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At least 19 recordsLinked to original sources
PubMed1999

Complications of neck dissection.

Neck dissection is a surgical procedure used in the diagnosis and treatment of head and neck cancer. The neck dissection involves excising the lymph nodes in specified regions of the neck with or without removing the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve. The removal of cervical lymph nodes not only aids in staging the malignancy but also treats the nodal disease and dictates further treatment such as radiation therapy. Because of the proximity of vital structures, certain risks and complications are inherent to this operation. The prevention, recognition, and treatment of early and late complications of neck dissection are discussed.

Head and Neck Neoplasms↗
PubMed2004

Surgical education: neck dissection.

Neck dissection is a valuable procedure for treating metastatic cancers of the head and neck. Radical neck dissection remains the standard for cervical metastasis. Because of the morbidity associated with such a treatment, more conservative approaches are being adopted. The authors describe how they do a neck dissection and review the issues that currently surround the choice of treatment.

Head and Neck Neoplasms↗
PubMed1999

Use of apron flap incision for neck dissection.

Neck dissection is one of the most commonly performed surgical procedures in the management of head and neck cancer. Different skin incisions with various modifications have been described in the literature. Three commonly used but conceptually different incisions were compared with respect to the incidence of wound dehiscence in a retrospective review. There were 166 patients with 184 neck dissections carried out using a triradiate (n = 85), modified MacFee (n = 25), or an apron flap incision (n = 74). The incidence of wound dehiscence in the three groups was 11 percent, 8 percent, and 0 percent for the triradiate, modified MacFee, and apron flap incisions, respectively. There was a statistically significant difference in the incidence of wound dehiscence between the apron flap incision and the triradiate incision groups (p = 0.004). The difference in wound dehiscence was not statistically significant between the apron flap incision and the modified MacFee incision groups (p = 0.06). Overall, there was a significant increase in the incidence of wound dehiscence in previously irradiated necks (p = 0.02), but this was significant only for the triradiate incision (p = 0.005) when analyzed individually. Comparison of triradiate, apron, and MacFee incisions did not show a statistically significant difference between the incisions with regard to other postoperative complications in terms of seroma, hematoma, wound infection, and fistula formation. The apron flap incision is the recommended approach in the presence of previous neck irradiation as it gives easier access than the MacFee incision. The robustness of the flap is because of the absence of a trifurcate point as well as a good vascular supply arising from arterial territory of the external carotid artery.

Female↗
PubMedDate not supplied

The influence of elective neck dissection on neck relapse in NO supraglottic carcinoma.

INTRODUCTION: Mortality due to cancer in patients treated for squamous cell carcinoma of the supraglottic larynx is closely associated with regional relapse in the neck. Controversy exists relative to the most effective way to manage potential cervical metastases. METHODS: The records of 126 patients with carcinoma of the larynx treated between 1975 and 1986 were reviewed. Sixty-three patients with T2-4,NO squamous cell carcinoma of the supraglottic larynx are the subject of this report. Twenty-one patients underwent surgical resection of the primary tumor plus elective neck dissection while 42 patients underwent surgical resection of the primary tumor without neck dissection. Subsequent relapse in the neck was ascertained. RESULTS: The overall neck relapse rate was 31.7%. In patients treated with neck dissection, the relapse rate was 14.3%, while relapse in the patients who did not have neck dissection was 40.5%. Radiation therapy did not seem to make a significant difference in relapse rate in this patient population. CONCLUSIONS: We conclude that elective neck dissection decreases the neck relapse rates significantly in patients treated for NO supraglottic carcinoma.

Carcinoma, Squamous Cell↗
PubMed2003

[Lateral neck dissection vs radical neck dissection in the management of supraglottic carcinoma with pathologically negative nodes].

OBJECTIVE: To compare the effectiveness of lateral neck dissection (LND) with radical or modified radical neck dissection (RND) for the management of supraglottic carcinoma with pathologically negative nodes (pNO). METHODS: Two treatment groups with pNO supraglottic carcinoma were retrospectively compared: 39 patients who were treated with RND between March of 1980 and December of 1996, and 54 patients who were treated with LND between January 1997 and December 2001. RESULTS: The neck recurrent for LND population was 2.3%, which was not statistically different from the neck recurrent in the RND population (0.0%). Also, the 5-year survival rates were no statistic difference between LND and RND groups (97% vs 94%). Complications and period of hospitalization were both decreased in LND group comparison of RND group (6.7% vs 38.5%; 28 days vs 39 days). CONCLUSION: Comparing to the radical or modified neck dissection, the LND offers less invasive surgery and less morbidity without oncologic compromise for patients with pNO supraglottic carcinoma.

