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PubMedDate not supplied

A modified single flap for neck dissection in oral cancer.

Modification of the single flap for neck dissection is described and illustrated based on experience with 33 cases of squamous cell carcinoma of the oral cavity. The advantages of this modified incision are that there are no three-point junctions. Hence, it can be used after previous radiotherapy to the neck; the vertical limb is well posterior to the carotid artery, and the horizontal limb can be conveniently extended upward and forward to permit a combined resection of the jaw and/or tongue. To avoid necrosis at the apex of the skin flap, particularly after previous radiotherapy, a margin of about 1 cm can be removed prophylactically from the apex. This incision is recommended particularly for neck dissections in squamous cell carcinomas of the oral cavity in patients who have had previous radiotherapy and/or when resection of the mandible or the tongue is to be done at the same time. The incision is not recommended for bilateral neck dissections, nor for neck dissection combined with total laryngectomy or thyroidectomy.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Tongue necrosis after radical neck dissection.

An unusual complication of radical neck dissection is presented. Necrosis of the anterior half of the tongue developed gradually within the first week of bilateral neck dissection. The patient had previously received radiotherapy.

Humans↗

PubMed1978

Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival.

Two hundred sixty-one patients who underwent three types of neck dissection for cervical lymphadenopathy in association with squamous cell cancer of the head and neck are analyzed retrospectively. Patients were grouped into those with histologically negative nodes and those with histologically positive nodes. Statistical analyses for neck recurrence and survival rates were made using the sampled permutation method. The results show that suprahyoid neck dissection is associated with an unusually high recurrence rate in the neck in patients with histologically negative nodes. Modified radical neck dissection and standard radical neck dissection are equivalent with regard to recurrences in the neck and five year survival rates when the disease is above the juguloomohyoid lymph node group. The study suggests that simple upper neck dissection is contraindicated in patients with negative or positive nodes and that modified radical neck dissection can be used in selected patients instead of the formal radical neck operation.

Adult↗

PubMed1975

Conservative neck dissection.

The areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses. These are derived from the embryonal mesenchyme, surrounding muscles and vessels, giving origin to a series of compartments which are in continuity with each other. These compartments, which contain the lymphatic structures, may be entirely removed en bloc including their limiting aponeurotical membranes, as long as the latter are carefully stripped from the muscular and vascular structures. This technique of neck dissection originating with O. Suarez in Argentina, is as radical as any traditional neck dissection, providing that some technical details are respected and that the nodes are still mobile. By preserving many useful or necessary structures of the neck, which themselves are unrelated to the lymphatic spread of cancer, conservative neck dissection presents important functional and cosmetic advantages as compared with traditional neck dissection.

Humans↗

PubMed1986

Tetracycline sclerotherapy for chylous fistula following neck dissection.

In chylous fistulas following radical neck dissections, we have found reexploration to be unrewarding, with infrequent identification of a specific leakage site intraoperatively and persistent fluid accumulation postoperatively. As an alternative, we injected tetracycline hydrochloride into the supraclavicular wound bed. This procedure resulted in a rapid, sustained decline in fistula output in two of three cases, avoiding surgical intervention. Tetracycline sclerotherapy has been described for treatment of intrathoracic and other intracavitary fluid collections. We believe that tetracycline sclerotherapy is an effective adjunct in the management of chylous fistulas following radical neck dissections and that this therapy should be attempted before surgical reexploration.

Adenocarcinoma↗

PubMed1986

The role of modified neck dissection in the treatment of cutaneous melanoma of the head and neck.

One hundred eighty-one patients were treated with a modified neck dissection for suspected or proved metastatic melanoma during a ten-year period. The overall failure rate in the neck was 16%. Eighty-three percent of the patients with neck recurrence died of disseminated disease. A modified neck dissection that preserves important functional and cosmetic structures but does not compromise cancer control seemed to be appropriate treatment for actual or suspected melanoma metastatic to cervical nodes.

Female↗

PubMed1992

Neck dissection for non-squamous malignancy.

Of 1030 patients who underwent neck dissection (radical, modified or selective) in a 27-year period 103 had malignant neck nodes from a primary site in the head and neck with a histological diagnosis other than squamous carcinoma. There were 71 men and 32 women in this group with a mean age of 55 years. 28 patients had neck dissection as part of their initial treatment and 75 for later nodal recurrence. Five-year survival was 52% (40-63%). Survival was site dependent, best for thyroid tumours and worst for tumours of the major salivary glands (chi 1(2) = 6.52, P < 0.05). Histology significantly affected survival, best for papillary tumours and worst for melanoma and undifferentiated tumours (chi 1(2) = 3.85, P < 0.05). Survival was worse with advanced N stage but varied little with node level. The number of nodes invaded had a highly significant effect on survival (chi 4(2) = 23.94, P < 0.001), but extracapsular rupture had no effect. Advanced T stage at the time of surgery had a significant adverse effect on survival using univariate analysis, but this effect disappeared using multivariate analysis. In the 75 patients who had neck dissections for nodal recurrence the presence of a simultaneous recurrence at the primary site had no significant effect on survival. These patients had a better 5-year survival than patients having neck dissection for squamous disease, but the usual predictors of survival in squamous carcinoma do not always apply to non-squamous malignancy.

