radical neck dissection


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Radical Neck Dissection

 

Definition

Radical neck dissection is an operation used to remove cancerous tissue in the head and neck.

Purpose

The purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. Variations on neck dissections exist depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is done when the cancer has spread widely in the neck. A modified neck dissection removes less tissue, and a selective neck dissection even less.

Precautions

This operation should not be done if cancer has metastasized (spread) beyond the head and neck, or if the cancer has invaded the bones of the cervical vertebrae (the first seven vertebrae of the spinal column) or the skull. In these cases, the surgery will not effectively contain the cancer.

Description

Cancers of the head and neck (sometimes inaccurately called throat cancer) often spread to nearby tissues and into the lymph nodes. Removing these structures is one way of controlling the cancer.
Of the 600 hundred lymph nodes in the body, about 200 are in the neck. Only a small number of these are removed during a neck dissection. In addition, other structures such as muscles, veins, and nerves may be removed during a radical neck dissection. These include the sternocleidomastoid muscle (one of the muscles that functions to flex the head), internal jugular (neck) vein, submandibular gland (one of the salivary glands), and the spinal accessory nerve (a nerve that helps control speech, swallowing and certain movements of the head and neck). The goal is always to remove all the cancer but to save as many components surrounding the nodes as possible.
Radical neck dissections are done in a hospital under general anesthesia by a head and neck surgeon. An incision is made in the neck, and the skin is pulled back to reveal the muscles and lymph nodes. The surgeon is guided in what to remove by tests done prior to surgery and by examination of the size and texture of the lymph nodes.

Preparation

Radical neck dissection is a major operation. Extensive tests are done before the operation to try to determine where and how far the cancer has spread. These may include lymph node biopsies, CT (computed tomography) scans, MRI scans, and barium swallows. In addition, standard pre-operative blood and liver function tests are performed, and the patient will meet with an anesthesiologist before the operation. The patient should tell the anesthesiologist about all drug allergies and all medication (prescription, non-prescription, or herbal) that he or she is taking.

Aftercare

A person who has had a radical neck dissection will stay in the hospital several days after the operation, and sometimes longer if surgery to remove the primary tumor was done at the same time. Drains are inserted under the skin to remove the fluid that accumulates in the neck area. Once the drains are removed and the incision appears to be healing well, patients are usually discharged from the hospital, but will require follow-up doctor visits. Depending on how many structures are removed, a person who has had a radical neck dissection may require physical therapy to regain use of the arm and shoulder.

Risks

The greatest risk in a radical neck dissection is damage to the nerves, muscles, and veins in the neck. Nerve damage can result in numbness (either temporary or permanent) to different regions on the neck and loss of function (temporary or permanent) to parts of the neck, throat, and shoulder. The more extensive the neck dissection, the more function the patient is likely to lose. As a result, it is common following radical neck dissection for a person to have stooped shoulders, limited ability to lift the arm, and limited head and neck rotation and flexion due to the removal of nerves and muscles. Other risks are the same as for all major surgery: potential bleeding, infection, and allergic reaction to anesthesia.

Normal results

Normal lymph nodes are small and show no cancerous cells under the microscope.

Abnormal results

Abnormal lymph nodes may be enlarged and show malignant cells when examined under the microscope.

Resources

Organizations

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345). http://www.cancer.org.
Cancer Information Service. National Cancer Institute, Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. 〈http://www.nci.nih.gov/cancerinfo/index.html〉.

Other

The Voice Center at Eastern Virginia Medical School. February 17, 2001. [cited June 7, 2001]. http://www.voice-center.com.

