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PubMed1990

Acute upper airway obstruction following 'staged' bilateral radical neck dissections in previously irradiated patients.

Synchronous bilateral radical neck dissection is generally avoided because of the dramatic oedema that usually ensues. One recommended safer alternative is to perform 'staged' operations. Two case are presented in which acute supraglottic obstruction followed the second neck dissection in patients who had also received radiotherapy to the neck. It is believed that the obstruction was due to swelling following lymphatic destruction secondary to the irradiation, rather than by venous congestion. Some recommendations are made for the management of such cases to avoid this complication.

Acute Disease↗
PubMed1980

[Secondary metastases after neck dissection (author's transl)].

Hundredfourty-eight patients who underwent three types of neck dissection for cervical lymphadenopathy for squamous cell cancer of the head and neck were analysed retrospectively. In patients with no recurrence of the primary tumour the secondary metastases appeared in 44% after suprachyoid neck dissection, in 33% after classical and in 19% after modified neck dissection.

Carcinoma, Squamous Cell↗
PubMed1992

Value of the supraomohyoid neck dissection with frozen section analysis as a staging procedure in the clinically negative neck in squamous cell carcinoma of the oral cavity.

A retrospective analysis was performed to evaluate with the efficacy of elective supraomohyoid neck dissection (SOND) with frozen section (FS) analysis in 57 newly diagnosed patients (62 SONDs) with squamous cell carcinoma of the oral cavity. The protocol included sampling of both the most suspect and largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present). These nodes were then studied with FS histological examination. In the absence of evident nodes for FS analysis during surgery, histological examination uncovered occult metastatic disease in 3 of 11 SOND specimens. Among the remaining patients FS analysis revealed occult metastatic disease in 10 of the 51 samples (19.6%). In these latter cases surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In 1 specimen only a single metastasis was found outside the original extent of the SOND. Among 41 FS analysis reports stating the absence of metastatic disease, histological examination of the SOND specimens demonstrated occult nodal disease in 7 (17%). All of the cervical metastases appeared in the ipsilateral side of the neck. False FS reports did not occur. In the histologically proven absence of metastatic disease in the SOND specimens, disease recurrence in the neck occurred only in 3 cases (7%), all in the presence of local failure: once in the previous SOND area, once in the ipsilateral supraclavicular region and once on the contralateral side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Supraomohyoid neck dissection: rationale, indications, and surgical technique.

The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submental and submandibular triangles (lymph node level I), the jugulodigastric and jugulo-omohyoid lymph node groups, and the lymph node-bearing tissues located anterior to the cutaneous branches of the cervical plexus and above the omohyoid muscle (lymph node levels II and III). The sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein are preserved. This type of neck dissection is indicated in the surgical management of the neck in patients with large T2, T3, and T4 squamous cell carcinomas of the oral cavity in whom the cervical lymph nodes are either clinically negative (N0) or single, discrete, and less than 3 cm in diameter (N1). In this paper, we discuss the rationale for this operation, its staging, and its therapeutic value, and present a detailed description of the surgical technique.

Carcinoma, Squamous Cell↗
PubMed1992

[Bilateral chylothorax after radical neck dissection. Apropos of a case].

Bilateral chylothorax following radical neck dissection is an uncommon complication of head and neck surgery. Only 9 more cases have been reported in the English literature until now. Early recognition is not difficult if it is bear in mind when evaluating dyspnoeic patients with bilateral pleural effusions after neck dissection. In this paper the authors report their experiences with a case and comment on the treatment employed. The authors believe that due to its potential severity, it must be considered when ever head and neck surgery is performed.

Chylothorax↗
PubMed1980

Functional neck dissection. A description of operative technique.

The operative technique involved in functional neck dissection is described to clarify its stepwise execution. Recent interest in functional preservation demands therapeutic techniques that are oncologically reliable but not multilating. The functional neck dissection seems to be a reasonable alternative to radical radiotherapy and a preferred alternative to traditional neck dissection in the control of regional metastasis when disease in the neck is either occult of still confined to mobile lymph nodes.

Head and Neck Neoplasms↗
PubMed1981

Bilateral radical neck dissection.

From January 1960 to December 1977, 61 patients had a simultaneous one-stage bilateral neck dissection with or without excision of the primary lesion, while 63 patients had a therapeutic second (two stage) neck dissection performed by our service. In ten patients, one or both of the internal jugular veins and spinal accessory nerve were preserved. Patients in both groups were staged, using the American Joint Commission 1977 clinical classification. All the pathologic specimens had lymph node clearance done. Simultaneous bilateral neck dissection, in the present study, has an operative mortality of 10%, with 11% life-threatening complications and with 62% significant postoperative facial swelling. There is an overall three- and five-year survival rate of 20% and 12.5%. Patients who had bilateral staged neck dissection had complications seen in 54%, with a 3.2% mortality rate. The overall three- and five-year survival in this group of patients was 60% and 38%, respectively.

