The limits for a complete functional neck dissection are similar to those of the classic radical neck dissection. Radical neck dissection conley 1975 the laryngoscope. N2 originally developed as a technique of monoblock lymphadenectomy for head and neck malignancies, radical neck dissection has been increasingly modified to minimize morbid dysfunction and disfigurement while preserving diagnostic and therapeutic integrity. Mayo clinic, rochester, minnesota 55901 surgical anatomy and technique of radical neck dissection oliver h. Surgical anatomy and technique of radical neck dissection. Case example posterolateral neck dissection and case example 2 posterolateral neck dissection and case example 2 anatomy and posterolateral neck dissection variant of trapezius innervation. We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity. Since the introduction of endoscopic technique to thyroid surgery, several endoscopic lateral neck dissection trials have been conducted with the aim of avoiding a long cervical scar, and the recent introduction of surgical robotic systems has. The sonography and physical findings on shoulder after. The functional neck dissection seems to be a reasonable alternative to radical radiotherapy and a preferred alternative to traditional neck dissection in the control of regional metastasis when disease in the neck is either occult or still confined to mobile lymph nodes. Technical hints and potential pitfalls in modified radical. Selective neck dissection iowa head and neck protocols. Scapula muscle exercises using the neurac technique for a. Radical neck dissection is a technique of monoblock removal of regional cervical lymph nodes from the lateral neck for malignant tumors involving the upper aerodigestive tract.
It is a complex operation and requires a sound knowledge of the 3dimensional anatomy of the neck. Dissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers. It has been the most effective method of attempting to control suspected or gross metastasis to the cervical region. This surgery, the removal of all neck lymph nodes levels iv while sparing one or more of structures, was termed modified radical neck dissection. Description of a neck dissection removal of the lymph. The accessory nerve function after modified radical neck dissection is better than function after lateral neck dissection because of increased stress applied to the nerve during retraction of the sternocleidomastoid muscle for achievement of a better exposed surgical field in lateral neck dissection. Comprehensive or therapeutic neck dissec tion involves surgical clearance of levels 1v and may either be a radical rnd or modified mnd neck dissection. This description is combined with intraoperative photographs and a medical artists illustrations to enhance and emphasize the most important points. The presence of cervical lymph node metastasis reduces survival of patients with squamous carcinoma of the upper aerodigestive tract by up to 50%. Increasing experience with this surgical technique and im. We present a patient with a t2n2bm0 epidermoid carcinoma of the tonsil to illustrate step by step the surgical procedure for tors radical tonsillectomy.
Our standard surgical approach to patients with papillary thyroid cancer is subtotal thyroidectomy with modified radical neck dissection mrnd on the affected side. Department of surgery, yonsei university college of medicine. The detailed surgical technique and claims for its reproducibility have been previously published. Two alternative procedures that have been developed include the modified radical neck dissection mrnd and selective neck dissection snd. Modified radical neck dissection mrnd is often performed in conjunction with total thyroidectomy for the management of thyroid cancer. The anatomical grounds of and surgical technique for functional neck dissection are described in detail in order to demonstrate that the radicalism of this procedure, from the viewpoint of surgical anatomy, is by no means less than that of the classical socalled radical neck dissection. A comparative study of robotic versus conventional. Posterolateral neck dissection iowa head and neck protocols. Scapula muscle exercises using the neurac technique for a patient after radical dissection surgery. Prevention of postoperative sequelae after mrnd is closely dependent on the avoidance of technical mistakes that may lead to significant complications and longterm morbidity. In certain situations, a neck dissection can also be performed prophylactically at the time of thyroidectomy to avoid a second operation due to recurrence. The technique embraces the en masse removal of all tissue elements in the space between the subdermis and the fascia colli. This technique was first described by george crile in 1906. The radical neck dissection is effective but produces characteristic cosmetic changes.
Radical neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. Since then, neck dissection has remained the mainstay of surgical treatment of metastatic cervical lymph nodes from mucosal and cutaneous carcinomas of the head and neck. In the past, radical neck dissection has been the standard surgical method for patients with hncs with neck lymph node metastasis. This entails clearance of essentially all of the fibrofatty and lymphatic tissue in the lateral neck as well as resection of the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, and the submandibular salivary gland in a monoblock fashion. Operative technique for modified radical neck dissection in papillary thyroid carcinoma. This surgery may also spare the nerves in the neck and, sometimes, the blood vessels or muscle. Purpose the purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. The anesthesiologist administers general endotracheal anesthesia, after which the patient is positioned for surgery. Initial dissection along lateral border of internal jugular vein ijv above level of clavicle. Variations on neck dissections exist depending on the. Return to cervical lymphadenectomy general considerations and selective neck dissection and radical neck dissection and minor modifications and sentinel. This procedure was pioneered by suarez and bocca, who were the first to understand the concept of nodal groups defined by fascial places during the second. Radical neck dissection is a surgical approach in head and neck cancer to treat the metastasis on the neck and had been done since 1906 in america by george crile.
