Central neck dissection
And facial plastic dissection d: oct 17, : ron mitzner, md; chief editor: arlen d meyers, md, mba more... Dissection dissection fication of neck s in the head and neck region commonly metastasize to cervical lymph nodes. The term "neck dissection" refers to a surgical procedure in which the fibrofatty contents of the neck are removed for the treatment of cervical lymphatic metastases. Neck dissection is most commonly used in the management of cancers of the upper aerodigestive tract. It is also used for malignancies of the skin of the head and neck area, the thyroid, and the salivary glands as depicted in the images ive neck dissection levels ive neck dissection levels ive neck dissection for thyroid cancer: selective neck dissection vi, or anterior neck ive neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection ii-v, postauricular, suboccipital, or posterolateral neck 6 levels of the neck with l neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. Crile described the operation in 1906, and until recently, radical neck dissection was considered the standard procedure for management of both occult and clinically positive neck disease. This shift is predicated upon the following 2 important insights that developed over a period of time: 1) the removal of lymphatic tissue is not hindered by preserving adjacent nonlymphatic structures; and 2) the specific nodal groups at risk for metastatic disease are predictable on the basis of the size, location, and other features of the primary dissection with conservation of nonlymphatic structures was shown by bocca, gavilan, and others to yield equivalent oncologic outcomes, with improved functional results. 2, 3] experimental studies of lymphatic drainage, coupled with clinical studies of the specific location of nodal metastasis within neck dissection specimens, provided the rationale for more targeted surgery. As a result, a great variety of surgical procedures have been described for use in various clinical order to bring uniformity to the terminology used to describe these operations, the american academy of otolaryngology-head and neck surgery (aao-hns) sponsored the committee for head and neck surgery and oncology to develop a classification system for neck dissections.
This schema, later modified in 2002 and 2008, has become universally accepted and is currently endorsed by both the aao-hns and the american society for head and neck lymphatic drainage of the mucosal surfaces and other tissues of the head and neck is directed to the lymph nodes located within the fibroadipose tissue that lies between the investing (superficial) layer of the deep fascia superficially and the visceral and prevertebral layers underneath. This classification was used to describe the patterns of metastatic dissemination observed in more than 1000 patients who were treated at the center with radical neck dissection. Lymph nodes in the neck are grouped into levels i-v, corresponding with the submandibular and submental nodes (level i); upper, middle, and lower jugular nodes (levels ii, iii, iv); and posterior triangle nodes (level v). Refer to the following 6 levels of the neck with level has been defined as being bound by the body of the mandible superiorly, the stylohyoid muscle posteriorly, and the anterior belly of the digastric muscle on the contralateral side anteriorly. The nodes of level ia are at greatest risk of harboring metastasis from cancers that arise from the floor of mouth, anterior tongue, anterior mandibular alveolar ridge, and lower lip, while the nodes of level ib often receive metastasis from cancers of the oral cavity, anterior nasal cavity, soft tissue structures of the midface, and submandibular ive neck dissection levels y related, although not strictly a part of the level i group of nodes, are the perifacial nodes, related to the facial vessels above the mandibular margin, and the buccinator nodes, which may become involved with metastasis from tumors in the buccal mucosa, nose, and soft tissues of the cheek and ii lymph nodes are related to the upper third of the jugular vein, extending from the skull base to the inferior border of the hyoid bone. The nodes in level ii are at greatest risk of harboring metastasis from cancers that arise from the oral cavity, nasal cavity, nasopharynx, oropharynx, hypopharynx, larynx, and parotid ive neck dissection levels iii nodes are located between the hyoid superiorly and a horizontal plane defined by the inferior border of the cricoid cartilage. See the image shown ive neck dissection levels refers to the group of nodes related to the lower third of the jugular vein. The nodes of level iv commonly harbor metastasis from cancer that originates in the larynx, hypopharynx, thyroid,[13] and cervical esophagus as shown ive neck dissection levels refers to the lymph nodes located in the posterior triangle of the neck. This level is subdivided by a plane defined by the inferior border of the cricoid cartilage into level va superiorly and level vb ive neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection ii-v, postauricular, suboccipital, or posterolateral neck va contains the nodes associated with the spinal accessory nerve, and level vb contains the transverse cervical and supraclavicular nodes.