Aged↗
PubMedDate not supplied

Cervical metastases following radical neck dissection that preserved the spinal accessory nerve.

In contrast to the original neck dissection technique, the spinal accessory nerve is routinely sacrificed in the so-called classical neck dissection. The benefit of this routine has never been documented; on the contrary, facts have accumulated that indicate that the nerve should be preserved. The results in this article serve to emphasize this opinion. Of 80 patients who underwent radical neck dissection that preserved the spinal accessory nerve, the potential for cure was not jeopardized in a single case.

Accessory Nerve↗
PubMedDate not supplied

Reconstruction of spinal accessory nerve after radical neck dissection.

Resection of the spinal accessory nerve in cases of radical neck dissection often causes considerable damage to the function of the shoulder girdle; it leads to limitation of the motion of the upper limb and pain in the shoulder girdle. It seems a sensible compromise to reconstruct the spinal accessory nerve in one-stage operation with radical neck dissection, which can often prevent extensive atrophy of the trapezius muscle, with a resultant improvement in the chance of successful rehabilitation. The technique of the operation is described: after completion of radical neck dissection, in one-stage operation an autogenous nerve transplant from the n. auricularis magnus is sewn onto the central and peripheral stumps of the spinal accessory nerve, which are protected by a "vein-muff" and the fascia of the muscle. After such spinal accessory nerve reconstruction, subjective complaints and objective symptoms were much milder in 6 patients than in the control group, which consisted of 10 patients who underwent a similar operation but without spinal accessory nerve reconstruction.

Accessory Nerve↗
PubMed1987

Modified radical neck dissection. Terminology, technique, and indications.

The terminology relating to the various modifications of radical neck dissection is loose and confusing. A simple system of nomenclature has been suggested which allows specification of the node levels dissected and the structures preserved. A technique of modified neck dissection, which excludes dissection of the posterior triangle and spares the sternocleidomastoid muscle and spinal accessory nerve, has been described. We believe this operation is appropriate when local disease is advanced and clinically uninvolved neck nodes are likely to harbor occult metastatic disease, when resection of the primary tumor is through the neck, or when clinical disease in the neck is minimal. Patients with multiple palpable nodes, patients with nodes larger than 3 cm in diameter, patients with disease in the posterior triangle, and patients in whom radiotherapy to the neck has failed may be better served by radical neck dissection.

Head and Neck Neoplasms↗
PubMed1985

Recurrence of carcinoma of the oral cavity, oropharynx and maxillary sinus after radical neck dissection.

Cervical recurrence was studied in 63 patients who had undergone radical neck dissection for the treatment of carcinoma of the oral cavity, oropharynx and maxillary sinus. Over the whole series, recurrence occurred in 17 patients (27%). The rate of recurrence did not decrease in patients who remained free of carcinoma at the primary site, but was significantly lower in patients in whom elective neck dissection was performed than in those who were treated by therapeutic or secondary neck dissection. With the exception of two patients, cervical recurrence was associated with the presence of metastatic lymph nodes. Although the rate of recurrence was not affected by the number of metastatic lymph nodes, it was very high (80%) in patients having metastatic lymph nodes with histological evidence of extra-nodal spread. The results indicate that elective treatment by irradiation or surgery may be needed to reduce cervical recurrence because of a high tendency of carcinoma of the oral cavity and adjacent regions to metastasize.

Carcinoma, Squamous Cell↗
PubMed1986

Neck dissection with and without radiotherapy: prognostic factors, patterns of recurrence, and survival.

A group of 179 patients who had 205 neck dissections between 1979 and 1984 has been reviewed to assess the influence of adjuvant radiotherapy on survival. Lymph nodes were histologically involved in 91 of 107 radical neck dissections (85 percent) and 55 of 98 modified neck dissections (56 percent). Eighty-two patients received adjuvant radiotherapy of 5,000 rads or more. Patients with involved nodes had significantly lower survival rates than those with uninvolved nodes. Among patients with involved nodes, survival was significantly lower when two or more nodes were involved, when there was nodal involvement at multiple levels, or when extracapsular spread was present. Adjuvant radiotherapy was associated with a reduced recurrence rate in the ipsilateral neck but the incidence of distant metastases was higher. When patients with involved nodes were subgrouped according to prognostic factors, the survival of irradiated patients was improved only in the highest risk group, but this was not statistically significant. When radiotherapy is added to neck dissection for treatment of cervical metastases it can be expected to reduced ipsilateral neck recurrence and prevent relapse in the contralateral neck. Improved survival may depend on an ability to detect and treat occult distant metastases.

