It is generally done as an elective neck dissection end. May 15, 2016 supraomohyoid neck dissection is indicated in the surgical management of patients with t2 to t4 n0 or tx n1 oral cavity tumours and when palpable nodes less than 3 cm, clearly mobile and located in either level i or ii. The purpose of snd is to selectively remove the lymphatic groups at high risk for metastasis and to decrease morbidity by preserving the sternocleidomastoid muscle. This description is combined with intraoperative photographs and.
This article reflects the 2001 classification by the american head and neck society and the american academy of otolaryngologyhead and neck surgery 1, 2. Mar 03, 2015 selective neck dissection cervical lymphadenectomy with preservation of one or more lymph node groups four common subtypes. Medinas phone number, address, insurance information, hospital affiliations and more. Marginal mandibular nerve weakness ramus mandibularis level i neck dissection extended recurrent pleomorphic adenoma see also. Medina is a entotolaryngologist in oklahoma city, ok. The initial neck surgery was unilateral sohnd in 43 patients and bilateral. However, disfiguring neck scars have been accepted to be unavoidable.
Shah ian ganly introduction the single most important factor affecting prognosis of squamous cell carcinoma of the head and neck, the sixth most common cancer worldwide, is the status of the cervical lymph nodes. Objectives to 1 present a succinct synopsis of the rationale and elements of our current surgical management strategy for papillary thyroid carcinoma and, within this context, 2 provide a detailed stepwise description of a compartmentoriented modified radical neck dissection. It is based on the rationale that radical neck dissection is the standard basic procedure for cervical lymphadenectomy, and all other procedures represent one or more modifications of this procedure. Precisely defining and describing a technique has the advantage of providing a basis for. A supraomohyoid neck dissection is performed when treating patients who are at risk for micrometastasis in levels i, ii, and iii. Unlike other parts of the body, postoperative scars are especially noticeable in the head and neck area. Crile first described the radical neck dissection in the early 1900s, but modifications. Supraomohyoid neck dissection is performed for the surgical control of. Neck dissection classification radiology reference. Recurrence rates after selective neck dissection in the n0. Central compartment neck dissection for thyroid cancer.
This technique has been frequently used in the management of the clinically lymph node. Various surgical techniques have been developed to optimize esthetic outcomes even in operations for malignancy. Supraomohyoid neck dissection sohnd is a partial regional neck dissection that removes the contents of the submental, submandibular, and uppermid internal jugular region level i, ii, iii, where lymph node metastasis is most likely to develop in patients with oral cancer. Selective neck dissection cervical lymphadenectomy with preservation of one or more lymph node groups four common subtypes. Go to open access atlas of otolaryngology, head and neck operative surgery at. These are the neck dissections commonly used in the treatment of patients with scca of the oral cavity. Radical neck dissection was first described by crile in 1906 1 and popularized by martin et al, 2 and it was the main surgical treatment of cervical lymphadenopathy secondary to squamous cell carcinoma scc until the last third of the 20th century. The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submental and sub mandibular triangles lymph. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most important factor in the spread. Mar 07, 2016 38724, supraomohyoid neck dissection same code used for extended supraomohyoid neck dissection endoscopic and robotic neck dissections minimally invasive surgery with the assistance of endoscopic and robotic instrumentation has been tried in head and neck cancer management, including neck dissection for cervical metastatic disease. Supraomohyoid neck dissection sond or modified radical neck dissection mrnd were performed to ensure dissection of level ivv lymph nodes, albeit preserving the spinal accessory nerve, the internal jugular, and the sternocleidomastoid muscle. Zender, evan mcbeath and pierre lavertu introduction neck dissection has been a standard method of removing atrisk or involved cancerous lymph nodes in the head and neck for more than 100 years. Apr 21, 20 academys classification 3 any neck dissection that preserves one or more groups or levels of lymph nodes is referred to as a selective neck dissection snd 4 an extended neck dissection refers to the removal of additional lymph node groups or non lymphatic structures relative to the rnd 65. Posterolateral neck dissection iowa head and neck protocols.
Supraomohyoid neck dissection posterolateral neck dissection lateral neck dissection anterior neck dissection indication. Apr 18, 2005 the selective neck dissection addresses a select group of lymph nodes based on the location of the highest incidence of metastatic disease, thus supraomohyoid neck dissection became very popular as a staging procedure for cancer of the oral cavity. The selective neck dissection addresses a select group of lymph nodes based on the location of the highest incidence of metastatic disease, thus supraomohyoid neck dissection became very popular as a staging procedure for cancer of the oral cavity. Selective neck dissection iowa head and neck protocols. Operative technique for modified radical neck dissection. Video panel 1 surgical pearls for neck dissection management of the n0 neck. Supraomohyoid neck dissection wiley online library. Neck dissection classification radiology reference article. Thyroidectomy in conjunction with a comprehensive neck dissection is best performed using a single transverse incision along the skin crease at the level of the cricoid cartilage. Cervical lymphadenectomy general considerations see also.
Robotassisted supraomohyoid neck dissection via a modified. Elective treatment of n0 neck with significant risk of regional metastasis. Neck treatment of patients with early stage oral tongue. Myositis ossificans of the neck surgical treatment heterotopic bone formation after trauma. The radical neck dissection is effective but produces characteristic cosmetic changes. The anesthesiologist administers general endotracheal anesthesia, after which the patient is positioned for surgery. This article reflects the 2001 classification by the american head and neck society and the american academy of. The surgical technique is essentially the same as that of the rnd. The role of supraomohyoid neck dissection in patients with. Neck dissection surgery, types, indications, risks.
