20 views

Right Neck Dissection

Introduction 

Neck dissection stands as a crucial surgical procedure predominantly utilized in addressing head and neck cancers. It involves the methodical elimination of lymph nodes and potentially adjacent tissues to curb cancer dissemination. This procedure can be delineated into several types based on the extent of surgery and the structures targeted, including radical neck dissection (RND), modified radical neck dissection (MRND), selective neck dissection (SND), and extended neck dissection.[1]

Neck dissection is recommended for various conditions such as metastatic neck cancer, cancers affecting the oral cavity, pharynx, larynx, or thyroid with a high risk of lymphatic spread, and as a prophylactic measure in cases of head and neck cancers with a high risk of occult metastasis.[1] Understanding the anatomy of the cervical lymphatic system, which is divided into distinct levels (I-VII) each containing specific groups of lymph nodes, is essential for conducting effective neck dissection.[2,3] The radical neck dissection (RND), introduced by George Crile Sr. in 1906, was long regarded as the standard treatment for metastatic neck disease.[2,4] However, modifications to the procedure have been developed over time to reduce associated morbidity while ensuring oncological safety.[1]

Surgical procedure 

The surgical procedure of neck dissection typically involves a series of steps: an incision is made along an existing neck crease, subplatysmal flaps are then elevated to expose underlying anatomical structures and lymph nodes, different groups of lymph nodes are systematically removed depending on the type of dissection, and finally, the surgical site is closed in layers with the placement of a drain.[4] Complications of neck dissection may include nerve damage resulting in shoulder dysfunction, bleeding and hematoma formation, infection and issues with wound healing, as well as the development of lymphedema.[1]

Conclusion 

Neck dissection is a vital procedure in the management of head and neck cancers, designed to remove lymph nodes that may harbor metastatic disease. The type of neck dissection performed is tailored to the extent of disease and the need to preserve function and reduce morbidity. A thorough understanding of the anatomy and careful surgical technique are essential to optimize outcomes and minimize complications.

References 

Harish K. Neck dissections: radical to conservative. World J Surg Oncol. 2005 Apr 18;3(1):21. doi: 10.1186/1477-7819-3-21. PMID: 15836786; PMCID: PMC1097761.
Jiang, Z., Wu, C., Hu, S. et al. Research on neck dissection for oral squamous-cell carcinoma: a bibliometric analysis. Int J Oral Sci 13, 13 (2021). https://doi.org/10.1038/s41368-021-00117-5
Rigual NR, Wiseman SM. Neck dissection: current concepts and future directions. Surg Oncol Clin N Am. 2004;13(1):151-166. doi:10.1016/S1055-3207(03)00119-4
Antonio Riera March, M. (2023, November 28). Radical neck dissection. Background, History of the Procedure, Problem. https://emedicine.medscape.com/article/849895-overview?form=fpf

