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PubMed1994

Lymphatic drainage system after left radical neck dissection.

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

Carcinoma, Squamous Cell↗
PubMed1978

[Is the prophylactic hemithyreoidectomy indicated in radical neck dissection? (author's transl)].

To find an explanation for tumor-recurrences around the tracheostoma, in 59 cases of squamous cell cancer of larynx, hypopharynx, oropharynx and tongue the ipsilateral hemithyreoidectomy was included into the tumorexstirpation and radical neck dissection. This histological work up of the thyroid showed no evidence of metastases within the gland. However in cases of extended metastasis or difficult surgical approach to the prae- and paratracheal areas the hemithyreoidectomy is advised.

Humans↗
PubMed1994

External beam irradiation alone or combined with neck dissection for base of tongue carcinoma: an alternative to primary surgery.

From 1964 to 1990, 134 patients were treated at the University of Florida with continuous-course external beam irradiation, alone or followed by a planned neck dissection, for T1 (n = 17), T2 (n = 47), T3 (n = 49), or T4 (n = 21) carcinoma of the base of tongue. The 5-year rate of local control was 90% for stage T1, 92% for T2, 73% for T3, and 35% for T4. Probability of control above the clavicles at 5 years according to modified American Joint Committee on Cancer (AJCC) stage was 100% for stages I and II, 75% for stage III, 84% for stage IVa, and 52% for stage IVb. Probability of relapse-free survival at 5 years was 100% for stages I and II, 68% for stage III, 81% for stage IVa, and 37% for stage IVb. Severe complications occurred in 2% of patients. Compared with surgical resection of the primary tumor, external beam radiotherapy results in similar rates of local control and survival with a lower risk of severe complications.

Adult↗
PubMed1992

Micrometastases from squamous cell carcinoma in neck dissection specimens.

The incidence of micrometastases in cervical lymph nodes from squamous cell carcinomas of the head and neck was studied using routine histopathological examination. Micrometastases were found in 66 lymph nodes in 41 of the 92 tumor-positive neck dissection specimens. The detection of these micrometastases influenced postoperative treatment in 3 of the 77 patients with neck node metastases. The value of additional sectioning for detecting micrometastases was thus assessed. Sectioning at a deeper level in 600 originally histopathologically negative lymph nodes from 64 patients revealed 7 additional micrometastases in 5 patients. Antikeratin staining with a mixture of two monoclonal antibodies (AE1 and AE3) revealed 4 micrometastases in 739 originally histopathologically negative lymph nodes in 3 of 13 patients studied. Because of the unknown prognostic significance of micrometastases and the consequent arbitrary consequences for postoperative treatment, present findings show that the extra workload of immunostaining and deeper sectioning does not warrant their routine use in clinical practise.

Carcinoma, Squamous Cell↗
PubMed1994

Pseudoaneurysm of the external carotid artery following radical neck dissection and irradiation: a case report and review of the literature.

A 54-year-old man developed a pseudoaneurysm of the left external carotid artery 8 years after concluding treatment for squamous cell carcinoma of the tongue. Treatment included radiation therapy, radical neck dissection and a myocutaneous pectoralis major flap. Percutaneous transcatheter embolization resulted in thrombosis of the pseudoaneurysm. A review of the literature yielded only six other reported cases of pseudoaneurysm of the external carotid artery proper.

Aneurysm↗
PubMed2002

[Origin of shoulder pain after "neck dissection". Importance of the cervical plexus].

BACKGROUND: The role of sensitive parts of the cervical plexus for the development of neuropathic pain is not yet clear. Our study investigated the correlation between shoulder pain and cervical plexus damage after different types of neck dissection (ND). MATERIAL AND METHODS: The sensitivity for warm/cold and sharp/blunt was tested in the dermatomes of C2, C3, C4, and the minor occipital nerve. Shoulder pain was measured semiquantitatively by a rating scale. RESULTS: Motion-dependent shoulder pain was observed 6 months postoperatively in 50% after resection and in 29.2% after preservation of these structures. Pain occurred more frequently following radical ND than after modified radical types 1 and 3 ND. DISCUSSION: Our investigations showed that the superficial cervical plexus function is assessable by cutaneous sensitivity tests. The minor occipital nerve seemed to be less affected. Fewer pain symptoms in cases with preserved cervical plexus could be demonstrated. We can conclude that preservation of the superficial cervical plexus is important to diminish postoperative shoulder pain.

