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Radical Neck Dissection

Background

Metastatic neck disease is the most important factor in the spread of head and neck squamous cell carcinoma from primary sites. The primary sites most commonly involved in the spread of this carcinoma are the mucosal areas of the upper aerodigestive tract, particularly the larynx, oropharynx, hypopharynx, and oral cavity.

Lymph node metastasis reduces the survival rate of patients with squamous cell carcinoma by half. The survival rate is less than 5% in patients who previously underwent surgery and have a recurrent metastasis in the neck. Therefore, the control of the neck is one of the most important aspects in the successful management of these particular tumors.

Radical neck dissection is an operation that was created in 1906 to solve the problem of metastatic neck disease. It is a well-designed operation that is relatively easy for the trained head and neck surgeon to learn and to perform. Classic radical neck dissection is still the criterion standard for surgical control of a neck metastasis.

See the image below.

Patient in supine position and head turned to the

Patient in supine position and head turned to the right side. Radical Left Neck Dissection completed: The classical radical neck dissection encompasses the lymphatic nodes in levels I-V. View of the surgical wound after removal of the operative monoblock specimen. S = Superior. I = Inferior. M = Medial. L = Lateral. (1) Anterior and posterior bellies of the digastric muscle. (2) Carotid artery and vagus nerve. (3) Anterior cervical nerve root. (4) Phrenic nerve. (5) Brachial plexus. (6) Internal jugular vein, inferior aspect, cut and ligated. (7) Anterior scalene muscle. (8) External jugular vein, inferior aspect, cut and ligated. (9) Hypoglossal nerve. (10) Sternocleidomastoid muscle, superior aspect, cut.

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In the last 3 decades, progressive advances have occurred in the understanding of cervical fascial planes, lymphatic drainage patterns, preoperative staging, and extracapsular spread. A concern to maximize control and to minimize morbidity has prompted modifications to the classic neck dissection. One such modification is the preservation of 1 or more nonlymphatic structures (eg, spinal accessory nerve, internal jugular vein, sternocleidomastoid muscle). Further observations have indicated that the pattern of nodal disease depends on the primary site. Therefore, these findings led to another neck dissection modification, which is the selective preservation of 1 or several lymph node groups.

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