1. Neck dissection involves removing lymph nodes from different levels in the neck to stage and treat head and neck cancers. 2. The extent of neck dissection, such as radical or modified radical, depends on how many non-lymphatic structures like the spinal accessory nerve are preserved. 3. Selective neck dissections remove nodes from only certain levels, while comprehensive dissections are used to treat cancer that has spread to lymph nodes.

1. Neck dissectionDr. Mansoor Khan Resident Plastic Surgery

2. Introduction Status of the cervical lymph nodes important prognostic factor in the head and neck tumors

3. Introduction Cure rates drop into half when there is regional lymph node involvement

4. Emil Theodor Kocher Earned 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

5. 1906 – George Crile described the classic radical neck dissection (RND)

6. 1967 - Bocca and Pignataro described the “functional neck dissection” (FND)

8. Level - I

9. Level - II

10. Level - III

11. Level - IV

12. Level - V

13. Level - VI

14. Subzones of Levels I-V

15. Level IA Floor of mouth, anterior oral tongue, anterior mandibularalveolar ridge, lower lip Level IB Oral cavity, anterior nasal cavity, soft tissue of midface, submandibular gland

16. Level IIA & IIB Oral cavity, nasal cavity, nasopharynx, oropharynx,, hypopharynx, larynx, parotid gland

17. Level III Oral cavity, nasopharynx, oropharynx, hypopharynx, larynx

18. Level IV Hypopharynx, thyroid, cervical esophagus, larynx

19. Level VA & VB Nasopharynx, oropharynx, posterior scalp/neck skin

20. Level VI Thyroid gland, glottic and subglotticlarynx, apex of piriform sinus, cervical esophagus

21. “N” classification – AJCC (1997) Consistent for all mucosal sites except the nasopharynx Staging of the neck Thyroid and nasopharynx have different staging based on tumor behavior and prognosis

22. Single ipsilateral lymph node 3 to 6 cm Single ipsilateral lymph node, < 3 cm No regional lymph node metastases Multiple ipsilateral lymph nodes < 6 cm Bilateral or contralateral nodes < 6cm Metastases > 6 cm Lymph node staging

23. Classification

24. Extent of Radical Neck Dissection Radical Neck Dissection All lymph nodes in Levels I-V including spinal accessory nerve (SAN), SCM, and IJV

25. Modified Radical Neck Excision of same lymph node bearing regions as RND with preservation of one or more nonlymphatic structures (SAN, SCM, IJV)

26. MRND Type I Preservation of SAN

27. MRND Type II Preservation of SAN and IJV

28. MRND Type III Preservation of SAN, IJV, and SCM ( “Functional neck dissection”)

29. Supraomohyoid neck dissection Selective Neck Dissections

30. Selective Neck Dissections Lateral neck dissection

31. Extended Neck Dissection Any dissection which includes removal of one or more additional lymph node groups and/or non-lymphatic structures.

32. Algorithm for treating an N0

33. T3 or T4 Oral cavity tumors and tumor thickness (>3 mm) supraomohyoidneck dissection. Increasing stage of the oropharynx, hypopharynx, and supraglottic larynx needs lateral neck dissection. Algorithm for treating an N0

34. N+ disease needs Comprehensive neck dissection

35. “Surgical approach”Incisions

36. A p r o n I n c i s i o n

37. H a l f A p r o n I n c i s i o n

38. C o n l e y I n c i s i o n

39. Y - I n c i s i o n

40. D o u b l e – Y I n c i s i o n

41. H -I n c i s i o n

42. M a c F e e I n c i s i o n

43. S c h o b i n g e rI n c i s i o n

44. 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

45. Steps of Radical Neck Dissection