The posterior triangle nodes are at greatest risk for harboring metastasis from cancers that arise in the nasopharynx, oropharynx, and skin of the posterior scalp and refers to lymph nodes of the anterior, or central, compartment of the neck. Lymph nodes in the central compartment are not routinely excised in radical neck dissection; most commonly, they are removed during surgery for thyroid, laryngeal, and hypopharyngeal cancer. See image shown ive neck dissection for thyroid cancer: selective neck dissection vi, or anterior neck fication of neck ples of current classification of neck dissections developed by the committee for head and neck surgery and oncology of the american academy of otolaryngology-head and neck surgery is based on the following governing principles:Radical neck dissection is the standard basic procedure for cervical lymphadenectomy, and all other procedures represent one or more modifications to this modification of the radical neck dissection involves preservation of one or more nonlymphatic structures, the procedure is termed a modified radical neck dissection (see the medscape reference ed radical neck dissection). The modification involves one or more lymph node groups that are routinely removed in the radical neck dissection, the procedure is termed a selective neck the modification involves removal of additional lymph node groups or nonlymphatic structures relative to the radical neck dissection, the procedure is termed an extended radical neck l neck ally described by crile in 1906, this procedure is an en bloc clearance of all fibrofatty tissue from one side of the neck, including the lymph nodes from levels i-v and lymph nodes that surround the tail of the parotid gland, the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle. Radical neck dissection does not include the removal of the postauricular, suboccipital, perifacial, buccinator, retropharyngeal, or central compartment nodes. Previously used for neck disease of any stage, from microscopic to bulky nodal disease, this procedure is now limited to patients with advanced neck disease, recurrent disease after chemoradiation, or gross extracapsular spread to the spinal accessory nerve, sternomastoid muscle, and the internal jugular ed radical neck operation involves the removal of the same lymph node groups as those involved in the radical neck dissection (levels i-v) but requires preservation of 1 or more of the following 3 nonlymphatic structures: the spinal accessory nerve, the internal jugular vein, and the sternomastoid muscle. The structure or structures preserved should be specifically indicated in the name of the procedure (eg, modified radical neck dissection with preservation of accessory nerve and internal jugular vein). Conversion to the radical neck dissection becomes necessary upon gross involvement of the nerve, vein, and muscle, although the involvement of all 3 is unusual, except in very advanced (n3) disease. This term refers to any type of neck dissection that involves removal of lymph nodes from levels i-v and corresponds, therefore, to radical neck dissections and modified radical neck dissections, according to the academy's ive neck term refers to a type of neck dissection in which one or more lymph node groups normally removed in a radical neck dissection are preserved.
The 1991 classification schema classified selective neck dissections into the following categories: supraomohyoid neck dissection (levels i, ii, iii), lateral neck dissection (levels ii, iii, iv), anterior compartment neck dissection (vi), and posterolateral neck dissection (levels ii, iii, iv, v). Because of the increased use of selective neck dissection and the increased selectivity with which lymph node groups are removed, the committee for head and neck surgery and oncology revised the classification of selective neck dissections in e the 1991 classification did not provide an accurate description of procedures in which the surgeon preserves certain sublevels, the 2002 classification excludes the above listed "named" selective neck dissections. In the 2002 classification, selective neck dissections are described with respect to the lymph node levels removed. Retrospective study by barzan et al indicated that selective neck dissection can be safely and effectively performed as primary and salvage surgery. The report involved 827 patients with primary head and neck tumors who underwent the selective operation, with just 22 of 40 neck cancer recurrences later arising on the dissected side of the neck. Kingdom (uk) national multidisciplinary guidelines from 2016 on the management of neck metastases in head and neck cancer included the following recommendations with regard to selective neck ive neck dissection is