Female↗

PubMed1987

The efferent supply of the trapezius muscle: a neuroanatomic basis for the preservation of shoulder function during neck dissection.

The hypothesis that there is an alternative motor input to the trapezius muscle through cervical spinal nerves is evaluated through a review of the literature and through experimental studies performed by the author. Electrophysiologic testing of the spinal accessory nerve and of the ventral rami of the cervical spinal nerves was performed in cats and humans. These studies indicated that motor potentials recorded in the trapezius muscle after stimulation of the ventral rami of cervical spinal nerves in general represented the spread of current to the contiguous portions of the spinal accessory nerve or directly to the trapezius muscle. Rarely did there seem to be evidence of motor innervation to the upper and lower trapezius by fibers conveyed by the ventral rami of cervical spinal nerves. The predominant motor input to the trapezius muscle is through the spinal accessory nerve. Subjective evaluation, objective strength testing, and electromyographic evaluation were performed on patients who had undergone neck dissections. Three types of neck dissection were employed. These were modified neck dissection with preservation of the spinal accessory nerve, radical neck dissection with sacrifice of the spinal accessory nerve, and reconstruction using a cable graft and classical radical neck dissection. Regarding all of the methods of evaluation and comparison, the patients who retained function of the spinal accessory nerve in the postoperative period fared better than those who had a classical radical neck dissection with sacrifice of the spinal accessory nerve. This again supports the concept that the most important and predominant motor supply to the trapezius muscle is through the spinal accessory nerve. All of this information was used to construct a model of the spinal portion of the accessory nerve and of the innervation of the trapezius muscle. The clinical implications of this model are stated.

Animals↗

PubMed1978

Indications for radical neck dissection following radiation therapy.

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.

Evaluation Studies as Topic↗

PubMedDate not supplied

Squamous cell carcinoma of the head and neck treated with radiotherapy: does planned neck dissection reduce the change for successful surgical management of subsequent local recurrence?

For patients with squamous cell carcinoma of the head and neck whose primary lesion is managed with radiotherapy, radiotherapy alone or in combination with neck dissection may be used to treat clinically positive neck nodes. Although these two treatment options produce similar control rates for small mobile nodes, it is our impression that radiotherapy plus neck dissection is the preferred treatment for more advanced neck disease. The question that arises is whether the addition of a neck dissection after radiotherapy will decrease the likelihood of successful surgical management of a subsequent recurrence at the primary site. In an effort to answer this question, the records of 227 patients with squamous cell carcinoma of the head and neck were reviewed. All patients had clinically positive neck nodes and were treated with radiotherapy alone to the primary lesion. There was no apparent difference in the rate of disease control at the primary site or in the ability to manage patients successfully who developed a local recurrence when comparing patients initially treated with radiotherapy alone to those managed by radiotherapy and neck dissection. We conclude that postradiotherapy neck dissection does not decrease the likelihood of successfully managing a recurrence at the primary site.

Carcinoma, Squamous Cell↗

PubMed1985

The role of supraomohyoid neck dissection at the time of supraglottic laryngectomy.

Uncontrolled cervical metastasis is the most common source of failure in the surgical treatment of supraglottic carcinoma. This study was designed to determine the value of supraomohyoid neck dissection in patients undergoing supraglottic laryngectomy. The rationale for considering the role of supraomohyoid neck dissection is that such a dissection encompasses the subdigastric and midjugular nodes which are the first echelon of lymphatic drainage of the supraglottic larynx. Thirty-eight patients with a diagnosis of epidermoid carcinoma of the supraglottis were treated by subtotal supraglottic laryngectomy (SSL). Ten patients underwent SSL with no neck dissection, 16 patients underwent SSL with supraomohyoid neck dissection (SOHD)--9 unilateral and 7 bilateral, and 12 patients underwent SSL with radical neck dissection (RND). The 3 groups had comparable T classifications. All of the SSL and SSL with SOHD patients were classified as N0. Of the 12 patients treated with SSL and RND, 4 were classified as N0, 4 as N1, 3 as N2, and 1 as N3. The patients were studied to determine the incidence and pattern of subsequent neck disease, survival, complications, and length of hospitalization. The data indicates that supraomohyoid neck dissection offers little benefit as an adjunct to supraglottic laryngectomy.

Carcinoma↗

PubMed1989

Elective versus therapeutic neck dissection in early carcinoma of the oral tongue.

