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PubMed1988

[Regional neck dissection in carcinoma of the cervical esophagus].

The metastatic spread in the neck of carcinoma of the cervical esophagus was studied in 10 patients from 1970 to 1985. The recurrent chain was involved in 6 patients: 2, unilateral and 4, bilateral. The metastatic nodes in each patients were counted 1, 2, 2, 2, 4 and 6, 17 in total. Their sizes ranged from 5 mm to 15 mm. However, they were not palpable preoperatively. Therefore, this area always should be dissected. The internal jugular chain including supraclavicular nodes had seven metastatic nodes in 6 patients; only one node, 3 cm in diameter, palpated preoperatively; 3 nodes, 2.5 cm, 6 mm and 5 mm, detected microscopically; and 3 nodes, 4 cm, 3 cm, a tip of small finger, palpated by clinical emergence in course of follow-up. Seven nodes distributed 0 in upper jugular, 3 in mid jugular (one node in the level of carotid bulbus was the highest one), 1 in lower jugular and 3 in supraclavicular. From this data the author feel that upper jugular nodes need not be dissected in the elective neck dissection for carcinoma of the cervical esophagus. The author recommend elective procedure for negative neck since 2 out of 4 patients developed positive nodes later in undissected necks, and 2 out of 4 patients revealed microscopically positive nodes in electively dissected necks. It is interesting that the rate of metastasis in jugular chain is high (5/6) in patients who have positive nodes in recurrent chain. There were two unusual sites of metastasis; one Delphian node in patient whose primary lesion invaded to thyroid gland, and pretracheal as well as upper mediastinal nodes in patient who had 6 positive nodes in recurrent chain and one positive node in jugular chain.

Aged↗
PubMed1997

Role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip.

Treatment of squamous cell carcinoma of the lip is primarily surgical. Unlike other oral lesions, lower lip cancers do not metastasize to lower cervical lymph nodes without invading submental and submandibular lymph nodes. This study presents 30 patients with N0 lower lip carcinoma who were treated by en bloc resection of the tumor with suprahyoid neck dissection. Occult metastasis was found in 4 patients (13%). Four patients, 3 of whom had no occult metastases, died of local or regional uncontrollable disease. Suprahyoid or modified radical neck dissection appears to be beneficial, even in small tumors of the lower lip, in detecting occult metastases.

Adult↗
PubMedDate not supplied

[Physiotherapy and diagnosis of shoulder lesions after radical neck dissection].

We examined 43 patients to study the influence of postoperative physiotherapy of shoulder disfunctions after radical neck dissection. We also wanted to elucidate the problem of the controversially documented multiple supply of this area by the cervical plexus. Shoulder function was examined clinically and by electrophysiology. Our results demonstrate that the degree of shoulder disfunction correlated well with clinical parameters like abduction in the frontal plane and lateral scapular movements. In all three muscular segments lesions were detected by electrophysiological tests. The majority of patients showed only minor impairment or normal results in the lower segment, which would point to a double or single enervation from the branches of the cervical plexus. These results confirm the value of postoperative physiotherapy for the treatment of shoulder disfunction. The study parameters are also important to assess the success of physiotherapy and to confirm its efficacy in cases of postoperative accessory nerve palsy.

Head and Neck Neoplasms↗
PubMed2003

Pulmonary thromboembolism following total laryngectomy and neck dissection: a case report.

A fifty-five-year-old male patient underwent total laryngectomy, bilateral modified radical neck dissection, and primary voice restoration for squamous cell carcinoma of the supraglottic larynx. During surgery the left internal jugular vein was found to be thrombosed and, therefore, ligated and resected. In the early postoperative period, pulmonary thromboembolism was suspected and confirmed by lung perfusion scintigraphy which showed bilateral segmental and subsegmental perfusion defects. The patient was successfully treated by anticoagulant therapy. It may be advisable to consider thromboprophylaxis in head and neck surgery in patients with clinically suspected pulmonary thromboembolism, if no contraindication exists.

Anticoagulants↗
PubMed2003

Venous drainage patterns in a case of pseudotumor cerebri following unilateral radical neck dissection.

We report the extracranial venous ultrasound findings in a case of pseudotumor cerebri (PTC) following unilateral radical neck dissection (rND). PTC is known to be a rare complication following bilateral rND, and is caused by venous outflow obstruction. Single cases of PTC have been reported after unilateral rND, and are thought to be due to resection of the dominant internal jugular vein (IJV) in the presence of a hypoplastic or aplastic contralateral transverse sinus. Our patient developed PTC despite prominent flow in the contralateral IJV as shown by venous ultrasound. No compensatory increase in flow in the vertebral veins was observed, as confirmed by digital subtraction angiography. We conclude that the physiological collateral function of the vertebral venous system and deep neck veins was insufficient and contributed to global venous outflow obstruction in our case of unilateral rND.