as effective as modified radical neck dissection for controlling regional disease in n0 necks for all primary ive neck dissection alone is adequate treatment for pn1 neck disease without adverse histologic national multidisciplinary guidelines from 2016 regarding recurrent head and neck cancer included the following er elective selective neck dissections in patients with recurrent primaries with n0 necks, especially in advanced ive neck dissection (with preservation of nodal levels, especially level v, that are not involved by disease) in patients with nodal (n+) recurrence appears to be as effective as modified or radical neck national multidisciplinary guidelines from 2016 for the management of thyroid cancer included the recommendation that patients with medullary thyroid cancer with lateral nodal involvement undergo selective neck dissection (iia–vb). National multidisciplinary guidelines from 2016 for the management of lateral skull base cancer included the recommendation that for patients undergoing surgery for squamous cell carcinoma, at least a superficial parotidectomy and selective neck dissection be carried ive neck dissection for oral cavity ive removal of the level i, ii, and iii lymph nodes is the surgical procedure of choice for management of n0 and n1 disease that originates from cancers of the oral cavity as shown below; however, because of the lymphatic drainage of the oral tongue, some authorities advocate selective neck dissection (i-iv) for cancers that originate from this subsite. These neck contents are peeled off from the internal jugular vein and from around the accessory nerve, sparing these structures (see the image below). Neck dissection levels ive neck dissection for oropharyngeal, hypopharyngeal, and laryngeal ive neck dissection (ii-iv) is the surgical procedure of choice in the elective treatment of neck disease in patients with cancers that originate in the oropharynx, hypopharynx, or larynx (refer to image below).
Neck dissection levels spinal accessory nerve, sternomastoid muscle, and internal jugular vein are spared in this operation, while the lymph nodes are removed from the skull base superiorly to the clavicle inferiorly, and from the cutaneous branches of the cervical plexus at the posterior border of the sternocleidomastoid muscle posteriorly to the sternothyroid muscle anteriorly. If the jugular chain nodes above the spinal accessory nerve were preserved, the procedure would be named selective neck dissection (iia, iii, iv). Neck dissection for cancer of the midline structures of the anterior lower operation involves excision of the level vi lymph nodes (selective neck dissection [vi]). The procedure is indicated for the treatment of cancers of the thyroid gland (see image below), hypopharynx, cervical trachea, cervical esophagus, and subglottic ive neck dissection for thyroid cancer: selective neck dissection vi, or anterior neck boundaries of the dissection are the hyoid bone superiorly, the suprasternal notch inferiorly, and the carotid sheaths on both sides. Alternatively, the dissection may be limited to one side if the lesion is not close to the midline, particularly if radiation therapy can be administered postoperatively. Study by song et al in which robotic selective neck dissection with total thyroidectomy was compared with conventional transcervical selective neck dissection with total thyroidectomy found that patients with papillary thyroid carcinoma who underwent the robotic surgery had higher postoperative cosmetic satisfaction. However, it was also found that length of surgery and degree of anterior chest pain were greater with the robotic ive neck dissection for cutaneous ive neck dissection (ii-v, postauricular, suboccipital) was initially described as a posterolateral neck dissection by rochlin in 1962 and later modified and popularized by geopfert et al for use in patients with cutaneous malignancies of the scalp and postauricular and suboccipital regions as depicted below. Unlike all other neck dissections, this operation is performed with the patient in the lateral decubitus position and consists of an en bloc removal of the lymph nodes in the suboccipital; postauricular; and upper, middle, and lower jugular nodes, along with posterior triangle nodes situated superior to the accessory nerve. See the image ive neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection ii-v, postauricular, suboccipital, or posterolateral neck gh the original description included sacrifice of the accessory nerve, internal jugular vein, and a portion of the trapezius muscle, diaz et al from the md anderson cancer center showed in 1996 that the preservation of these nonlymphatic structures does not increase the failure rate of this operation.
