![]() Recurrence rates were no different to more radical procedures but the morbidity of the “selective” procedures was shown to be less. It was demonstrated that the fascial envelopes containing the metaststatic nodes could be removed with preservation of the functional structures if those structures were not directly invaded by metastases. Bocca and others realised that the lymph nodes were arranged within fascial envelopes in the neck and were not present in the muscles, nerves or veins. Selective Neck Dissectionĭuring the 1960’s there was a paradigm shift in the management of neck lymph nodal metastases. Right modified radical neck dissection performed in conjunction with a segmental mandibular resection for SCC of the right lower alveolus stage T2N2b. ![]() The Extended Radical Neck Dissection refers to a similar operation but also involves removing other surrounding strucutres that are involved by tumour including skin, prevertebral muscle or mandible. This can only be done if it is oncologically feasible and it usually means sparing the spinal accessory nerve which is the only “functional” aspect of this procedure. The Modified versions of this operation involve sparing one or more of the non lymph node structures. The Radical Neck Dissection described initially by George Crile in 1906 involves removal of lymph node levels I-V, the sternocleidomastoid muscle, the internal jugular vein and the spinal accessory nerve. In thyroid cancer metastases this type of neck dissection would be reserved for nodal disease that invaded surrounding structures. There are two types of Neck Dissection and several subtypes within these two groups: Selective Neck Dissection Level I-III (Supraomohyoid)Ĭomprehensive neck dissections invlove removal of all five lateral lymph node levels and are usually performed for clinically detectable neck metastases particulary if these are multiple, large or involve a number of levels. Adjuvant treatment with radiation or sometimes chemotherapy and radiation together is recommended if there is more than one lymph node involved on pathological review or if there is extranodal extension present. If the primary tumour extends towards the midline or if it involves an area that has a high risk of spread to both sides of the neck, bilateral neck dissections are performed. Elective Neck Dissections are performed if the risk of occult metastatic nodes is 20-30% or greater. where there is high probability that lymph nodes will be involved even though there are no clinically or radiologically involved nodes (Elective Neck Dissection). where neck lymph nodes are clinically or radiologically involved with cancer (Therapeutic Neck Dissection). Neck Dissections are performed in two situations. The types of Head and neck cancers that readily spread to neck lymph nodes include: The levels of lymph nodes in the neck used for staging metastatic head and neck cancer. A larger node has a higher chance of extranodal extension. This phenomenon is known as extranodal extension and it is also a bad prognostic factor. Cancer also has the ability to grow beyond the confines of the lymph node into surrounding soft tissue. The larger and lower in the neck the nodes are the worse the prognosis. The number, size and position of lymph nodes involved by tumor is prognostically important. As the disease advances lower neck nodes tend to become involved. For example, skin tumours from the lip and anterior face tend to spread to facial and sudmandibular/submental nodes (level I) intially. As cancer progresses metastases spread from primary eschelon nodes to nodes further afield. Primary tumours spread (metastasise) to different nodal groups depending on their site. The neck is divided into seven different levels of nodes as seen on the diagram below. NZĪ Neck Dissection is an operation designed to remove groups of lymph nodes from the neck for treatment of cancer that has actually or has potentially spread from a primary site in the head and neck to the regional lymph nodes. ![]() ![]() Louis: “Relief from Shingle Pain.Neck Dissection Dr John Chaplin – Head and Neck Surgeon. Washington University School of Medicine in St. Medscape: “Scrofula Overview of Scrofula.” UpToDate: “Patient education: Conjunctivitis (pink eye).” Johns Hopkins Medicine: “Tinea Infections (Ringworm).” New York State Department of Health: “Gonorrhea,” “Bacterial Skin Infections: Impetigo and MRSA.”Īmerican Academy of Family Physicians: “Syphilis.” Journal of Clinical Medicine Research: “Generalized Lymphadenopathy as Presenting Feature of Systemic Lupus Erythematosus: Case Report and Review of the Literature.” Medscape: “Early Symptomatic HIV Infection.”Īmerican Cancer Society: “Lymph Nodes and Cancer.” Harvard Health: “The respiratory tract and its infections.”ĬDC: “About HIV/AIDS,” “Cat-Scratch Disease.” Mayo Clinic: “Tooth abscess,” “Swollen lymph nodes,” “Gonorrhea,” “Phenytoin (Oral Route).” ![]()
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