Neck dissection is a critical aspect of head and neck surgeries, addressing lymphatic metastasis in the regional area. The primary objective remains the removal of nodal disease while minimizing functional morbidity by preserving vital structures. Various classification systems categorize neck dissections based on the extent of lymph node removal, ranging from selective to radical approaches. Indications include visible lymphadenopathy, high-risk primary tumors, and specific histologic subtypes with increased nodal metastatic potential. Surgical advancements, aided by improved imaging and minimally invasive procedures, have enhanced neck metastasis management. Challenges persist, such as balancing oncologic control with postoperative complications. Additionally, the evolving role of adjunctive therapies like radiation and chemotherapy impacts treatment strategies and outcomes. A deep understanding of neck dissection nuances is crucial for informed surgical decisions and optimizing patient care in head and neck oncology.
Right neck dissection is a surgical procedure that involves the removal of lymph nodes and surrounding tissue from the right side of the neck. The history of neck dissection reveals a continuing quest to reduce its complications and sequelae. Since its original description by Crile in 1906 and subsequent popularization by Hays Martin in 1951, the neck dissection remained the standard treatment for palpable or potential cervical metastasis in head and neck cancers [1]. The goal of right neck dissection is to remove all the lymph nodes within a predefined anatomic area, which includes the levels I to V lymph nodes.
The hemiapron neck incision was made, followed by raising subplatysmal flaps with monopolar electrocautery and placing self-retaining retractors. Fibrofatty tissue dissection involved preserving the marginal mandibular nerve and separating tissue between the mandible and digastric muscle bellies. The common facial vein and submandibular gland vessels were ligated and transected. Anterior sternocleidomastoid muscle dissection was followed by deep dissection to locate the jugular vein and cranial nerve XI. Fibrofatty tissue from level IIb was included in the specimen without compromising cranial nerve XI. Dissection continued superiorly to inferiorly through level III, preserving cervical rootlets as the posterior boundary. Omohyoid was transected, and dissection proceeded to level IV, where neck base fat was tied off. The specimen was carefully removed, divided for pathological examination into levels Ib, II, III, and IV.
The patient was taken to the recovery room for postoperative care. He was monitored closely for any signs of complications or bleeding. The patient was discharged from the hospital with instructions for wound care and follow-up appointments in the clinic.
There are several types of neck dissections, including radical neck dissection, selective neck dissection, and modified radical neck dissection [2,3].There are generally no absolute contraindications to neck dissection except for cases where a patient is deemed unfit for general anesthesia and resection, with the exception being unresectable disease [4,5]. However, there are relative contraindications, which include severe cardiopulmonary disease, preoperative imaging showing deep tumor infiltration in critical structures, uncontrollable primary tumors, distant metastatic disease. An absolute contraindication is a fixed neck mass in deep neck muscles, involvement of the prevertebral fascia, and/or skull base, indicating unresectable disease [6]. Radical Neck Dissection involves the removal of all lymph nodes from levels I-V, as well as the ipsilateral sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. Its primary advantage lies in offering the most extensive lymph node clearance, ensuring the elimination of all possible sites of metastatic disease. However, this comprehensive approach comes with notable drawbacks, including significant morbidity associated with the removal of critical structures such as the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. This can lead to shoulder dysfunction, neck deformity, and potential difficulties with swallowing and speech [2,3,7]. Selective Neck Dissection  involves the removal of specific groups of lymph node levels, determined by the pattern of lymphatic drainage and the location of the primary tumor. Its primary advantage lies in reducing morbidity by preserving non-lymphatic structures and removing only the lymph node levels at risk of harboring metastatic disease. However, a potential drawback is the risk of incomplete lymph node clearance if the selected levels do not accurately reflect the pattern of lymphatic drainage or the extent of metastatic disease [2,3,7]. Modified Radical Neck Dissection entails removing all lymph nodes from levels I-V while preserving one or more non-lymphatic structures such as the sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve. Its advantage lies in reduced morbidity compared to Radical Neck Dissection as it spares these structures while still achieving thorough lymph node clearance. However, a potential downside is the risk of incomplete lymph node clearance if the preserved non-lymphatic structures are affected by the disease[2,3,8]. In summary, neck dissection is a surgical procedure for removing lymph nodes and adjacent tissue while retaining one or more critical extranodal structures. It's recommended for patients with advanced nodal disease from squamous cell carcinoma of the oral tongue, offering a balance between oncological effectiveness and morbidity. The surgical approach entails a transverse incision in the neck, which is then extended vertically on the affected side. Potential complications of this procedure include bleeding, infection, and nerve injury.
None
None
1. Sharma N, George NA, Sebastian P. Neurovascular Complications After Neck Dissection: a Prospective Analysis at a Tertiary Care Centre in South India. Indian J Surg Oncol. 2020 Dec;11(4):746-751. doi: 10.1007/s13193-020-01229-w. Epub 2020 Sep 26. PMID: 33299287; PMCID: PMC7714874. 2. Stack, B. C., & Moreno, M. A. (2019). Neck dissection. Thieme Medical Publishers, Inc. 3. Harish K. Neck dissections: radical to conservative. World J Surg Oncol. 2005 Apr 18;3(1):21. doi: 10.1186/1477-7819-3-21. PMID: 15836786; PMCID: PMC1097761. 4. Lydiatt DD, Karrer FW, Lydiatt WM, Johnson PJ. The evaluation, indications, and contraindications of selective neck dissections. Nebr Med J. 1994;79(5):140-144. 5. Byers RM. Neck dissection: concepts, controversies, and technique. Semin Surg Oncol. 1991;7(1):9-13. doi:10.1002/ssu.2980070104 6. Gogna S, Kashyap S, Gupta N. Neck Cancer Resection and Dissection. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536998/ 7. Wistermayer P, Anderson KG. Radical Neck Dissection. [Updated 2023 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563186/ 8. O'Brien CJ, Urist MM, Maddox WA. Modified radical neck dissection. Terminology, technique, and indications. Am J Surg. 1987;153(3):310-316. doi:10.1016/0002-9610(87)90614-3

Review Right Neck Dissection.

Your email address will not be published. Required fields are marked *

Related Videos

Sponsored Videos

Your 30-second teaser has ended. Log in or sign up to watch the full video.

Newsletter Signup

"*" indicates required fields