- 9.27.24
Quick Review #236 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental
1. Radical Neck Dissection (RND):
This is the most extensive type of neck dissection and involves the removal of:
• All lymph nodes from Levels I to V.
• The sternocleidomastoid muscle (SCM).
• The internal jugular vein (IJV).
• The spinal accessory nerve (cranial nerve XI).
This procedure is used when cancer has extensively involved these structures, and there is no option for their preservation.
2. Modified Radical Neck Dissection (MRND):
The goal of the modified radical neck dissection is to remove all lymphatic tissue from Levels I-V while preserving one or more of the following non-lymphatic structures that are removed in a radical neck dissection:
• Type I: Spinal accessory nerve preserved.
• Type II: Spinal accessory nerve and internal jugular vein preserved.
• Type III: Spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle preserved.
This approach is designed to reduce morbidity, particularly related to shoulder dysfunction, while still removing the affected lymph nodes.
3. Selective Neck Dissection (SND):
Selective neck dissection involves the removal of only certain groups of lymph nodes, depending on the location of the primary tumor and the risk of metastasis to specific levels. The following are the most common types of selective neck dissections:
• SND (I-III): Levels I, II, and III lymph nodes are removed (used for oral cavity cancers).
• SND (II-IV): Levels II, III, and IV are removed (used for oropharyngeal, laryngeal, and hypopharyngeal cancers).
• SND (I-IV): Levels I, II, III, and IV lymph nodes are removed.
• SND (Posterior Triangle or Level V): Lymph nodes in Level V are removed (often used for skin cancers or melanoma of the head and neck).
The selective approach is designed to minimize functional and cosmetic morbidity while still achieving oncologic control.
4. Extended Neck Dissection:
This involves removing lymph node groups or structures when cancer extends into areas beyond the typical boundaries of the neck:
• Retropharyngeal lymph nodes.
• Paratracheal nodes.
• Mediastinal nodes.
• Additional non-lymphatic structures like the hypoglossal nerve or vagus nerve, depending on cancer involvement.
References:
1. BrainKart. (n.d.). Neck dissection. Medical surgical nursing: Management of patients with oral and esophageal disorders.
2. Shah, J. P., & Patel, S. G. (2012). Head and neck surgery and oncology (4th ed.). Elsevier.
3. Robbins, K. T., Ferlito, A., Shah, J. P., Hamoir, M., Takes, R. P., & Rinaldo, A. (2011). The evolving role of selective neck dissection for head and neck squamous cell carcinoma. European Archives of Oto-Rhino-Laryngology, 268(3), 433-438.
4. Medina, J. E., & Byers, R. M. (1989). Supraomohyoid neck dissection: Rationale, indications, and surgical technique. Head & Neck, 11(2), 111-122.
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