In cancers that arise in the preauricular, anterior scalp, or temporal region, the elective neck dissection of choice is selective neck dissection (ii, iii, va, parotid, facial, external jugular nodes). Neck cases of advanced neck disease, certain lymphatic or nonlymphatic structures not routinely included in the aforementioned neck dissections may have to be removed. How, when, and from whom neck dissection operative technique is learned: an international survey on neck dissection education among head and neck oncologic surgeons. Neck dissection classification update: revisions proposed by the american head and neck society and the american academy of otolaryngology-head and neck surgery. Effectiveness of selective neck dissection in head and neck cancer: the experience of two italian centers. Comparison of robotic versus conventional selective neck dissection and total thyroidectomy for papillary thyroid carcinoma. Neck dissection levels ive neck dissection levels ive neck dissection for thyroid cancer: selective neck dissection vi, or anterior neck ive neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection ii-v, postauricular, suboccipital, or posterolateral neck 6 levels of the neck with butor information and mitzner, md resident physician, department of surgery, division of otolaryngology - head and neck surgery, penn state university college of medicine, milton s hershey medical centerron mitzner, md is a member of the following medical societies: american academy of otolaryngology-head and neck surgery, american medical association, phi beta kappadisclosure: nothing to lty editor sco talavera, pharmd, phd adjunct assistant professor, university of nebraska medical center college of pharmacy; editor-in-chief, medscape drug referencedisclosure: received salary from medscape for employment. For: h calhoun, md, facs, faaoa professor, department of otolaryngology-head and neck surgery, ohio state university college of medicinekaren h calhoun, md, facs, faaoa is a member of the following medical societies: american academy of facial plastic and reconstructive surgery, american head and neck society, association for research in otolaryngology, southern medical association, american academy of otolaryngic allergy, american academy of otolaryngology-head and neck surgery, american college of surgeons, american medical association, american rhinologic society, society of university otolaryngologists-head and neck surgeons, texas medical associationdisclosure: nothing to d meyers, md, mba professor of otolaryngology, dentistry, and engineering, university of colorado school of medicinearlen d meyers, md, mba is a member of the following medical societies: american academy of facial plastic and reconstructive surgery, american academy of otolaryngology-head and neck surgery, american head and neck societydisclosure: serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: cerescan;rxrevu;cliexa;preacute population health management;the physicians edge
received income in an amount equal to or greater than $250 from: the physicians edge, cliexa
received stock from rxrevu; received ownership interest from cerescan for consulting; . J gosselin, md, frcsc associate professor of surgery, dartmouth medical school; director, comprehensive head and neck oncology program, norris cotton cancer center; staff otolaryngologist, division of otolaryngology-head and neck surgery, dartmouth-hitchcock medical centerbenoit j gosselin, md, frcsc is a member of the following medical societies: american head and neck society, american academy of facial plastic and reconstructive surgery, north american skull base society, american academy of otolaryngology-head and neck surgery, american medical association, american rhinologic society, canadian medical association, canadian society of otolaryngology-head & neck surgery, college of physicians and surgeons of ontario, new hampshire medical society, ontario medical associationdisclosure: nothing to s p ruggiero, md assistant professor, division of otolaryngology-head and neck surgery, department of surgery, penn state university, milton s hershey medical s p ruggiero, md is a member of the following medical societies: american academy of otolaryngology-head and neck surgery and american medical sure: nothing to p samant, mbbs ms, frcs, chief, division of head and neck and skull base surgery, associate professor, department of otolaryngology-head and surgery, university of tennessee health sciences p samant, mbbs is a member of the following medical societies: royal college of surgeons of sure: nothing to would you like to print?