Adult↗
PubMedDate not supplied

Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection.

A multiinstitutional study to define the impact of total treatment programs involving radical neck dissection (RND) and modified neck dissection (MND) on patients' permanent disability was undertaken. A total of 243 patient responses were included in the study. Comparative analyses between the treatment groups show no advantage of one surgical operation over the other in returning patients to their pretreatment employment status. Radiation therapy was identified as adding significantly to the patient's permanent disability.

Adaptation, Psychological↗
PubMed2004

Long-term results of 100 consecutive comprehensive neck dissections: implications for selective neck dissections.

OBJECTIVE: The optimal surgical procedure for the neck in patients with squamous head and neck cancers is controversial. Selective neck dissections have replaced modified radical neck dissections as the procedure of choice for the clinically negative (N0) neck and are now being considered for patients with early-stage neck disease. We report the long-term local recurrence rates in 100 consecutive patients undergoing a radical or modified radical neck dissection for clinically positive (N+) and N0 neck disease and review comprehensively the literature reporting and comparing regional control rates for both neck dissection types. PATIENTS: The clinical records of 100 consecutive patients who underwent a comprehensive neck dissection (levels I-V) for squamous head and neck cancers with a minimum of a 2-year follow-up were retrospectively reviewed for primary site of disease, clinical and pathologic neck status, histopathologic grade, neck dissection type, and the site and time of recurrence. RESULTS: Complete data were available for 97 patients on whom 99 neck dissections were performed. Three patients died from unknown causes. Seventy-six patients with N+ disease underwent a therapeutic neck dissection, while 24 patients with clinically N0 disease underwent an elective dissection. The overall neck recurrence rate in patients with controlled primary disease was 7%. The neck or regional failure rate for patients completing the recommended adjuvant radiotherapy was 4%. Six (25%) of 24 patients with clinically N0 disease had occult metastases. The recurrence rate for this group was 4%. CONCLUSION: Further study is needed to determine the optimal surgical management of the N0 and limited N+ neck.

Adult↗
PubMed1996

The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections.

Although modern imaging techniques become more accurate for the assessment of lymph node metastases in the neck as criteria and technology evolve, micrometastases remain occult with any technique. Even the routine histopathological examination of neck dissection specimens is unable to detect all micrometastases. Because knowledge on the incidence of micrometastases in the clinically NO neck might be of importance for decision making regarding elective treatment, a retrospective study on 96 elective neck dissections was conducted. Meticulous histopathological examination of the neck dissection specimens yielded 3092 lymph nodes of which 67 (2.2%) were tumor-positive. Twenty-six of these 67 lymph node metastases were micrometastases. Of the 36 tumor-positive neck dissection specimens, 21 contained micrometastases. In 9 tumor-positive specimens only micrometastases were found. This high incidence of micrometastases has important implications for the diagnostic work-up, the treatment, and histopathological examination of the NO neck.

Carcinoma, Squamous Cell↗
PubMed1999

Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma.

BACKGROUND: The study aims at evaluation of the efficacy of elective neck dissection as a staging and therapeutic procedure for N0 neck of early carcinoma of the oral tongue by whole organ serial sectioning. METHODS: There were 50 stage I and II patients. The neck dissection specimens were whole organ sectioned in 3-mm intervals for the evaluation of nodal metastasis. RESULTS: There were 18 (36%) patients with subclinical nodal metastasis. The total number of metastatic nodes were 31 (1%) among all 2,826 nodes being examined. The metastatic foci had a median size of 3 mm and occupied a median of 6% of the cross sectional area of the involved nodes. The ipsilateral level II nodes were the commonest (26%) site of metastasis. Metastatic nodes were present in 34% patients who had negative preoperative radiological assessment and in 20% patients who had negative intraoperative frozen section sampling of neck nodes. Patients with subclinical nodal metastasis had a high incidence of regional recurrence (62%) and low survival (27%) when postoperative radiotherapy was not given after elective neck dissection. CONCLUSIONS: Ipsilateral level I,II,III neck dissection is an adequate diagnostic procedure for staging of the N0 neck of early oral tongue carcinoma. Its diagnostic role cannot be replaced by the available pre-operative radiological screening and intra-operative frozen section sampling. However, elective selective neck dissection is an effective but not adequate therapeutic procedure, and post-operative adjuvant radiotherapy and chemotherapy have to be considered for all pathologically positive necks.

