c:neck dissection
TRANSCRIPT
Neck dissection Dr. Mansoor Khan MBBS, FCPS-I, Resident Surgeon
Introduction
Status of the cervical lymph nodes
important prognostic factor in SCCA of theupper aerodigestive
tract
Introduction
Cure rates drop in half when there is regional lymph
node involvement
Emil Theodor KocherEarned Nobel Prize in 1909 for his work in thyroid and neck
surgery — the first ever awarded to a surgeon.
1880 – Kocher proposed
removing nodal
metastases
1906 – George Crile described the classic radical neck dissection (RND)
1967 - Bocca and Pignataro described the “functional neck dissection” (FND)
• Superficial cervical fascia• Deep cervical fascia– Superficial layer• SCM, strap muscles, trapezius– Middle or Visceral Layer• Thyroid• Trachea• esophagus– Deep layer (also prevertebral fascia)• Vertebral muscles• Phrenic nerve
Level - I
Level - II
Level - III
Level - IV
Level - V
Level - VI
Subzones of Levels I-V
Staging of the neck
“N” classification – AJCC (1997)Consistent for all mucosal sites except the nasopharynx
Thyroid and nasopharynx have different staging based on tumor behavior and
prognosis
Lymph node
staging
No regional lymph node metastases
Single ipsilateral lymph node, < 3 cm
Single ipsilateral lymph node 3 to 6 cm
Multiple ipsilateral lymph nodes < 6 cm
Bilateral or contralateral nodes < 6cm
Metastases > 6 cm
“Surgical approach”
Incisions
A p r o n I n c i s i o n
H a l f A p r o n I n c i s i o n
C o n l e y I n c i s i o n
D o u b l e – Y I n c i s i o n
Y -
I n
c i s
i o
n
H - I n c i s i o n
M a c F e e I n c i s i o n
M o d i f i e d S c h o b i n g e r
I n c i s i o n
S c h o b i n g e r I n c i s i o n
Academy’s
class
ificatio
n
Radical neck dissection (RND)
Modified radical neck dissection (MRND)
Selective neck dissection (SND)• Supra-omohyoid type• Lateral type• Posterolateral type• Anterior compartment type
Extended radical neck dissection
Extent of Radical Neck Dissection
IndicationsExtensive cervical involvement or matted lymph nodes with gross extracapsular spread and invasion into the SAN, IJV, or SCM
Radical Neck Dissection All lymph nodes in Levels I-V including spinal accessory nerve (SAN), SCM, and IJV
Modified Radical Neck Excision of same lymph node bearing regions as RND with preservation of one or more nonlymphatic structures (SAN, SCM, IJV) analogous to the “functional neck
MRND Type I
Preservation of SAN
MRND Type II
Preservation of SAN and IJV
MRND Type III
Preservation of SAN, IJV, and SCM ( “Functional neck dissection”)
Selective Neck DissectionsCervical lymphadenectomy with preservation of one or more
lymph node groups (Supraomohyoid neck dissection, Posterolateral neck dissection ,
Lateral neck dissection, Anterior neck dissection)
Sup
raom
ohyo
id n
eck
diss
ectio
n
Selective Neck Dissections
Lateral neck dissection
Extended Neck Dissection
Any previous dissection which includes
removal of one or more additional lymph node groups and/or non-
lymphatic structures.
Radical Neck Dissection