Humans↗
PubMed1979

Indication and clinical evaluation of radical and semiradical neck dissection on the basis of 271 operations.

Between the period of 1956 and 1973, 271 radical and semiradical neck dissections were performed. The 'en bloc' method was used in 75 patients with cancer of the larynx and in 47 thyroid cancer patients. Analysis of the patient material revealed the operative mortality of 1.5%. 5-year survival was observed in 34.8% of the patients. The incidence of local recurrence amounted to 21%.

Aged↗
PubMed1995

[Postoperative blindness after buccal tumorectomy and bilateral radical neck dissection].

A case of bilateral blindness in a 47-year-old patient after buccal tumorectomy and bilateral neck dissection is reported. The diagnosis of posterior optic ischaemia was substantiated by the features of blindness and the negativity of cerebral CT-scanography and NMR imaging. The respective roles of atherosclerosis, arterial hypotension, acute anaemia and increased intracranial pressure are discussed. Preventive measures include a strict control of blood pressure, blood loss and head position.

Blindness↗
PubMed1992

Effectiveness of salvage neck dissection for advanced regional metastases when induction chemotherapy and radiation are used for organ preservation.

The recently completed VA Cooperative Study (CSP #268) of induction chemotherapy (cisplatin/5-FU) and definitive radiation (6600 to 7600 cGy) for organ preservation in advanced (stage III or IV) laryngeal cancer demonstrated that, although larynx preservation could be achieved in 64% of randomized preservation could be achieved in 64% of randomized patients, overall survival rates were not improved over conventional treatment (surgery/postoperative radiation). Of 166 patients randomized to induction chemotherapy, 46 had N2 or N3 disease and were analyzed to determine the effectiveness of the organ preservation treatment strategy on control of neck disease and survival. The clinical response of neck metastases to induction chemotherapy was significantly associated with subsequent salvage neck dissection (P = .008). The overall death rate was increased (P = .014) and survival time decreased in patients with less than a complete response in the neck after chemotherapy (P = .15). This was related primarily to failure to control the disease in the neck. The overall survival of patients achieving a complete response in the neck was improved over the randomized group of N2 or N3 patients treated with primary surgery. The findings suggest that response of neck nodes should be assessed independently of primary tumor response in trials of organ preservation strategies using induction chemotherapy, and that failure to achieve a clinical complete response in the neck warrants planned early salvage neck dissection in order to achieve improved overall survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

The innervation of the trapezius muscle in connection with radical neck-dissection. An anatomical study.

The accessory nerve, the cervical plexus, the sternocleidomastoid and trapezius muscles and neighbouring structures were examined in 47 corpses. Considerable inter- as well as intra-individual differences could be found both in the course and shape of the accessory nerve and in the participation of the cervical plexus in the innervation of the trapezius muscle. The great variation in the manifestation of the shoulder-arm-syndrome in patients after radical neck-dissection can thus be explained. Finally a new method of restoring the innervation of the trapezius muscle is proposed.

Accessory Nerve↗
PubMed1990

The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts.

Neck recurrence-free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections. In 42 dissections, no radicality could be obtained. Of the 523 histologically radical dissections, examination revealed tumor in 352 cases. Patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy. In the histologically N0 group, the incidence of neck recurrence after 5 years was 3%; in the N+ group as a whole, it was 10%. Analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread (that did not receive postoperative radiotherapy) did not statistically differ from the other groups. This suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy.

Adult↗
PubMed1975

Limitations of supraglottic laryngectomy and conservative neck dissection.

Limitations of supraglottic laryngectomy may arise from either the primary location, or secondary spread of the tumor in the vestibule. When a growth reaches the epilarynx a modified supraglottic laryngectomy or a more radical operation must be envisaged. Other limitations include poor bronchopulmonary condition, age of the patient, and previous radiotherapy. All these conditions may jeopardize healing and/or, even more important, functional rehabilitation. New hands to this surgery should know its limitations and should be warned against its risks. On the other hand no limitations exist to conservation neck dissection, except fixed nodes or lymph node metastases following radiation or earlier surgery. The conservative technique is as radical as the traditional technique, but respects essential structures and thus widens instead of limiting the indications for elective bilateral neck dissection.

Adult↗
PubMed1978

Radical or modified neck dissection: a therapeutic dilemma.

Three hundred ten evaluable patients received a classic, functional, or spinal accessory-nerve-sparing neck dissection during 1970 to 1975. The functional procedure was at least equal to the classic procedure in the patients in whom it was employed. The spinal accessory-nerve-sparing operation is offered as an alternative to the classic procedure in all patients in whom the nerve is not directly invaded by cancer. If these guidelines are followed, the patient will rarely experience the pain and shoulder dysfunction that result from the loss of the trapezius muscle, while the chances of control of cancer in the neck remain optimal.

Head and Neck Neoplasms↗
PubMed1987

Thyroidectomy and neck dissection for the carcinoma of the thyroid gland in children.

