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Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
Neck dissection-slides-060920
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    • 1. Neck DissectionNeck DissectionJeffrey Buyten, MDJeffrey Buyten, MDSusan McCammon, MDSusan McCammon, MDFrancis B. Quinn, MDFrancis B. Quinn, MDUniversity of Texas Medical BranchUniversity of Texas Medical BranchDepartment of OtolaryngologyDepartment of OtolaryngologyGrand Rounds PresentationGrand Rounds PresentationSeptember 2006September 2006
    • 2. OutlineOutline HistoryHistory AnatomyAnatomy– Nodal levelsNodal levels– Common nodal drainage patternsCommon nodal drainage patterns StagingStaging ClassificationClassification Sentinel Lymph NodeSentinel Lymph Node
    • 3. HistoryHistory Metastatic cervical lymph nodesMetastatic cervical lymph nodes– Early 19Early 19ththCenturyCentury  incurable diseaseincurable disease– 2020ththCenturyCentury  improved treatment ofimproved treatment ofneck diseaseneck disease– 2121ststCenturyCentury  second worst prognosticsecond worst prognosticindicator for head and neck SCCAindicator for head and neck SCCA
    • 4. 1919ththCenturyCentury 18801880  Kocher advocates wide marginKocher advocates wide marginlymphadenectomylymphadenectomy 18811881  Kocher and Packard recommendKocher and Packard recommenddissection of submandibular triangledissection of submandibular trianglefor lingual cancerfor lingual cancer 18851885  Butlin questions RND for oral NButlin questions RND for oral N00diseasedisease 18881888  Jawdynski describes en blocJawdynski describes en blocresection with resection of carotid,resection with resection of carotid,IJV, SCM.IJV, SCM.Ferlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
    • 5. 2020ththCenturyCentury 19011901  Solis-Cohen advocateSolis-Cohen advocatelymphadenectomy for Nlymphadenectomy for N00 laryngeallaryngealCACA 1905 -19061905 -1906  Crile describes enCrile describes enbloc resection in JAMAbloc resection in JAMA 19261926  Bartlett and CallanderBartlett and Callanderadvocate preservation of XI, IJV,advocate preservation of XI, IJV,SCM, platysma, stylohyoid,SCM, platysma, stylohyoid,digastricdigastric 19331933  Blair and Brown advocateBlair and Brown advocateremoval ofremoval of XI.XI.Ferlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
    • 6. 2020ththCenturyCentury 19511951  Martin advocates Radical Neck Dissection after anaysis ofMartin advocates Radical Neck Dissection after anaysis of1450 cases1450 cases– Advocated RND for all cases.Advocated RND for all cases.– Standardized the Radical Neck DissectionStandardized the Radical Neck Dissection 1952 – Suarez describes a functional neck dissection1952 – Suarez describes a functional neck dissection– Preservation of SCM, omohyoid, submandibular gland, IJV, XI.Preservation of SCM, omohyoid, submandibular gland, IJV, XI.– Enables protection of carotid.Enables protection of carotid. 19601960’’s – MD Anderson advocate selective ND of highest risk nodals – MD Anderson advocate selective ND of highest risk nodalbasinsbasins 1967 - Bocca and Pignataro describe the1967 - Bocca and Pignataro describe the ““functional neckfunctional neckdissectiondissection”” 1975 – Bocca establishes oncologic safety of the FND compared to1975 – Bocca establishes oncologic safety of the FND compared tothe RNDthe RNDFerlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
    • 7. AnatomyAnatomy Lymph Node LevelsLymph Node Levels– Sloan Kettering nomenclatureSloan Kettering nomenclature– SubgroupsSubgroups Common Nodal Drainage PatternsCommon Nodal Drainage Patterns
    • 8. Level ILevel I Submental triangleSubmental triangle(Ia)(Ia)– Anterior digastricAnterior digastric– HyoidHyoid– MylohyoidMylohyoid SubmandibularSubmandibulartriangle (Ib)triangle (Ib)– Anterior andAnterior andposterior digastricposterior digastric– Mandible.Mandible.
