% v 89%, 82% v 77%, 79% v 80.5%, 62% v 61.5%, and 88% v 94.5% (not significant). Thirty-eight PET negative patients underwent LS/SNB. Sentinel lymph nodes were found in all 38 patients. Five patients had positive nodes (PET false-negatives) and underwent neck dissection (ND). Fifty-one neck sides in 36 patients who were CT-negative would have been treated with selective ND according to the guidelines, and at least 45 neck sides would have had to undergo extensive ND because of positive CT findings (96 of 124 neck sides). In contrast, PET in combination with LS/SNB spared 59 neck sides, and 41 of 124 neck sides actually underwent ND as a result of PET staging, LS/SNB, and intraoperative decision. After a median follow-up of 35 months, two patients (both cN+ve and pN+ve) suffered from neck relapses. CONCLUSION: Diagnostics using PET in combination with LS/SNB considerably reduced the number of extensive ND in OOSCC as compared to CT without locoregional hazard.

Adult↗
PubMed1979

[Indication and treatment results in elective neck dissection (author's transl)].

Only in about 17 per cent of 129 patients was elective radical neck dissection (RND) carried out in a seven-year-period from 1970 to 1976. In spite of clinical negative lymphatic-nodes-palpation-findings there were 10 observations of histological sured metastases from 22 patients. There occurred especially often tonsil-lateral larynx-entry-and tongue carcinoma of tumour stage T3 as primary localisation. Because of the high seize-rates in the resection-preparations we recommend inclusion of operation in so-called tumour findings more than before in treatment plan.

Carcinoma, Squamous Cell↗
PubMed2005

[Validity of high negative pressure drainage for chylous fistula after neck dissection: a report of eight cases].

BACKGROUND & OBJECTIVE: Chylous fistula, a severe complication after operation on neck, has close correlation with definite anatomical position and variation. Its treatment remains controversial. This study was to evaluate the validity of high negative pressure drainage for chylous fistula after neck dissection. METHODS: A treatment of high negative pressure (-30 to -50 kPa) drainage, fasting, and reasonable venous nutrition was applied to 8 patients with postoperative chylous fistula. RESULTS: Of the 8 patients, 7 recovered smoothly without severe complication, and pectoralis major muscle flap was adopted to cure the failed one. CONCLUSION: A treatment of high negative pressure drainage and reasonable diet is effective and safe for chylous fistula at early stage.

Chyle↗
PubMed1989

[Prolongation of the QT interval in the ECG following surgery of the neck (neck dissection)].

The QT interval on the ECG was determined in 40 patients undergoing major resection plus neck dissection. The readings were taken before operation, between 1 and 3 h after operation, and the 1st and the 7th day after the operation. The QT interval was prolonged significantly more often and more intensively in patients undergoing surgery on the right side (from 411 +/- 17 to 459 +/- 50 ms) than in those operated on the left side (409 +/- 14 to 431 +/- 32 ms; all values mean +/- SD). The cause of the prolongation of QT interval is thought to be either direct surgical damage to the sympathetic cardiac nerves during the operation, or a temporary disturbance of nerve function due to pressure, tension or oedema in the wound. An explanation for the observed side difference might be differing functional effects of right- and left-sided sympathetic innervation of the heart. Attention is drawn to the meaning of these findings as a predisposing factor for ventricular tachyarrhythmias.

Adult↗
PubMed1982

Primary procedure in carcinoma of the tongue: local resection versus combined local resection and radical neck dissection.

Whether to perform local resection alone (LR) or to combine local resection with ipsilateral radical neck dissection (LR and RND) as primary treatment for carcinoma clinically confined to the tongue is controversial. To compare the outcomes of the two procedures, we reviewed the records of 502 patients treated for carcinoma of the tongue from 1949 to 1974, 128 of whom had no evidence of disease beyond the tongue. Immediate LR and RND was performed in 39; 16 (41%) had recurrences, and 14 (36%) died. On the other hand, 89 patients underwent LR alone; 43 (48%) had recurrences, and 29 (31%) died. All were followed for a minimum of 5 years or until their deaths. There was no statistical difference between the two procedures in recurrence or outcome. The two groups were compared with respect to tumor size according to the TNM classification, and no significant differences in recurrence or survival were apparent. LR alone appears to be adequate primary treatment for patients with no evidence of metastatic disease, provided close postoperative follow-up is observed. LR and RND may result in increased morbidity and certainly in disfigurement, and fails to improve prognosis or survival.

Adult↗
PubMed1986

Radical neck dissection.

This article discusses how the spread of tumor occurs and reviews surgical treatment, including classic and functional radical neck dissection, as well as complications.

Face↗
PubMed1988

Interposition spiral saphenous vein graft bypass in bilateral simultaneous radical neck dissection.

We advocate the use of the spiral saphenous vein bypass of the IJV when bilateral radical neck dissections are performed with the sacrifice of both IJV. The technique we have described herein is uniformly successful in this setting and associated with only 30 minutes to one hour of increased operative time. This bypass will decrease the postoperative facial edema and associated complications and allow the patient to go on to radiation and chemotherapy in an expeditious and safe manner.

Humans↗