Cervical Plexus↗
PubMed1995

Microsurgical neck dissection for metastasizing medullary thyroid carcinoma.

Surgery is the only accepted method for a potentially curative treatment of metastatic medullary cancer of the thyroid (MCT). Between 5/1988 and 2/94 53 patients (mean age 43, 14-65 years) were treated. A total of 24 patients underwent surgery of both sides of the neck whereas 29 patients required only one side. Six months after surgery, a profound reduction in basal serum calcitonin levels (CT) was detected in all patients. Upon pentagastrin stimulation, CT levels remained suppressed in eight patients. A pathological increase of normalized basal CT values was noted in 33 patients. In 12 patients, basal CT concentrations remained elevated after surgery. We conclude that metastatic MCT can be effectively treated by microsurgical modified radical neck dissection.

Adolescent↗
PubMed1992

Ascending pharyngeal artery-internal jugular vein fistula complicating radical neck dissection.

Arteriovenous fistulae of the ascending pharyngeal artery (AP) and internal jugular vein (IJ) are rare. Only two spontaneous AP-IJ fistulae have been described previously, both of which presented with pulsatile tinnitus. A unique case of an AP-IJ fistula developing after radical neck dissection is described in which the clinical presentation was identical to that of a carotid-cavernous fistula.

Angiography↗
PubMed2002

The 11th nerve syndrome in functional neck dissection.

OBJECTIVES: Assessment of the incidence of shoulder joint disability and evaluation of the role of a personal postoperative physical rehabilitative protocol therapy in reducing pain and shoulder dysfunction and improving the quality of life (QOL) of patients who have undergone functional neck dissection (FND) associated with total laryngectomy. SETTING, DESIGN, AND OUTCOME MEASURES: Sixty laryngectomees who had undergone FND were divided into two groups (A and B). Group A received physical therapy after surgery. Clinical evaluation was done according to the Constant modified questionnaire, including physical assessment of passive and active shoulder movement and information regarding patients' QOL. Bilateral quantitative electromyography (Q-EMG) of scapulohumeral muscles was carried out on all patients. Results were evaluated by Student t test and multivariate analysis to find out which variables were important in predicting pain and return to work. RESULTS: Six months after surgery, the patients in group A had better results concerning passive forward elevation (P = 0), shoulder active motility (P = 0), pain (P <.001), working and recreational activity (P = 0), and score of Constant (P = 0) compared with the patients in group B. From a multivariate analysis of clinical parameters important in predicting pain, significant predictors (P <.01) were shown to be global shoulder active motility, active forward elevation, abduction, active external rotation, internal rotation hand to back, working and recreational activity, and score of Constant. Regarding return to work, a significant predictor (P <.01) was the score of Constant. Electromyography work-up showed deterioration in early postoperative periods and improvements in late postoperative periods. CONCLUSION: The post-surgical variable clinical picture of shoulder disability is related not only to the accessory nerve injury, but also to the secondary glenohumeral stiffness resulting from the scapulohumeral girdle muscles weakness and postoperative forced immobility. Physical therapy aimed to early recover passive motion and to avoid the occurrence of joint fibrosis has been shown to have a real contributory role in decreasing shoulder complaints and improving the patients' QOL.

Accessory Nerve Diseases↗
PubMed2000

Neck dissection and ipsilateral radiotherapy in the management of cervical metastatic carcinoma from an unknown primary.

BACKGROUND: In a small proportion of patients presenting with metastases to cervical lymph nodes the primary cancer remains occult despite thorough evaluation. The present report examines patterns of failure and outcome following an initial treatment strategy directed principally at the clinically involved side of the neck. METHODS: From a prospectively compiled computerized database 38 patients were identified with metastatic squamous cell carcinoma from an occult primary site. These patients were evaluated with respect to initial treatment, subsequent detection of a primary tumour, neck recurrence and survival characteristics. RESULTS: Thirty-seven of 38 patients were treated with curative intent and all had neck dissection. Adjuvant radiotherapy was given to 34 of the 37 (90%; 32 postoperatively and two pre-operatively). Radiotherapy was directed at the ipsilateral neck alone in 24 patients while 10 received comprehensive treatment to both sides of the neck and potential occult primary sites. The rate of control of disease in the ipsilateral neck was 91% while the failure rate in the contralateral neck was 16% (six patients). A primary cancer was ultimately identified in five patients (13%). Disease-specific survival was 63% at 4 years. Clinical N3 stage, extracapsular tumour extension and involved surgical margins predicted for poorer survival on univariate analysis. Analysis using multiple risk factors found that only involved surgical margins predicted for treatment failure. CONCLUSIONS: Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted, but approximately half will develop recurrent disease. Careful follow-up is required if effective salvage treatment is to be instituted.

