Correspondence: K Harish email@example.com
World Journal of Surgical Oncology 2005, 3:21 doi:10.1186/1477-7819-3-21
(2005-04-30 21:24) Department of Otolaryngology, Head&Neck Surgery
Which type of neck dissection is appropriate technique?
Several types of neck incisions have been devised over the years.
Bocca questioned the logic of performing en-bloc resections while structures, such
as the vagus and hypoglossal nerves, which are equally related anatomically to the
lymphatics and lymph nodes, were left behind. He subsequently developed the concept
of modified radical neck dissection (MRND)(1).
In the last decade, emphasis has been placed on the use of selective neck dissection
(SND) in the management of N0 necks. This procedure, initially developed as a ‘staging
operation’ to assess the presence of occult metastasis, has evolved into another
treatment modality for node negative necks. A better understanding of the pattern
of metastasis has been key in the development of this new approach to the management
of N0 necks.
Shah et al. looked at more than 1000 specimens from comprehensive neck dissections
for head and neck squamous cell carcinomas and found a predominance of cervical metastasis
to certain levels for each primary site(2).
Traynor et al.(3) suggested that the use of SND could be extended to N2B and N2C disease,
in the absence of massive lymphadenopathy, nodal fixation, gross extracapsular spread
(ECS) and a history of previous neck surgery.
At present, RND and MRND remain the mainstay for the surgical management of advanced
nodal disease. However, there is still considerable debate regarding the use of SND
in cases with advanced nodal disease.
Radical neck dissection (RND) has long been the standard treatment for the management
of cervical metastasis.
Classical radical neck dissection have indications despite the esthetic and functional
morbidity. The current indications for a classical radical neck dissection are following(4):
1) N3 disease in the upper part of the neck;
2) Gross invasion of the spinal accessory nerve by metastatic lymph nodes at level
II in the neck; and
3) Recurrent or persistent metastatic carcinoma after previous radiation therapy,
chemoradiation therapy, or previous selective neck dissection.
1- Bocca, Functional neck dissection: an evaluation and review of 843 cases. Laryngoscope
148 (1984), pp. 478–482.
2- J.P. Shah, Patterns of cervical lymph node metastasis from squamous carcinomas
of the upper aerodigestive tract. Am J Surg 160 4 (1990), pp. 405–409.
3- J. Traynor et al., Selective neck dissection and the management of the node-positive
neck. Am J Surg 172 6 (1996), pp. 654–657.
4- Cervical lymph nodes In: J.P. Shah, Editors, Color Atlas of Operative Techniques
in Head and Neck Surgery Face, Skull, and Neck, Grune & Stratton, Orlando, FL
(1987), pp. 353–394.
Dr. Murat Enoz
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