Radical neck dissection
Radical neck dissection, also known as classical radical neck dissection, is a comprehensive surgical procedure primarily used to treat head and neck cancers, including squamous and basal cell carcinomas, lymphoma, and thyroid carcinoma. This operation involves the excision of not only the malignant tumor but also several surrounding structures such as cervical lymph nodes, salivary glands, and various muscles and vessels in the neck. It is commonly performed when cancer has spread to adjacent tissues, significantly affecting vital functions like breathing, speech, and circulation.
The procedure requires careful preoperative assessments, including imaging studies and tissue biopsies, to evaluate the extent of the disease. During surgery, a specific incision is made, allowing for the careful removal of affected tissues while aiming to minimize damage to surrounding structures. While radical neck dissection has been the standard of care since its introduction in 1906, advances in surgical techniques have focused on preserving critical anatomical structures, thereby reducing complications and improving patient outcomes.
Despite potential risks such as bleeding, infection, and nerve damage, radical neck dissection remains a crucial option for managing advanced cancers. Modifications to the procedure, including selective neck dissection techniques, have enhanced its effectiveness while addressing individual patient needs.
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Radical neck dissection
ALSO KNOWN AS: Classical radical neck dissection
DEFINITION: A radical neck dissection is a surgical procedure that involves the excision of a primary malignant cancer and several adjacent head and neck structures (salivary glands, sternocleidomastoid muscle, cervical lymph nodes, fatty tissue, jugular vein, and spinal accessory nerve).
Cancers treated:Squamous and basal cell carcinomas of the head and neck, lymphoma, thyroid carcinoma, metastatic cancer
Why performed: On gross examination of the neck, masses that preserve the outer tissue can suggest a benign tumor but cannot eliminate the possibility of cancer. Microscopically, benign tumor cells have an increased, orderly growth, while malignant cells have an increased, disorderly growth and large nuclei relative to the surrounding cytoplasm. Cervical lymph node samples possessing cancerous cells strongly suggest microscopic spread outside the neck.
Extensive infiltration of the neck by a tumor can affect breathing, speech, and movement, as well as blood circulation to the head. Surgery may be necessary to restore the function of the affected structures. The procedure is performed when malignant cancer has spread to adjacent facial and neck structures. Introduced in 1906 by George W. Crile, it remains the standard surgical treatment for metastasis.
Patient preparation: Surgical risk assessment, tissue biopsy, computed tomography (CT), or magnetic resonance imaging (MRI) are done.
Steps of the procedure: A hockey-stick-shaped incision is made over the anterolateral neck. The superficial neck muscle (platysma) is cut and retracted. The submandibular gland and duct, lymph nodes, a segment of the facial artery, and the tail of the parotid gland are removed or ligated. The sternocleidomastoid muscle is cut above the clavicle and retracted. The posterior omohyoid, anterior trapezius, spinal accessory nerve, jugular vein, surrounding lymph nodes, and the upper border of the sternocleidomastoid are ligated, cut, and removed.
After the procedure: The patient is monitored until stable. A breathing tube may be placed to protect the airway until the wound heals. Food intake may be withheld for at least twenty-four hours after the operation. The patient may be discharged if stable after a few days.
Although radical neck dissection remains the standard of care in treating nodules and cancers of the head and neck, advances have been made in the procedure that have reduced the rate of morbidity and complications and increased its effectiveness in treating cancer. Doctors better understand cervical anatomy, including cervical fascial planes and lymphatic drainage patterns. Modifications have been made in the surgical technique that more effectively preserves spinal nerves, the internal jugular vein, and the sternocleidomastoid muscle. Finally, selective neck dissections have allowed the procedure to be targeted to the patient's specific needs.
Risks: Bleeding is the most common complication because of the dense capillary network around the head and neck. Breathing problems, infections, formation of an abnormal connection between the esophagus and the trachea, shoulder muscle paralysis, and significant disfigurement can also occur.
Results: Although neck dissection has veered toward preserving function, radical neck dissection remains a sound surgical option for advanced stages of cancer.
Bibliography
Brockstein, Bruce, and Gregory Masters, editors. Head and Neck Cancer. Boston: Kluwer Academic, 2003.
Crile, George. “Radical Neck Dissection - StatPearls.” NCBI, 30 Apr. 2023, www.ncbi.nlm.nih.gov/books/NBK563186. Accessed 25 June 2024.
Kelloff, Gary, Ernest T. Hawk, and Caroline C. Sigman. Cancer Chemoprevention. Totowa, N.J.: Humana Press, 2004.
"Metastatic Squamous Neck Cancer with Occult Primary Treatment." National Cancer Institute, 21 Sept. 2023, www.cancer.gov/types/head-and-neck/patient/adult/metastatic-squamous-neck-treatment-pdq. Accessed 25 June 2024.
“Neck Dissection.” MedlinePlus, 29 Nov. 2022, medlineplus.gov/ency/article/007573.htm. Accessed 25 June 2024.
Sitges-Serra, Antonio, Leyre Lorente, and Juan J. Sancho. "Technical Hints and Potential Pitfalls in Modified Radical Neck Dissection for Thyroid Cancer." Gland Surgery, vol. 2.4, 2013, pp. 174–79.
Thaller, Seth R., and W. Scott McDonald. Facial Trauma. Miami: Informa Health Care, 2004.