Aged↗
PubMed1994

The unilateral hockey-stick incision for neck dissection in oral carcinoma. Technical note.

In 42 patients, a hockey-stick incision was used as standard approach in unilateral neck dissection. This approach permits a good overview of all structures in the neck and allows en bloc resection with intraoral tumor removal. The incision does not interfere with simultaneous reconstruction by pedicled or free flaps, and results in a scar which is barely visible and easily covered.

Adult↗
PubMed2006

Is lack of placement of drains after thyroidectomy with central neck dissection safe? A prospective, randomized study.

OBJECTIVE: Selective use of drains after thyroidectomy has been suggested in the literature. Although the safety of thyroidectomy without drains has been reviewed, there is little specific data available to identify the safety of thyroidectomy combined with central neck dissection (CND) without drains. This study aims to determine the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND. STUDY DESIGN: Prospective, randomized study. MATERIALS AND METHODS: One hundred ninety-eight consecutive thyroidectomized patients were enrolled in this study. Drain group (n = 101) consisted of 41 hemithyroidectomies (HT), 28 total thyroidectomies (TT), and 32 total TT with CND. No-drain group (n = 97) consisted of 42 HT, 18 TT, and 37 TT with CND. The following variables were examined: perioperative complications (hemorrhage, hematoma, seroma), intraoperative bleeding, operation time, volume of resected thyroid gland, time of hospital discharge after operation, duration of drain placement, and total amount of drainage (drain group). RESULTS: There were no significant differences in age, sex, volume of resected thyroid gland, types of operation, operation time, and histopathlologic diagnosis between two groups. In the drain group, overall perioperative complications occurred in seven (7/101, 6.9%) patients. In the no-drain group, overall perioperative complications occurred in nine (10/97, 10.3%) patients. There was no significant difference in overall perioperative complications between the drain and no-drain groups, even in cases of performing CND. Time of hospital discharge after operation was significantly shorter in the no-drain group than the drain group (P < .05). CONCLUSIONS: We conclude that thyroidectomy without drains is safe and effective even in combination with CND and appears to confer several advantages over the routine drainage method. In addition, we achieved significant reduction of hospital stay, which led to a reduction in costs for the patients.

Adolescent↗
PubMed2000

Quantitative analysis of the drainage after neck dissection.

The goals of this study are to determine the normal volume and lipid values of the drainage after neck dissection (ND) and to evaluate the changes of these values according to the type and side of the ND. Ninety-seven uncomplicated NDs involving zones I through IV were evaluated prospectively in this study. The most important result of the analysis of the drainage is that levels of triglyceride and cholesterol in the drainage were lower than serum levels in all but 1 case (P< 0.001). When matched for the type and side of the dissection, only mean total drainage volume was significantly higher in radical NDs than in selective NDs (P = 0.001). The normal volume and lipid values of neck drainage are reported in this study. Being aware of the changes in these values may help early diagnosis of some pathologic conditions.

Adult↗
PubMed2002

Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip.

BACKGROUND: Supraomohyoid neck dissection (SOHND) is generally considered an adequate staging procedure in selected patients with squamous cell carcinoma (SCC) of the lip and oral cavity, with clinically negative nodes in the neck that are at increased risk for occult metastatic disease. The potential role of SOHND as a therapeutic surgical procedure for cervical metastasis limited to level I is controversial. METHODS: A series of 44 patients with clinical cervical lymph node metastases at level I from SCC of the lower lip is reported to evaluate the results of a treatment protocol consisting of therapeutic SOHND on indication followed by radiotherapy. RESULTS: Regional recurrences were observed in four (9%) patients. All recurrences developed within the SOHND dissected area only. CONCLUSIONS: A therapeutic SOHND, on indication followed by radiotherapy, can be an oncologically sound and effective procedure in the management of regional lymph node metastases at level I from SCC of the lower lip.

Adult↗