This document summarizes changes in neck dissection techniques over the last two decades. It discusses the evolution from radical to more selective dissection methods beginning in the 1950s. Classification systems from 1991 are presented. The aim is to analyze trends in dissection types from 1982-2001 at a hospital in Zagreb, based on location of primary squamous cell carcinoma. Results show a shift from radical to more selective and modified radical dissections, reflecting improved staging and targeting of dissection. Conclusions include stricter acceptance of metastasis patterns and more precise surgical and follow-up methods.

1. Neck dissection; evolution in the
last two decades
Shejbal D, Alerić Z, Barač I, Odobašić Ž, Zurak K, Šimunjak B, Bedeković V,
Ivkić M.
Klinika za ORL i cervikofacijalnu kirurgiju Medicinskog i Stomatološkog fakulteta
Sveučilišta u Zagrebu
KB “Sestre milosrdnice” Zagreb

2. INTRODUCTION
• 1906. Crile – “ en block” resekcion, first step
to increase cancer head and neck mortality
• Carcinoma metastasis depends of tumor
location
– Mapping lymph drainage
• 1950. Suarez i Ballantyne introduce selective
methods of dissection
– Aim was increasing the same efficiency and
surviving rate and achieve less morbidity

3. CLASSIFICATION
• American Academy of
Otolaryngology Head and
Neck Surgery, 1991.
• THE RADICAL NECK
DISSECTION
• MODIFIED RADICAL NECK
DISSECTION
• SELECTIVE NECK
DISSECTION
• EXTENDED NECK
DISSECTION

4. AIM
• SECURE TYPE AND NUMBER
OF DISSECTION
• DINAMICS OF INDICATION IN
LAST TWO DECADES
• CHANGE OF ATTITUDE
RECFLECTED ON TUMOR
POSSITION AND MAKE
DISSECTION
Data 1982 – 2001, ENT dep, KB
“Sestre milosrdnice” Zagreb

5. METHODS
• Patient sqwamous cell carcinoma
• Location of primary tumor
• Other data: time of procedure, age, sex,
surgeon
• I 82-91, II 92-01

6. DIFFICULTIES IN 80- ies
• DIFFERENCES IN TERMINOLOGY
• UNDEFINED AND GENERALISED
DIAGNOSIS
• LACK OF DOCUMENTATION
• THE NEED TO COMBINE AND GROUP DATA

7. DOCUMENTATION
DOCUMENTATION
EXAMPLE IN
EXAMPLE IN
90-IES
90-IES

9. MAIN NUMBER OF TREATED
PATIENTS
180
160
140
120
100
80
60
40
20
0
2300
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1

10. 60
50
40
30
20
10
0
82-91 92-O1
DCR %
DCS %
DCRM %
OBOSTR. %
DISSECTION
No. 692 No. 932

11. LARYNGECTOMY WITH DISSECTION
120
100
80
60
40
20
0
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1
LARYNGECTOMY DISSECTION

12. SUPRAGLOTTIC TUMORS, FREQUENCY AND TYPE OF DISSECTION
100
90
80
70
60
50
40
30
20
10
0
82-91 92-O1
UK. DIS. %
DCR %
DCS %
DCRM %
OBOSTR.
No. 49 No. 79

13. GLOTTIC, TRANSGLOTTIC AND SUBGLOTTC TUMORS
70
60
50
40
30
20
10
0
DISSECTION
82-91 92-O1
UK.DIS. %
DCR %
DCS %
DCRM %
OBOSTR
No. 631 No. 373

14. CONCLUSIONS
• strict acceptance of aknowledgements about tumor
methastasis
• presurgical “staging”
• Precise methods of surgical and patohistological
follow-up head and neck tumors
• Systemized nomenclature
• Increased number of elective dissection
• Increased number of bilateral dissection
• Decreased number of elective dissection
• Decreased number of postsurgical irradiation