The entire contents dissection fication of neck material on this website is protected by copyright, copyright © 1994-2017 by webmd llc. This website also contains material copyrighted by 3rd d search term (neck%20dissection%20classification) and neck dissection to read next on d conditions and and neck cancer revention strategies in head and neck and neck cancer - and neck cancer treatment and neck cancer - resection and neck rray technologies in the diagnosis and treatment of head and neck and neck carcinoma in the young with locally advanced thyroid cancer benefit from adjuvant uvant pembrolizumab promising in head and neck some oropharyngeal cancer patients skip adjuvant chemo, radiation with tors? Head and neck cancers you should popular ing to oncologist/l is a cancer risk, asco r walking, even if minimal, tied to lower death tattoos raise the risk for cancer? Us, 4 out of 10 cancers could be -term ppi use tied to doubled risk for gastric es & es & and neck cancer revention strategies in head and neck and neck cancer - resection and neck and neck cancer - a curbside consult? And 4) possible improvement in overall survival s against cnd are: possible side-effects of dissection, primarily transient or permanent hypocalcaemia related to parathyroid gland damage and recurrent laryngeal nerve injury and overtreatment in n0 literature offers no definitive evidence that cnd improves both overall survival and disease-free survival. Finally, most practitioners do not perform a true cnd: sometimes lymphadenectomy is limited to the peri-glandular, pre-tracheal, pre-laryngeal and delphian nodes without dissection above the thyroid cartilage all the way to the hyoid bone 23. For all these reasons, the need and the extent of prophylactic cnd according to the tumour size and localization are still a matter of al techniquea recent report in the literature provides one of the first attempts to give a standard and rational description of the surgical technique for central neck (or central compartment) dissection 42. Leaving the loose fibro-fatty glandulo-stromal tissue adhering to the thyroid isolation and dissection of the strap muscles on the right side and thus removing the a area, the homolateral hemi-thyroid is visualized, the middle thyroid vein is ligated and the carotid fascia is isolated. The dissection proceeds in its deepest portion from lateral to medial, detaching the glandulo-stromal tissue from the oesophageal musculature and the lateral aspect of the trachea, taking great care to preserve the branches of the sympathetic cervical plexus and the recurrent laryngeal nerve.
It is important to remember the virtual line extending from the brachio-cephalic trunk on the right side to the carotid artery on the left, which delineates the inferior boundary of the central compartment to be dissected and sbetween april 2010 and december 2011, 65 patients, 16 (24. The clinical, pathological and follow-up characteristics of patients are shown in table al, pathological and follow-up characteristics of patients who received total thyroidectomy and central neck dissection for differentiated thyroid cancer (n = 65). Total of 601 lymph nodes from central compartment (a, b, c, d areas) were removed in the first 65 patients. Patients, the analysis of nodal spreading showed an homolateral nodal diffusion (b if right, d if left) and/or central (a and c) lymph nodal diffusion when t disease arises within each lobe. It is clear from the available scientific literature and from the approach taken in multiple major clinical centres worldwide that cnd and the central compartment of the neck are not one and the same. Our clinical experience is congruent with the consensus recommendation to remove all four areas of the central neck in patients with cn1 disease. The decision to perform a prophylactic cnd in patients with cn0 disease should be taken into account not only for t3 and t4 tumours, but also for all lesions above 1 cm in diameter, because complete pathological examination of central neck nodes can change both the tumour stage and therapeutic approach, especially for small tumours. In fact, pt1 tumours with central node metastasis (pt1pn1) are usually submitted to radioiodine treatment, while larger tumours such as pt2 without nodal involvement can avoid it patients with dtc, neck ultrasound is the most important imaging technique for pre-operative assessment of non-palpable lymph node metastasis, but diagnostic accuracy in central neck disease is lower than that for lateral node disease, even in skilled hands 24. Standardizing neck dissection terminology: official report of the academy's committee for head and neck surgery and oncology.
Preoperative ation for lymph node metastases: designing lymph node dissection for papillary oma of the thyroid. American thyroid association surgery working group, author; american association of endocrine surgeons, author; y of otolaryngology-head and y, author; american head and neck society, author. Neck dissection classification update:Revisions proposed by the american head and y and the american academy of otolaryngology-. Extent of node dissection in the central neck area of the papillary thyroid carcinoma: comparison of limited hensive lymph node dissection in a 2-year . Prospective total thyroidectomy versus ipsilateral ral central neck dissection in patients with -negative papillary thyroid carcinoma. Medicinebookshelfdatabase of genotypes and phenotypes (dbgap)genetic testing registryinfluenza virusmap vieweronline mendelian inheritance in man (omim)pubmedpubmed central (pmc)pubmed clinical queriesrefseqgeneall genetics & medicine resources... Utilitiesjournals in ncbi databasesmesh databasencbi handbookncbi help manualncbi news & blogpubmedpubmed central (pmc)pubmed clinical queriespubmed healthall literature resources...