Neck dissection
| Neck dissection | |
|---|---|
| Intervention | |
| ICD-9-CM | 40.4 |
| MeSH | D037981 |
The neck dissection is a surgical procedure for control of neck lymph node metastasis. This can be done for clinically or radiologically evident lymph nodes or as part of curative surgery where risk of occult nodal metastasis is deemed sufficiently high. The aim of the procedure is to remove lymph nodes from the neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck is one of the strongest prognostic indicators for head and neck cancer. The metastases may originate from tumours of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp. Neck nodal metastasis can sometimes also originate from lung cancer or intra-abdominal malignancy. However, neck dissection is rarely performed for such purposes.
Lymph nodes in a particular region are numerous and generally referred to in groups. It is impossible to dissect through all the soft tissue to remove individual lymph nodes. As such the neck dissection is the en-bloc resection of all soft tissue in the region including all the lymph nodes and structures passing through them. In the case of a neck dissection, this entails the resection of everything within the superficial layer of deep cervical fascia (also known as the investing layer of cervical fascia). Where deemed excessively morbid, the structures within are conserved. These include the carotid and in some instances the three structures - IJV, SCM and Accessory Nerve.
Memorial Sloan-Kettering Cancer Center developed the lymph node regional definitions most widely used today.
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 is no longer used. Instead, lymph nodes in other non-neck regions are referred to by the name of their specific nodal groups.
Region II, III, IV: nodes associated with the IJV; fibroadipose tissue located medial to the posterior border of SCM and lateral to the border of the sternohyoid.
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