Adolescent↗
PubMed1999

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas.

BACKGROUND: Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients. Patients and Methods This prospective randomized study began in 1990, and patient accrual was closed on December 1993. A total of 132 patients was included in the trial. All patients had previously untreated T2-T4 N0 M0 supraglottic or transglottic squamous cell carcinoma. No significant imbalance was found between groups with respect to demographic, clinical, pathologic, and other therapeutic variables. Seventy-one patients were given MRNDs (13 bilateral) and 61 were given LNDs (18 bilateral). RESULTS: The false-negative rate was 26%, and most positive nodes were sited at levels II and III. Complications and period of hospitalization were similar in both groups. There were 6 ipsilateral neck recurrences (4 in the MRND group, and 2 in the LND group). The 5-year actuarial survival calculated by Kaplan-Meier method was 72.3% in the MRND group and 62. 4% in the LND group (log-rank test p =.312). CONCLUSIONS: The rate of false-negative nodes in supraglottic and transglottic carcinomas was 26%, and most positive nodes were at levels II and III. The rates of 5-year overall survival, neck recurrences, and complications were similar in both groups. These results confirm the efficacy of lateral neck dissection in the elective treatment of the neck in patients with supraglottic and transglottic carcinomas.

Adult↗
PubMed1997

[Spinal accessory nerve and lymphatic neck dissection].

Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.

Accessory Nerve↗
PubMed2005

Elective and therapeutic selective neck dissection.

Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.

Carcinoma, Squamous Cell↗
PubMed2004

Botulinum toxin type A for the treatment of chronic neck pain after neck dissection.

BACKGROUND: Neck dissection surgery is often followed by chronic head and neck pain. To date optimal treatment of this type of pain is lacking. Botulinum toxin type A (BTX-A) has been shown to be effective in the treatment of myofascial pain syndrome and headache. In a pilot study, we wanted to test the effectiveness of BTX-A for the treatment of chronic neck pain after neck dissection. METHODS: Sixteen patients with chronic neck pain after neck dissection were included in this prospective, open study. Eighty to 320 units of BTX-A (Dysport) were injected into muscular trigger points. Outcome measures included chronic pain and shooting pain on the basis of visual analog scales and quality of life improvement (EORTC QLQ-C-30; EORTC QLQ-H and N35) before and 4 weeks after treatment. RESULTS: Patients showed a significant reduction in chronic pain (4.5 before to 3.3 after treatment, p =,005) and in shooting pain (6.1 before to 4.7 after treatment, p =.005). There was a trend toward improvement in global quality of life (QLQ-C30, p =.097) and an increase on the functional scale "pain" (QLQ-H and N35, p =.071). CONCLUSIONS: BTX-A treatment of subjects with chronic neck pain after neck dissection resulted in a fast and significant reduction of pain. A significant improvement in quality of life may be expected in a longer time course after treatment.

Adult↗
PubMed1999

The role of neck dissection in head and neck mucosal squamous cancer.

The most clinically useful system of classification of neck lymph nodes is grouping into levels I-V. Anatomical, clinical and pathological studies demonstrate that although generally lymphatic flow is from above downwards, level I is often bypassed and level V is seldom involved. Neck dissection is classified into radical, modified radical, selective and extended radical neck dissections. Recent studies demonstrate that elective neck dissection is beneficial to the outcome of oral cancer patients, but not necessarily to laryngeal and pharyngeal cancer patients. Modified radical neck dissection is as effective as radical neck dissection when performed in the elective situation. Selective neck dissection in the form of supra-omohyoid neck dissection is useful as a staging procedure. Modified radical neck dissection is acceptable for the N1 neck provided postoperative radiotherapy is given.

Carcinoma, Squamous Cell↗