A peculiarity in thyroid cancer in children is discussed in terms of clinical course and pathology. A case report of well differentiated papillary carcinoma of the thyroid gland in a 6-year-old boy is presented, with emphasis on the clinical course and pathology. The clinical course indicated a slowly growing, firm tumor lateral to the superior cornu of the thyroid cartilage, up to the hyoid bone. As treatment of the tumor and its lymph node metastases, a hemithyroidectomy with simple neck dissection was performed. Thyroid hormone was administered for suppression of endogenous thyroid-stimulating hormone postoperatively, and the patient tolerated this therapy well. An review of the literature dealing with the question of whether or not a radical neck dissection is appropriate in thyroid cancer in children was carried out.

Adenocarcinoma, Papillary↗
PubMed1983

The value of postoperative radiotherapy as an adjuvant to radical neck dissection.

In this study the results of combined radiotherapy and surgery are compared with the results of surgery alone in patients with neck node metastases from squamous cell carcinomas of the head and neck region. Postoperative radiotherapy decreases the recurrence rate in the neck, especially in cases with histologically established extranodal spread. Results of preoperative radiotherapy were similar to those of irradiation after surgery. Postoperative radiotherapy is favored, because it allows a selection of patients for extra treatment on the base of prognostic information, provided by the histologic characteristics of the neck dissection specimen.

Carcinoma, Squamous Cell↗
PubMed2004

Preserving level IIb lymph nodes in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma.

OBJECTIVE: To determine whether level IIb lymph nodes can be saved in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma of the oral cavity. DESIGN: Prospective analysis of a case series. SETTING: University hospital. PATIENTS AND INTERVENTIONS: From 1997 to 2001, 74 patients with squamous cell carcinoma of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. MAIN OUTCOME MEASURES: The incidence of pathological metastasis to level IIb lymph nodes and the regional recurrence within this area after elective SOHND was performed were evaluated. RESULTS: Of the 74 patients, 24 (32%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Four (5%) of the 74 patients had involvement of level IIb lymph nodes. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. There were 6 cases of the ipsilateral neck recurrences, and of these, 2 patients (3% of all patients) developed recurrences in the level II lymph nodes. CONCLUSIONS: Level IIb lymph node metastasis was rare in this study, and nodal recurrence in this area after SOHND in squamous cell carcinoma of the oral cavity was infrequent. Therefore, this region may be preserved in elective SOHND in patients with squamous cell carcinoma of the oral cavity.

Adolescent↗
PubMed1990

[Problems associated with radical neck dissection in patients with tongue carcinoma: four cases of stage I tongue carcinoma that recurred in the cervical area after the dissection].

Reported are four cases of a stage I tongue carcinoma which recurred in the cervical area after a radical neck dissection (RND). In all cases, the primary lesion was controlled with radium needle implants. Clinically, these tumors manifested endophytic growth and, histologically, had a high malignant grading. In most cases, a latent lymph metastasis appeared within 6 months after initial treatment and an early metastatic lesion developed beyond the capsule of the node. The site of cervical recurrences was located in non treated areas that were outside the range of the RND.

Aged↗
PubMed2000

Effect of preoperative prophylaxis with filgrastim in cancer neck dissection.

BACKGROUND: Cancer surgery is known to lead to a deterioration in host defence mechanisms and an increase in susceptibility to infection after operation. Filgrastim enhances important antimicrobial functions of neutrophils including chemotaxis, phagocytosis and oxidative killing mechanisms. METHODS: The effects of additional (all patients received perioperative 3 ' 25 mg kg-1 cefotiam and 1 ' 20 mg kg-1 metronidazole) preoperative prophylaxis with filgrastim (5 microg kg-1 12 h prior to surgery plus 5 microg kg-1 0 h prior to surgery) on neutrophil phagocytosis and reactive oxygen radical production and postoperative infections in 24 patients undergoing cancer neck dissection were studied. Phagocytic capacity was assessed by measuring the uptake of fluorescein isothiocyanate-labelled Escherichia coli and Staphylococcus aureus by flow cytometry. Reactive oxygen generation after phagocytosis was estimated by determining the amount of dihydrorhodamine 123 converted to rhodamine 123, intracellularly. RESULTS: In the filgrastim-treated patients a higher neutrophil phagocytic capacity was seen intraoperatively, and 1-5 days postoperative, but not prior to surgery. Reactive oxygen radical production was significantly higher in filgrastim-treated patients prior to surgery, intraoperative and postoperative (1-5 days). 2/12 (17%) patients had postoperative infections in the filgrastim group and 9/12 (75%) patients had infections in the placebo group (P < 0.001). In particular, wound infections were recorded more often in the placebo group (1/12 vs. 6/12; P = 0.004). CONCLUSION: We conclude that filgrastim enhances perioperative neutrophil function and could be useful in the prophylaxis of postoperative wound infections in patients undergoing cancer neck dissection.

Adult↗