A prospective, randomized trial was carried out to assess the value of elective versus therapeutic neck dissection in early squamous cell carcinoma of the oral tongue. Disease-free survival (median follow-up 20 months) was 52 percent versus 63 percent in patients who underwent hemiglossectomy alone and those who underwent hemiglossectomy and radical neck dissection, respectively (difference not statistically significant). Patients with a tumor depth of less than 4 mm did significantly better than those with a tumor depth of greater than 4 mm; they were also more likely to have uninvolved nodes at elective radical neck dissection compared with those with a tumor depth of greater than 4 mm. However, when the survival rates of patients in the two treatment groups were compared with respect to a tumor depth of 4 mm, there was no significant difference between the hemiglossectomy and the hemiglossectomy and radical neck dissection groups. A policy of interval elective radical neck dissection only in those with a tumor depth of greater than 4 mm may optimize cure rates and avoid neck dissection in those unlikely to develop neck recurrence.

Adult↗

PubMedDate not supplied

A prospective study of shoulder disability resulting from radical and modified neck dissections.

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation.

Accessory Nerve↗

PubMed1987

Postoperative hypertension associated with radical neck dissection.

The incidence of hypertension following radical neck dissection was examined in 94 consecutive patients. Nine patients (9.6%) had postoperative blood pressure readings of 200/100 mm Hg or higher (n = 4) or of more than 40 mm Hg systolic and more than 20 mm Hg diastolic above preoperative levels (n = 5); ten patients (10.6%) had blood pressure readings of more than 40 mm Hg systolic or more than 20 mm Hg diastolic above preoperative levels. These elevations usually occurred in the first two postoperative hours and lasted approximately nine hours. Six patients required interventional therapy (intravenous nitroglycerin or sodium nitroprusside). No cardiac or central nervous system sequelae resulted, but two patients had postoperative hemorrhage and flap elevation by hematoma attributed to the hypertension. Carotid sinus denervation during radical neck dissection may be the cause of the reflex hypertension once general anesthesia-induced vasodilation has ended. Stripping of tumor from the carotid artery or placement of dermis grafts directly on the artery do not appear to influence postoperative development of hypertension.

Carotid Arteries↗

PubMed1989

Five-year results of functional neck dissection for cancer of the larynx.

Two hundred forty-two patients with a diagnosis of epidermoid carcinoma of the larynx were studied. All of them underwent surgery. One hundred sixty-one patients underwent functional neck dissection, with a total of 206 performed. Thirty-three patients underwent classic radical neck dissection, with a total of 35 performed. The overall 5-year neck tumor recurrence rate in the necks with functional neck dissection was 3.4%. Recurrences developed in 5.7% of fields protected by radical neck dissection. The overall recurrence rate in the surgically unprotected necks was 6.2%. Our results confirm that functional neck dissection is the procedure of choice in cases with NO disease and in cases with mobile nodes. From the oncologic viewpoint, functional neck dissection is a safe technique to treat the cervical spread from cancer of the larynx as long as its indications and technical characteristics are carefully observed.

Adult↗

PubMed1985

Radical neck dissection for squamous cell carcinoma of the head and neck: early and long-term results of treatment.

An account is given of the use of radical neck dissection in a consecutive series of 147 patients treated during the years 1967-76 in the Head and Neck Unit of the Royal Marsden Hospital. The majority had received previous treatment principally by irradiation to full dosage, some by previous surgery, and a minority by induction cytotoxic chemotherapy. The 5-year determinate survival results for surgical salvage are 28.03%, and 20.5% at 10 years. Prevention of recurrent cancer in the neck was achieved in 70% of all those who later succumbed to their disease.

Adult↗

PubMedDate not supplied

Neck dissection for cutaneous malignant melanoma.

This retrospective study examines the experience of the Sydney Melanoma Unit in the management of cervical lymph nodes among patients with cutaneous melanoma of the head and neck. From 1960 to 1990, 397 patients had neck dissections for cutaneous malignant melanoma of the head and neck. This number represents 40% of all patients treated for head and neck melanoma at the Sydney Melanoma Unit during this period. Neck dissections were therapeutic in 152 patients, elective in 234 patients and for an unknown indication in 11 patients. Lymph nodes were histologically positive in 39% of operations overall and in 7% of elective neck dissections. The incidence of recurrence in the neck after dissection was 24% overall, 28% when nodes were histologically positive and 13% when nodes were histologically negative. Patients who developed recurrent neck disease after neck dissection had a worse prognosis than those with positive nodes who did not recur, but the difference in survival was not statistically significant. Patients with histologically positive nodes had a significantly worse survival than those with negative nodes, 34% vs 67% respectively at 10 years (p less than 0.001). Elective neck dissection was associated with a significant improvement in survival for patients with melanomas 1.5-3.9 mm thick, using univariate analysis. This apparent benefit was lost when multivariate analysis was carried out. Patients having elective neck dissection currently have selective modified radical dissections depending upon the anatomic site of the primary melanoma. Postoperative radiotherapy is used for multiple positive nodes or extracapsular spread.

Female↗

PubMedDate not supplied

Neck dissection: radical or conservative.

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.

Carcinoma, Squamous Cell↗