PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Neck Dissection”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
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↗
PubMed1993

Neck dissection with or without postoperative radiotherapy in supraglottic carcinomas.

A retrospective review of 302 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. The 302 patients underwent a total of 383 functional neck dissections and 45 classic radical neck dissections. Pathological examination revealed nodal involvement in 117 patients (39%). In the histologically N0 group, the incidence of contralateral neck recurrence when a unilateral neck dissection and postoperative radiotherapy were carried out was 8%, rising 21% when no postoperative radiation was given. There was no difference in the ipsilateral recurrence rate in the N0 group, radiated patients (3%) and nonradiated patients (2%). Similar figures were found in the N1 group. Bilateral functional neck dissection in histologically N0, N1, and N2 necks had similar recurrence rates with or without radiotherapy. Distant metastasis appeared in 10% of N0 patients and in 35% of N3 patients. Patients who received postoperative radiotherapy showed a significantly higher rate of distant metastasis (21%) than patients who did not (8%). The number of involved lymph nodes had no relevance both in neck recurrence and distant metastasis.

Carcinoma↗
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↗
PubMed1993

Impact of bilateral neck dissection on recovery following supraglottic laryngectomy.

Previously reported data from our institution has led us to perform bilateral neck dissections for therapeutic as well as staging advantages for horizontal supraglottic laryngectomies. Concern over the possibility of increased morbidity associated with simultaneous bilateral neck dissection prompted this retrospective review of patients with supraglottic laryngectomy who were treated with either unilateral (46 patients) or bilateral (23 patients) neck dissection. No significant differences were found in morbidity when patients were evaluated for transfusion rate, cervical wound drainage, need for tracheotomy, oral diet, or duration of hospitalization. Significant differences were noted in surgical operating time, eg, it took 100 minutes longer to perform bilateral dissections, and slight increases were noted in estimated blood loss and fluids given intravenously. No significant differences were noted in the percentage or type of postoperative complications. It seems that bilateral neck dissection in conjunction with supraglottic laryngectomy does not increase postoperative surgical morbidity and may actually avoid complications associated with postoperative radiation therapy in patients with supraglottic laryngectomy.

Carcinoma, Squamous Cell↗
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↗
PubMedDate not supplied

Reflex sympathetic dystrophy following neck dissections.

PURPOSE: Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections. PATIENTS AND METHODS: Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls. RESULT AND CONCLUSION: The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

Accessory Nerve↗
PubMed1996

[Significance of sternocleidomastoid muscle resection in radical neck dissection].

Surgical therapy of cervical lymph node metastasis is based on their accessibility for en bloc resections. First described by Crile in 1906 as a radical neck dissection, this original approach has since undergone various modifications. This has produced an ongoing controversy with regard to the indications of the individual techniques. In a retrospective study, the data of 438 patients with head and neck malignancies managed at the ENT Department of Hamburg University between 1988 and 1994 were analyzed after surgical treatment of cervical lymph nodes. Results showed that 337 patients (76.9%) required unilateral or bilateral selective neck dissections. In 101 patients (23.1%) in whom a radical neck dissection was performed, the sternocleidomastoid muscle was resected completely. Analysis of these cases showed that intraoperative macroscopic invasion occurred in 12 patients (11.9%) and was confirmed histologically. The vast majority of cases (n = 89; 88.1%) had an intact muscle resected without tumor involvement. Further analysis showed no difference between radically or functionally neck-dissected stage III or IV patients with oral cavity, oropharyngeal, hypopharyngeal and laryngeal carcinomas. On the basis of these findings, resection of the sternocleidomastoid muscle is not mandatory in patients undergoing primary surgery without previous (cervical) radiation and when the muscle is found to be macroscopically intact.

Adult↗
PubMed1998

Histologic evaluation of neck dissection specimens.

Histologic evaluations of neck dissection specimens from carcinomas of the head and neck provide information required for disease staging, planning further treatment, and prognosis. Histologic evaluation performed adequately and accurately can and continues to provide a more accurate, meaningful, and promising means of formulating and predicting prognosis including risk of metastases. A multi-institutional study using comprehensive standardized histologic evaluation of histopathologic variables of primary tumor and cervical lymph nodes among homogenous patient groups receiving similar therapy is important. Histopathologic parameters remain an important adjunct parameter to clinical evaluation in guiding, planning treatment, and predicting prognosis for patients with head and neck cancers.

Carcinoma↗
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↗
PubMed1994

Pathological findings in clinically false-negative and false-positive neck dissections for oral carcinoma.

A series of 86 patients presenting with oral cancer underwent neck dissection (114 sides of neck), after preoperative staging by palpation under general anaesthesia and CT imaging. Detailed histopathological assessment of the surgical neck dissection specimens showed the incidence of clinically false-negative and false-positive assessments was 27% and 40%, respectively. Extranodal spread of metastatic carcinoma was present in 16% of clinically negative necks. The pathological findings provided plausible explanations for the clinical misdiagnosis in all 19 of the false-positive necks and in 13 of the 18 false-negative necks, where micrometastases or metastasis to nodes measuring less than 1.7 cm accounted for five and seven misdiagnosed cases, respectively. We conclude that the most stringent clinical protocols, even when supplemented by CT scanning, cannot be expected to achieve 100% accuracy. Detailed histopathological assessment provides the most reliable, currently available method of diagnosing cervical metastatic disease.

Adult↗
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↗
PubMed1984

Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve.

To compare the difference in the degree of pain and functional disability of the shoulder in patients who underwent neck dissection for the treatment of head and neck cancer, 23 patients with and 12 patients without spinal accessory nerve preservation were evaluated with a questionnaire and a physical examination. In addition, to determine what effect radiation treatment has on pain and shoulder disability, eight patients who had whole neck radiation but no neck dissection were similarly evaluated. The results of this study show that, on the average, neck dissection patients with their spinal accessory nerve preserved have less pain in their shoulders, less functional disability, and stronger results on their physical examination than did those with their spinal accessory nerve sacrificed. It was also found that the patients who received whole neck radiation treatment without neck dissection had little pain, infrequent and insignificant functional disability, and normal strength on physical examination.

Accessory Nerve↗