    • 9. Marginal Mandibular NerveMarginal Mandibular Nerve Most commonly injuryMost commonly injurydissection level Ibdissection level Ib Landmarks:Landmarks:– 1cm anterior and inferior1cm anterior and inferiorto angle of mandibleto angle of mandible– Mandibular notchMandibular notch SubplatysmalSubplatysmal Deep to fascia of theDeep to fascia of thesubmandibular glandsubmandibular gland Superficial to facial veinSuperficial to facial vein
    • 10. Marginal Mandibular NerveMarginal Mandibular Nerve
    • 11. Hypoglossal nerveHypoglossal nerve Lies deep to the IJV,Lies deep to the IJV,ICA, CN IX, X, and XIICA, CN IX, X, and XI Curves 90 degreesCurves 90 degreesand passes betweenand passes betweenthe IJV and ICAthe IJV and ICA Ranine veinsRanine veins Lateral to hyoglossusLateral to hyoglossus Deep to mylohyoidDeep to mylohyoid
    • 12. Level ILevel I IaIa– ChinChin– Lower lipLower lip– Anterior floor of mouthAnterior floor of mouth– Mandibular incisorsMandibular incisors– Tip of tongueTip of tongue IbIb– Oral CavityOral Cavity– Floor of mouthFloor of mouth– Oral tongueOral tongue– Nasal cavity (anterior)Nasal cavity (anterior)– FaceFace
    • 13. Level IILevel II Upper Jugular NodesUpper Jugular Nodes AnteriorAnterior  Lateral borderLateral borderof sternohyoid, posteriorof sternohyoid, posteriordigastric and stylohyoiddigastric and stylohyoid PosteriorPosterior  PosteriorPosteriorborder of SCMborder of SCM Skull baseSkull base Hyoid bone (clinicalHyoid bone (clinicallandmark)landmark) Carotid bifurcationCarotid bifurcation(surgical landmark)(surgical landmark) Level IIa anterior to XILevel IIa anterior to XI Level IIb posterior to XILevel IIb posterior to XI– Submuscular recessSubmuscular recess– Oropharynx > oral cavityOropharynx > oral cavityand laryngeal metsand laryngeal mets
    • 14. Spinal Accessory NerveSpinal Accessory Nerve CN XI – Relationship with the IJVCN XI – Relationship with the IJV
    • 15. Level IILevel II Oral CavityOral Cavity Nasal CavityNasal Cavity NasopharynxNasopharynx OropharynxOropharynx LarynxLarynx HypopharynxHypopharynx ParotidParotid
    • 16. Level IIILevel III Middle jugular nodesMiddle jugular nodes– AnteriorAnterior  Lateral border ofLateral border ofsternohyoidsternohyoid– PosteriorPosterior  Posterior borderPosterior borderof SCMof SCM– Inferior border of level IIInferior border of level II– Cricoid cartilage lowerCricoid cartilage lowerborder (clinical landmark)border (clinical landmark)– Omohyoid muscle (surgicalOmohyoid muscle (surgicallandmark)landmark) Junction with IJVJunction with IJV
    • 17. Level IIILevel III Oral cavityOral cavity NasopharynxNasopharynx OropharynxOropharynx HypopharynxHypopharynx LarynxLarynx
    • 18. Level IVLevel IV Lower jugular nodesLower jugular nodes– AnteriorAnterior  Lateral borderLateral borderof sternohyoidof sternohyoid– PosteriorPosterior  PosteriorPosteriorborder of SCMborder of SCM– Cricoid cartilage lowerCricoid cartilage lowerborder (clinicalborder (clinicallandmark)landmark)– Omohyoid muscleOmohyoid muscle(surgical landmark)(surgical landmark) Junction with IJVJunction with IJV– ClavicleClavicle
    • 19. Phrenic NervePhrenic Nerve Sole nerve supplySole nerve supplyto the diaphragmto the diaphragm C3-5C3-5 Anterior surface ofAnterior surface ofanterior scaleneanterior scalene Under prevertebralUnder prevertebralfasciafascia Posterolateral toPosterolateral tocarotid sheathcarotid sheath