Gasless, transaxillary robotic approach enabled the surgeon to do meticulous and precise dissection in the complex procedure, such as nd, eventually showed favorable surgical. Because so much tissue is removed, one side of the neck may appear flatter than the other. Mrnd preserves the jugular vein, the sternocleidomastoid muscle, and the accessory nerve, effectively conserving function and cosmesis. This article reflects the 2001 classification by the american head and neck society and the american academy of otolaryngologyhead and neck surgery 1, 2. Neck dissection, also known as cervical lymphadenectomy, is the surgical procedure for the management of metastatic cervical lymphadenopathy.
Evidence of extracapsular spread by clinical or radiographic evaluation ie, fixed nodes, involvement of deep neck muscles, cranial nerves, sternocleidomastoid muscle, internal jugular vein, carotid artery would require more radical dissection than a selective neck dissection extent of neck dissection. N2 all patients with a diagnosis of thyroid cancer should have a complete preoperative ultrasound of the central and lateral compartments of the neck, with a clear documentation of the description and location of suspicious lymph nodes using the standard nomenclature. Since criles landmark publication in 1906, the radical neck dissection rnd has remained the criterion standard for excision of cervical nodal metastases resulting from head and neck cancer. The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck.
Radical neck dissection a radical neck dissection involves removing the lateral neck lymph nodes as well as surrounding tissue in order to remove cancer in the neck. Radical neck dissection has evolved into a standard surgical technique over the past century. Modified radical neck dissection for differentiated. Cervical lymphadenectomy, or neck dissection, is the treatment of choice when there is evidence of lymph node metastasis from thyroid cancer. Objectives to 1 present a succinct synopsis of the rationale and elements of our current surgical management strategy for papillary thyroid carcinoma and, within this context, 2 provide a detailed stepwise description of a compartmentoriented modified radical neck dissection. Surgical technique refinements in head and neck oncologic. Traditionally, total thyroidectomy was performed through an open transcervical incision. To 1 present a succinct synopsis of the rationale and elements of our current surgical management strategy for papillary thyroid carcinoma and, within this context, 2 provide a detailed stepwise description of a compartmentoriented modified radical neck dissection. Functional neck dissection using the fascial plane. Credit for successfully performing this operation is given to suarez 10, who first published it in the spanish literature.
Sangwook kang, md, so hee lee, md, haeng rang ryu, md, woong youn chung, md. A radical neck dissection would be done if the tumor spread to the neck is quite extensive. If the nodes from zones i through v are removed and one of these three structures is preserved, it is called a modified radical neck dissection. The radical neck dissection was designed to ensure complete cancer removal in individuals with very advanced cancers in the neck. And if the operation does not involve all five zones, it is called a selective neck dissection. Moreno abstract a modified radical neck dissection is defined as functional resection of the lymphatic levels i to v in the neck. Neck dissection classification radiology reference. Robotic neck dissection nd for the thyroid cancer with lateral neck metastasis case is one of the emerging surgical techniques, and has been highlighted as minimally invasive surgical technique recently. The surgical field should expose superiorly the inferior border of the mandible and the tail of the parotid gland. The classical radical neck dissection includes excision of cervical lymph nodes at all 5 levels of the lateral neck. Radical neck dissection definition of radical neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Go to open access atlas of otolaryngology, head and neck operative surgery at. This technique is less frequently used than a modified radical neck dissection but may be used in patients with advanced cancer where removing as much tissue as possible is.
Presurgical preparation the patient is placed on the or table in the supine position. Accessory nerve function after modified radical and. Modified radical neck dissection northwestern scholars. Although a published classification of neck dissections has suggested the term selective neck dissection be applied when 1 or more lymph node groups are preserved that would normally be included in the level i through v radical neck dissection, 15 modified radical neck dissection or functional neck dissection are terms still widely used to. Definition radical neck dissection is an operation used to remove cancerous tissue in the head and neck. Comprehensive or therapeutic neck dissection involves surgical clearance of levels 1v and may either be a radical rnd or modified mnd neck dissec. Operative technique for modified radical neck dissection. Neck dissection oral, laryngeal and thyroid cancer. Rnd includes resection of sternocleido mastoid muscle scm and accessory nerve xin and internal jugular vein ijv. There are multiple types of neck dissection that vary by the structures removed 1. Surgery of the thyroid and parathyroid glands third edition 2021, pages 379385, 385. However, recent innovation in the surgical technique of thyroidectomy has offered the opportunity to reduce the.