Adult↗
PubMed1988

Radical neck dissection: is it enough?

This series of 307 patients who underwent radical neck dissection showed an overall recurrence rate of 19 percent. Clinical staging of disease was an accurate predictor of both recurrence and survival. Extranodal disease dramatically increased recurrence and decreased survival. Although our recurrence rate after radical neck dissection was lower than that previously reported for surgery alone, it was still significantly higher than that after adjuvant radiotherapy. We conclude that histologically proved neck disease should be treated by radical neck dissection, followed by adjuvant radiotherapy to decrease recurrence and, it is hoped, improve survival.

Aged↗
PubMed1985

Modified radical neck dissection for metastatic carcinoma of the thyroid. A reappraisal.

From January 1958 through December 1983, 56 modified radical neck dissections were performed on 47 patients with metastases to the cervical nodes from differentiated carcinomas of the thyroid. In nine patients, a second modified radical neck dissection was performed either simultaneously or at a later date. Lymph node clearance was performed on all but one surgical specimen. The number of nodes in each specimen ranged from 10 to 96, and the number of involved nodes ranged from 1 to 20. Thirty-eight of the 56 neck specimens contained four or more positive nodes. Seventeen patients were followed for 10 to 26 years, 18 patients for 5 to 9 years, and 5 patients for less than 5 years. Seven other patients died, three from other causes and four from lung metastases. There were no recurrences in the neck sides that would have been cleared if standard radical neck dissection had been performed. This reappraisal with long-term follow-up supports our initial impression that a modified radical neck dissection sparing the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, or any combination thereof is an effective procedure for differentiated cancer of the thyroid, with preservation of good shoulder function and improvement in the cosmetic appearance of the neck.

Adenocarcinoma↗
PubMed1988

Modified neck dissection in treatment of thyroid cancer: a safe procedure.

Differentiated carcinoma of the thyroid metastasizes early and frequently to cervical lymph nodes. Radical neck dissection performed electively or therapeutically results in high cure rates. Modified neck dissection consisting of a single transverse incision, resection of the jugular chain of nodes and those in the posterior triangle of the neck with preservation of the sternomastoid muscle, the spinal accessory nerve and the submandibular salivary gland provides a cosmetic, functional result with minimal morbidity. In a series of 313 neck dissections for thyroid carcinoma, only three patients with papillary or follicular carcinoma, which was resectable, treated by thyroidectomy and modified neck dissection died of disease.

Adolescent↗
PubMed1983

Functional evaluation of the spinal accessory nerve after neck dissection.

The pain and dysfunction associated with a loss of innervation by the spinal accessory nerve has motivated surgeons to modify the classic radical neck dissection. A prospective study of 109 patients who underwent either a radical neck dissection or a modification of it with preservation of the spinal accessory nerve revealed that those patients in whom the nerve, muscle, and vein were preserved had less dysfunction (30 percent) than those with nerve preservation only (50 percent) or classic radical neck dissection (60 percent). In addition, even when the functional disability was the same, there was less associated pain with nerve-sparing procedures. Furthermore, a large group of patients (40 percent) who underwent classic radical neck dissection had minimal disability. Given these results, a prospective study of recurrence data in these patients is indicated.

Accessory Nerve↗
PubMed1987

Indications for bilateral neck dissection in well-differentiated carcinoma of the thyroid.

This paper analyses the results of sixty-eight patients with thyroid carcinoma in whom bilateral modified radical neck dissection was performed, and discusses the indications for bilateral modified radical neck dissection. High frequencies of bilateral jugular lymph node metastases were found in eleven patients with obviously widespread involvement of both thyroid lobes, 13 with cancer mainly located in the isthmus, 2 with clinically detectable bilateral or contralateral jugular chain lymph node metastases, and 10 with recurrent thyroid cancer. Bilateral modified radical neck dissection, therefore appears to be indicated for those conditions. On the other hand, lymph node metastases in the contralateral neck were histologically confirmed in 6 out of 27 patients (22 per cent), in whom papillary carcinoma was clinically confined to one lobe, and where there were no obviously enlarged lymph nodes in the contralateral neck. In those patients, the histological confirmation of the contralateral thyroid lobe involvements, and of the contralateral paratracheal lymph node metastasis, appears to be a valid indication for elective contralateral modified radical neck dissection.

Adenocarcinoma↗