Neck dissection

surgical power point presentation on neck dissection

1. NECK DISSECTION AKANA MOHAN PHANEENDRA 8 th SEMESTER 26 th JULY , 2016

2. Academy’s committee for head & neck surgery & oncology . Radical neck dissection (RND) is the standard basic procedure for cervical lymphadenopathy against which all other modifications are compared Modifications of RND  preservation of any non-lymphatic structures  modified radical neck dissection (MRND)

3. Any neck dissection that preserves one or more groups or levels of lymphnodes  Selective neck dissection (SND) Extended radical neck dissection (ERND)  removal of additional lymphnode groups or non lymphatic structures relative to the RND.

4. TYPES OF NECK DISSECTION Classic radical neck dissection (RND) Modified radical neck dissection (MRND) Selective neck dissection (SND) Supra omohyoid block Postero lateral neck dissection Lateral neck dissection Anterior (central) dissection Commando operation Bilateral neck dissection Extended radical dissection (ERND)

5. Classical radical neck dissection Resection of: Fascia Fat Gland : Sub- mandibular , Lower part of parotid Muscle : Sternomastoid , Omohyoid Vein : Internal & External jugular Nerve : Spinal accesory Lymph nodes (Level 1 to 5) En-block(Crile’s operation)

6. Mc fee incision Also called “ Fischel T or modified Crile’s incision” Only incision with bony landmarks. It has two components namely: SUBMANDIBULAR COMPONENT : 1 st limb begins over mastoid ,goes down to hyoid, again superiorly to submental area. SUPRACLAVICULAR COMPONENT : 2 nd limb – 2cm above clavicle , laterally from anterior border of trapezius to mid line.

7. Mc fee incision ADVANTAGES: Good blood supply from medial & lateral aspects Flap necrosis chances are rare Central bipedicled flap has good vascularity & covers most length carotid vessels & protect carotid artery, easy to repair DISADVANTAGES: Difficult to perform in short neck patients Dissection under central bipedicled flap is tedious with intensive retration required by assistant for proper exposure

8. Crile’s incision ADVANTAGES: Easy to perform Maximum exposure to repair field DISADVANTAGES: Trifurcation point is prone for delayed healing Vertical limb of this incision overlies carotid artery.compromised healing results in exposure of carotid vessels Unsightly scar later forms contracture band

9. Other incisions for RND / MRND SCHOBINGER CONLEY / SCHECHTER HOCKEY STICK HAYES MARTIN TRIRADIATE APRON FISCHEL T-J / CIRCLES

10. MODIFIED RADICAL NECKDISSECTION(MRND) Also called Conservative Functional Block Dissection Well-differentiated & less aggressive tumor(like PAPILLARY CARCINOMA OF THYROID with lymph node secondaries ) Structures preserved : Spinal accessory nerve (SAN) Sternocleido mastoid muscle (SCM) Internal jugular vein (IJV)

11. MRND type-1 : only Spinal accessory nerve is preserved(only N) MRND type-2 : Accessory nerve & Sternocleido mastoid(NM-preserved) MRND type-3 : Accessory nerve , Stenocleidomastoid muscle , Internal jugular vein (NMV-Preserved)  functional neck dissection

12. SELECTIVE NECK DISSECTION: SUPRA OMOHYOID BLOCK : Fat , Fascia , Lymph nodes , Muscles , Sub- Mandibular Salivary Gland + OMO-HYOID MUSCLE Well-differentiated tumor & involvement of few sub- mandibular lymph nodes(levels-1,2,3) LATERAL NECK DISSECTION(ANTERO-LATERAL \ ALND \ JUGULAR) : LEVELS 2 , 3 , 4 are removed Bilaterally Laryngeal and pharyngeal primaries with clinically negative nodes

13. POSTERO-LATERAL DISSECTION: LEVELS- 2 , 3 , 4 , 5 are removed for cutaneous malignancies , with sub occipital nodes ANTERIOR(CENTRAL) DISSECTION : Level 6 (pre-tracheal , para -tracheal) are removed

14. COMMANDO OPERATION (Combined mandibular dissection & neck dissection) Wide excision of primary tumor with hemi- mandibulectomy and neck block dissection (en-block removal) Composite resection of primary tumor , mandible & radical neck dissection (RND) Ex: carcinoma of tongue or floor of mouth

15. BILATERAL NECK DISSECTION IJV is preserved on one side Always the side where preserved operated first Ligating one IJV increases ICP by 3 fold Both IJV ligation increases ICP by 5 fold ICP gradually falls over 8-10 days

16. EXTENDED RADICAL DISSECTION Removal of one or more additional group of lymphatics or removal of non lymphatic structures with RND

17. COMPLICATIONS OF BLOCK DISSECTION HEMORRHAGE INFECTION LYMPHATIC OOZE CAROTID BLOW OUT SEROMA & FLAP NECROSIS FROZEN SHOULDER IS COMMON RARELY PNEUMOTHORAX & CHYLOUS FISTULA DROOPING OF SHOULDER DUE TO PARALYSIS OF TRAPEZIUS IN RADICAL NECK DISSECTION