The neck dissection is a

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

for control of neck

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

metastasis Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, ...

from

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

(SCC) of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease. The metastases may originate from SCC of the upper aerodigestive tract, including the oral cavity, tongue,

nasopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

oropharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

hypopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

, and

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

, as well as the

thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thy ...

parotid The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the ma ...

and posterior scalp.

History of neck dissections

* 1906 –

George W. Crile George Washington Crile (November 11, 1864 – January 7, 1943) was an American surgeon. Crile is now formally recognized as the first surgeon to have succeeded in a direct blood transfusion. He contributed to other procedures, such as neck dis ...

of the

Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...

describes the radical neck dissection. The operation encompasses removal of all the lymph nodes on one side of the neck, and includes removal of the

spinal accessory nerve The accessory nerve, also known as the eleventh cranial nerve, cranial nerve XI, or simply CN XI, is a cranial nerve that supplies the sternocleidomastoid and trapezius muscles. It is classified as the eleventh of twelve pairs of cranial nerves ...

(SAN),

internal jugular vein The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posteri ...

(IJV) and

sternocleidomastoid muscle The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. The sternocleidomastoid is innervated by the access ...

(SCM). * 1957 – Hayes Martin describes routine use of the radical neck dissection for control of neck metastases. * 1967 – Oscar Suarez and E. Bocca describe a more conservative operation that preserves SAN, IJV and SCM. * Last 3 decades – Further operations have been described to selectively remove the involved regional lymph groups.

Division of the neck into levels and sublevels

To describe the lymph nodes of the neck for neck dissection, the neck is divided into 6 areas called ''Levels''. The levels are identified by Roman numeral, increasing towards the chest. A further Level VII to denote lymph node groups in the superior

mediastinum The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...

is no longer used. Instead, lymph nodes in other non-neck regions are referred to by the name of their specific nodal groups. * Level I – This includes the submental and submandibular lymph nodes. *: The

submental triangle The submental triangle (or suprahyoid triangle) is a division of the anterior triangle of the neck. Boundaries It is limited to: * Lateral (away from the midline), formed by the anterior belly of the digastricus * Medial (towards the midline), ...

(sublevel IA) is bounded by the anterior belly of the

digastric muscle The digastric muscle (also digastricus) (named ''digastric'' as it has two 'bellies') is a small muscle located under the jaw. The term "digastric muscle" refers to this specific muscle. However, other muscles that have two separate muscle bellie ...

s (laterally) and the

hyoid The hyoid bone (lingual bone or tongue-bone) () is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. At rest, it lies between the base of the mandible and the third cervical vertebra. ...

(inferiorly). The

submandibular triangle The submandibular triangle (or submaxillary or digastric triangle) corresponds to the region of the neck immediately beneath the body of the mandible. Boundaries and coverings It is bounded: * ''above'', by the lower border of the body of the man ...

(sublevel IB) is bounded by the body of the

mandible In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower tooth, teeth in place. The mandible sits beneath the maxilla. It is the only movabl ...

(superiorly), the

stylohyoid The stylohyoid muscle is a slender muscle, lying anterior and superior of the posterior belly of the digastric muscle. It is one of the suprahyoid muscles. It shares this muscle's innervation by the facial nerve, and functions to draw the hyoid ...

(posteriorly), and the anterior belly of the digastric (anteriorly). * Level II – This includes lymph nodes of the upper jugular group and is divided into sublevels IIA and IIB. *: Level II is bounded by the inferior border of the hyoid (inferiorly), the base of

skull The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...

(superiorly), the

stylohyoid muscle The stylohyoid muscle is a slender muscle, lying anterior and superior of the posterior belly of the digastric muscle. It is one of the suprahyoid muscles. It shares this muscle's innervation by the facial nerve, and functions to draw the h ...

(anteriorly) and the posterior border of the SCM (posteriorly). Sublevel IIA nodes lie anterior to the SAN. Sublevel IIB nodes lie posterior to the SAN. * Level III – This includes lymph nodes of the middle jugular group. *: This level is bounded by the inferior border of the hyoid (superiorly) and the inferior border of the

cricoid The cricoid cartilage , or simply cricoid (from the Greek ''krikoeides'' meaning "ring-shaped") or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment sit ...

(inferiorly), the posterior border of the

sternohyoid The sternohyoid muscle is a thin, narrow muscle attaching the hyoid bone to the sternum. It is one of the paired strap muscles of the infrahyoid muscles. It is supplied by the ansa cervicalis. It depresses the hyoid bone. Structure The sternohy ...

(anteriorly) and the posterior border of the SCM (posteriorly). * Level IV – This includes lymph nodes of the lower jugular group. *: This level is bounded by the inferior border of the cricoid (superiorly), the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the rig ...

sternal The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...

notch (inferiorly), the posterior border of the sternohyoid (anteriorly) and the posterior border of the SCM (posteriorly). * Level V – This includes posterior compartment lymph nodes. *: This compartment is bounded by the clavicle (inferiorly), the anterior border of the

trapezius The trapezius is a large paired trapezoid-shaped surface muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. It moves the scapula and supports the ...

(posteriorly), the posterior border of the SCM (anteriorly). It is divided into sublevels VA (lying above a transverse plane marking the inferior border of the anterior cricoid arch) and VB (below the aforementioned plane). * Level VI – This includes the anterior compartment lymph nodes. *: This compartment is bounded by the common

carotid In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
suprasternal notch The suprasternal notch, also known as the fossa jugularis sternalis, jugular notch, or Plender gap, is a large, visible dip in between the neck in humans, between the clavicles, and above the manubrium of the sternum. Structure The suprasternal ...

(inferiorly).

Classification of neck dissections

The 2001 revisions proposed by the American Head and Neck Society (AHNS) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) are as follows. # Radical Neck Dissection (RND) – removal of all

ipsilateral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

cervical lymph node groups from levels I through V, together with SAN, SCM and IJV. # Modified Radical Neck Dissection (MRND) – removal of all lymph node groups routinely removed in a RND, but with preservation of one or more nonlymphatic structures (SAN, SCM and IJV). # Selective Neck Dissection (SND) (together with the use of parentheses to denote the levels or sublevels removed) – cervical

lymphadenectomy Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the ...

with preservation of one or more lymph node groups that are routinely removed in a RND. Thus for oral cavity cancers, SND (I–III) is commonly performed. For oropharyngeal, hypopharyngeal and laryngeal cancers, SND (II–IV) is the procedure of choice. # Extended Neck Dissection. This refers to removal of one or more additional lymph node groups or nonlymphatic structures, or both, not encompassed by the RND.

References

External links

Patient Information
for neck dissection at Georgetown Univ. Hospital
Neck dissection: an operation in evolution
in ''World Journal of Surgical Oncology''

* ttp://www.emedicine.com/ent/topic502.htm eMedicine: Radical Neck Dissection {{Operations and other procedures of the hemic and lymphatic system Surgical oncology Surgical procedures and techniques Otorhinolaryngology Oral and maxillofacial surgery