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