The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma scc of the head and neck. Advantages of a new technique of neck dissection using. Presurgical preparation the patient is placed on the or table in the supine position. Recommended surgical steps for supraomohyoid neck dissection. Understanding the regional lymphatic drainage pathways is critical when planning which type of neck dissection will be employed. Supraomohyoid neck dissection in patients with squamous. The purpose of snd is to selectively remove the lymphatic groups at high risk for metastasis and to decrease morbidity by. Supraomohyoid neck dissection in patients with squamous cell. Functional neck dissection using the fascial plane. May 30, 2012 however, disfiguring neck scars have been accepted to be unavoidable. Supraomohyoid neck dissection is performed for the surgical control of early metastatic neck disease in a selected group of patients with sccs of.
Neck dissection, also known as cervical lymphadenectomy, is the surgical procedure for the management of metastatic cervical lymphadenopathy. Lymph node removal by neck dissection is per formed for therapeutic. The skin is elevated in a subplatysmal plane up to the opposite anterior belly of. Comprehensive or therapeutic neck dissection involves surgical clearance of levels 1v and may either be a radical rnd or modified mnd. Figure 17 step 5 level iv dissection with a lateral neck dissection, level iv is dissected by applying traction to the fibrofatty tissue deep to the omohyoid. Advantages of a new technique of neck dissection using ultrasonic scalpel article in journal of craniomaxillofacial surgery 351. Interest developed in understanding the prognostic factors of metastatic disease in the neck. Selective supraomohyoid neck dissection, levels iiii. Apr 30, 2011 several professional societies have in the past few years joined forces to standardize and define terminology for central compartment neck dissection, with the objective of improving communication among professionals and encouraging a more uniform surgical approach to neck nodes. In this study, we sought to introduce and evaluate the feasibility of our surgical technique to hide the external scar of neck dissection using the robotic system via a modified facelift or retroauricular approach. The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submentai and submandibular triangles lymph node level i, the jugulodigastric and jugulo. Precisely defining and describing a technique has the advantage of providing a basis for communication and for. Chapter 1 selective supraomohyoid neck dissection, levels iiii chad a. Supraomohyoid neck dissection is indicated in the surgical management of patients with t2 to t4 n0 or tx n1 oral cavity tumours and when palpable nodes less than 3 cm, clearly mobile and located in either level i or ii.
Neck dissection techniques and complications 27 comprehensive classification widely accepted. Academys classification 3 any neck dissection that preserves one or more groups or levels of lymph nodes is referred to as a selective neck dissection snd 4 an extended neck dissection refers to the removal of additional lymph node groups or non lymphatic structures relative to the rnd 65. The patients head is extended moderately with the affected. Rationale, indications, and surgical technique medina, jesus e byers, robert m. Jan 21, 2016 the radical neck dissection was designed to ensure complete cancer removal in individuals with very advanced cancers in the neck. There are multiple types of neck dissection that vary by the structures removed 1.
Central neck dissection encompasses only level vi figure 1. Neck treatment of patients with early stage oral tongue cancer comparison between observation, supraomohyoid dissection, and extended dissection. The treatment of the neck in oral cavity cancer has undergone numerous changes during the past 50 years. The surgical technique of neck dissections has evolved from radical neck dissection rnd to modified or functional neck dissection and then to selective neck dissection snd 4. Selective neck dissection vula university of cape town. Robot assisted supraomohyoid neck dissection via retroauricular approach the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Thyroidectomy in conjunction with a comprehensive neck dissection is best performed using a single transverse incision along. Listing a study does not mean it has been evaluated by the u. The credit for neck dissection as a curative procedure for cervical metastases belongs to george washington crile from the cleveland clinic 6. Mark the skin incision with methylene blue or a surgical marking pen.
No single set of indications exists for supraomohyoid neck dissection. Selective neck dissection snd is done for n 0 necks no clinical evidence of neck nodes or for very limited cervical metastases figure 2. Rationale, indications, and surgical technique supraomohyoid neck dissection. Aug 12, 2016 chapter 1 selective supraomohyoid neck dissection, levels iiii chad a. Selective neck dissection is an operative procedure designed to remove cervical lymph nodes at risk for involvement by metastatic disease and is characterized by the preservation of one or more lymph node groups that are routinely removed in radical neck dissections.
Surgical technique refinements in head and neck oncologic surgery. The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submental and submandibular triangles lymph node level i, the jugulodigastric and juguloomohyoid lymph node groups, and the lymph nodebearing tissues located anterior to the cutaneous branches of the cervical plexus and above the. Surgical technique refinements in head and neck oncologic. Because so much tissue is removed, one side of the neck may appear flatter than the other. Neck dissection is an important procedure for the head and neck surgeon with diagnostic, therapeutic and prognostic role. The supraomohyoid neck dissection is a selective cervical node dissection that removes the contents of the submental and submandibular triangles lymph node level i, the jugulodigastric and. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. This incision is adequate for a supraomohyoid neck dissection as well as a comprehensive neck dissection. The surgical technique of neck dissections has evolved from radical neck dissection rnd to modified or functional neck dissection and then to selective neck dissection snd4. In 1900, he performed different types of neck dissections and subsequently described the classic operation of radical neck dissection in his seminal article of 1905 published in the transactions of the southern. Jun 15, 2010 this incision is adequate for a supraomohyoid neck dissection as well as a comprehensive neck dissection. Several professional societies have in the past few years joined forces to standardize and define terminology for central compartment neck dissection, with the objective of improving communication among professionals and encouraging a more uniform surgical approach to neck nodes. Supraomohyoid neck dissection is well recognized as a staging technique in patients with clinically negative nodes in the neck in the management of squamous cell carcinoma of the oral cavity and oropharynx.
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