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Open Access Highly Accessed Review

Neck dissections: radical to conservative

K Harish

World Journal of Surgical Oncology 2005, 3:21  doi:10.1186/1477-7819-3-21

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Which type of neck dissection is appropriate technique?

Murat Enoz   (2005-04-30 21:24)  Department of Otolaryngology, Head&Neck Surgery email

Dear Editor

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.

References

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.

Sincerely

Dr. Murat Enoz

Competing interests

None declared

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