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Results for “Neck Dissection”

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At least 127 records · Page 7Linked to original sources

PubMed1993

A technique for diagnosing the individual patterns of innervation of the trapezius muscle prior to neck dissection.

Based on the techniques of regional anaesthesia, a method for simulating the effects of radical neck dissection on the innervation of the trapezius muscle by selectively and reversibly blocking the accessory nerve and its superficial cervical anastomoses, was developed and tested on 40 patients who were due to undergo radical neck dissection. Action potentials of the three portions of the muscle were recorded after this blockade as well as after radical neck dissection, and compared. It was found that the electromyograms were congruent in 92.5% of the cases. Four patterns of innervation were demonstrated, ranging from complete substitution of the resected or blocked nerves to a remaining muscle activity of less than 20% after blockade or radical neck dissection.

Accessory Nerve↗

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↗

PubMed1985

Modified neck dissection. A study of 967 cases from 1970 to 1980.

The medical records of 967 patients treated with a modified neck dissection were carefully reviewed, and the data were collected and statistically analyzed. For a primary tumor in the oral cavity or oropharynx, a supraomohyoid neck dissection was adequate treatment for the neck that was both clinically staged N0 or N1 and pathologically staged N1 without evidence of extracapsular invasion. For primary tumors in the larynx and hypopharynx, an elective bilateral anterior neck dissection is considered proper treatment if the nodes are not multiple or if connective tissue disease is not present. A functional neck dissection is effective neck treatment regardless of the primary site or stage of the disease. The selective use of postoperative radiotherapy can more effectively decrease the incidence of neck recurrence compared with surgery alone in patients with multiple positive nodes, a node more than 3 cm in size, or nodes with extracapsular invasion.

Adult↗

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↗

PubMed1992

Functional neck dissection: three decades of controversy.

Functional neck dissection (FND) is a neck-functional, tumor-radical approach for the management of the neck in patients with head and neck cancer. Based on the anatomic knowledge of the lymphatic compartments of the neck, FND is a different surgical technique rather than a modification of the classic procedure described by Crile. From an oncologic viewpoint, FND is a relatively safe operation to treat the cervical spread from head and neck cancer as long as the indications and technical details are carefully followed. In this report, based on our experience with more than 1,000 FNDs, we analyze the history and the philosophy of the operation.

Argentina↗

PubMed1990

Accessory nerve conduction in neck dissection subjects.

Evaluation of the accessory nerve and trapezius muscle was performed on eight subjects with neck dissection secondary to oropharyngeal/laryngeal cancer. The latencies and amplitudes of the upper, middle, and lower trapezius muscle in neck dissection subjects were compared to those in healthy subjects similar in age. Subjects after neck dissection showed abnormalities of evoked responses and abnormal spontaneous discharges in electromyographic studies of the upper trapezius. Future serial studies that seek prognostic indicators of shoulder dysfunction common to neck dissection patients are warranted.

Accessory Nerve↗

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↗

PubMed1993

Microsurgical neck dissection for occultly metastasizing medullary thyroid carcinoma. Three-year results.

BACKGROUND: Medullary thyroid carcinoma (MTC) metastasizes early into the regional lymph nodes, but distant metastases occur late. Modified radical neck dissection might improve the treatment results for occultly metastasizing MTC. METHODS: The authors report 23 patients after a minimal follow-up of 2 years (median, 36 months). There were 11 female and 12 male patients. The mean age was 43 years (+/- 13 years). The surgical technique included the meticulous dissection of all compartments of the neck, resulting in a unilateral or bilateral modified radical neck dissection with the complete removal of the lymphatic and fatty tissue between important anatomical structures. The surgical boundaries extended cranially to the mastoid, caudally to the brachiocephalic vein involving a transcervical mediastinal dissection, and laterally to the edge of the trapezoid muscle. Ten patients were treated bilaterally and 13 patients unilaterally. RESULTS: The basal calcitonin values of 18 of the 23 patients were postoperatively normalized with 4 patients having normal basal and pentagastrin-stimulated calcitonin levels. Five patients with persistently elevated basal serum calcitonin values had a marked reduction of the postoperative calcitonin levels compared with their preoperative concentrations. However, in these five patients histologic abnormalities precluded a surgical cure. The permanent complication rates were tolerable (4 of 33 neck dissections). CONCLUSIONS: The microsurgically extended neck dissection can reduce basal and pentagastrin-stimulated serum calcitonin values to normal levels even after long intervals following primary thyroidectomy.

Adolescent↗

PubMed1994

Functional neck dissection for treatment of recurrent branchial remnants.

OBJECTIVE: To evaluate the role of functional neck dissection for treatment of cervical branchial remnants that are recurrent after previous surgical intervention. DESIGN: A retrospective review was undertaken of six patients undergoing functional neck dissection for excision of recurrent branchial anomalies treated over an 18-year period. SETTING: Academic tertiary referral medical center. PARTICIPANTS: Six patients with recurrent branchial cysts, sinuses, or fistulas. Each participant previously had undergone between one and 14 ineffective surgical procedures. INTERVENTION: Each patient was treated by functional neck dissection. OUTCOME MEASURES: Clinically noted complications and recurrences. RESULTS: There were no major complications. Minor complications included one postoperative wound infection and one transient spinal accessory nerve paresis. There were no recurrences. CONCLUSIONS: Functional neck dissection is a safe and effective procedure for surgical management of recurrent cervical branchial remnants.

Adolescent↗

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↗