Key terms

Barium swallow — Barium is used to coat the throat in order to take x-ray pictures of the tissues lining the throat.
Computed tomography (CT or CAT) scan — Using × rays taken from many angles and computer modeling, CT scans help size and locate tumors and provide information on whether they can be surgically removed.
Lymph nodes — Small, bean-shaped collections of tissue found in lymph vessels. They produce cells and proteins that fight infection and filter lymph. Nodes are sometimes called lymph glands.
Lymphatic system — Primary defense against infection in the body. The tissues, organs, and channels (similar to veins) that produce, store, and transport lymph and white blood cells to fight infection.
Magnetic resonance imaging (MRI) — MRI uses magnets and radio waves to create detailed cross-sectional pictures of the interior of the body.
Malignant — Cancerous. Cells tend to reproduce without normal controls on growth and form tumors or invade other tissues.
Metastasize — Spread of cells from the original site of the cancer to other parts of the body where secondary tumors are formed.

radical neck dissection

an operation for the removal of metastases to the lymph nodes of the neck in which all of the tissue is removed between the superficial and the deep cervical fascia from the mandible to the clavicle.
See also: functional neck dissection.

radical neck dissection

A common major operation for head & neck CA, most of which are SCC; in a 'radical neck'–RN, the neck is opened laterally, most of the sternocleidomastoid muscle is removed, as are cervical lymph nodes, jugular vein, spinal accessory nerve, submaxillary gland and most of the parotid gland; it may be combined with a partial resection of the mandible and tongue, depending on lesion topography. Cf Commando operation, 'Heroic' surgery, Mutilating surgery.

rad·i·cal neck dis·sec·tion

(rad'i-kăl nek di-sek'shŭn)
An operation for the removal of metastases to the lymph nodes of the neck in which all of the tissue is removed between the superficial and the deep cervical fascia from the mandible to the clavicle.
See also: functional neck dissection

rad·i·cal neck dis·sec·tion

(rad'i-kăl nek di-sek'shŭn)
An operation for the removal of metastases to the lymph nodes of the neck in which all tissue is removed between the superficial and the deep cervical fascia from the mandible to the clavicle.
References in periodicals archive ?
In our results, radical neck dissections presented no disease-free or disease-specific survival advantages over selective neck dissections.
Table 1: Characteristics of 25 Patients with Thyroid Cancer Sex ratio (M/F) 4:21 Mean age (years) 55 (18-62 years) Euthyroid 23 Hyperthyroidism 1 Hypothyroidism 1 Unilateral thyroid nodule 20 Bilateral thyroid mass 4 Isthmus thyroid nodule 1 Cervical lymphadenopathy 2 Table 2: Fine Needle Aspiration Biopsy Papillary carcinoma 19 Follicular neoplasm 2 Medullary carcinoma 1 Colloid Goitre 3 Table 3: Postoperative Histopathological Diagnosis Papillary carcinoma 24 Follicular carcinoma 1 Table 4: Types of Surgery Total thyroidectomy 20 Total thyroidectomy + Modified radical neck dissection 2 Total thyroidectomy + Central neck dissection 3 Table 5: Complication of Surgery Hypocalcaemia 10 Wound infection 1 Recurrent laryngeal nerve injury Nil
(1.) Strauss M, Bushey MJ, Chung C, Baum S: Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature.
Epidermoid carcinoma of the oral cavity and oropharynx: elective vs therapeutic radical neck dissection as treatment.
He was treated with Composite resection with modified Radical Neck Dissection and reconstruction with Pectoralis major Myocutaneous Flap.
The major complication from radical neck dissection was shoulder dysfunction, which led to modifications in neck dissection techniques.
In our case distant metastasis was seen after one year but was treated successfully by radical neck dissection combined with adjuvant radiotherapy.
"I had a radical neck dissection and tonsillectomy plus chemotherapy and radiotherapy to treat it.
A radical neck dissection was positive in 3 of the 5 cases in which it was done at the time of the original diagnosis.
In 56% of patients type 3 modified radical neck dissection was done, being a functional dissection it offered a benefits of low morbidity.Grade-3 shoulder dysfunction was noted in 3 cases with extended dissection and 4 cases with type 1 dissection.