    • 20. Thoracic ductThoracic duct Conveys lymph from theConveys lymph from theentire body back to the bloodentire body back to the blood– Exceptions:Exceptions: Right side of head and neck,Right side of head and neck,RUE, right lung right heartRUE, right lung right heartand portion of the liverand portion of the liver– Begins at the cisterna chyliBegins at the cisterna chyli– Enters posterior mediastinumEnters posterior mediastinumbetween the azygous veinbetween the azygous veinand thoracic aortaand thoracic aorta– Courses to the left into theCourses to the left into theneck anterior to the vertebralneck anterior to the vertebralartery and veinartery and vein– Enters the junction of the leftEnters the junction of the leftsubclavian and the IJVsubclavian and the IJV
    • 21. Thoracic DuctThoracic Duct
    • 22. Level IVLevel IV HypopharynxHypopharynx LarynxLarynx ThyroidThyroid Cervical esophagusCervical esophagus
    • 23. Level VLevel V Posterior triangle of neckPosterior triangle of neck– Posterior border of SCMPosterior border of SCM– ClavicleClavicle– Anterior border ofAnterior border oftrapeziustrapezius– VaVa Spinal accessorySpinal accessorynodesnodes– VbVb  Transverse cervicalTransverse cervicalartery nodesartery nodes Radiologic landmarkRadiologic landmark– Inferior border of CricoidInferior border of Cricoid– Supraclavicular nodesSupraclavicular nodes
    • 24. Spinal Accessory NerveSpinal Accessory Nerve Penetrates deep surface ofPenetrates deep surface ofthe SCMthe SCM Exits posterior surface ofExits posterior surface ofSCM deep to ErbSCM deep to Erb’’s points point Traverses the posteriorTraverses the posteriortriangle on the levatortriangle on the levatorscapulaescapulae Enters the trapezius aboutEnters the trapezius about5 cm above the clavicle5 cm above the clavicle
    • 25. Level VLevel V NasopharynxNasopharynx OropharynxOropharynx Posterior neck and scalpPosterior neck and scalp
    • 26. Level VILevel VI Anterior compartmentAnterior compartment– HyoidHyoid– Suprasternal notchSuprasternal notch– Medial border of carotidMedial border of carotidsheathsheath– Perithyroidal lymph nodesPerithyroidal lymph nodes– Paratracheal lymph nodesParatracheal lymph nodes– Precricoid (Delphian)Precricoid (Delphian)lymph nodelymph node
    • 27. Level VILevel VI ThyroidThyroid Larynx (glottic and subglottic)Larynx (glottic and subglottic) Pyriform sinus apexPyriform sinus apex Cervical esophagusCervical esophagus
    • 28. Level VLevel V NasopharynxNasopharynx OropharynxOropharynx Posterior neck and scalpPosterior neck and scalp
    • 29. SubgroupsSubgroups IaIa SubmentalSubmental IbIb SubmandibularSubmandibular IIaIIa Upper jugular (Anterior to XI)Upper jugular (Anterior to XI) IIbIIb Upper jugular (Posterior to XI)Upper jugular (Posterior to XI) IIIIII Middle jugularMiddle jugular IVaIVa Lower jugular (Clavicular)Lower jugular (Clavicular) IVbIVb Lower jugular (Sternal)Lower jugular (Sternal) VaVa Posterior triangle (XI)Posterior triangle (XI) VbVb Posterior triangle (TransversePosterior triangle (Transversecervical)cervical) VIVI Central compartmentCentral compartment
    • 30. Face and Scalp Anterior Facial, IbLateral ParotidPosterior Occipital, VEyelids Medial IbLateral Parotid, IIChin Ia, Ib, IIExternal Ear Anterior Parotid, IIPosterior Post auricular, II, VMiddle Ear Parotid, IIFloor of mouth Anterior Ia, Ib, IIa > IIbLower incisors Ia, Ib, IIa > IIbLateral Ib, IIa > IIb, IIITeeth except incisors Ib, IIa > IIb, IIINasal Cavity Anterior IbPosterior Retropharyngeal, II, VCommon Nodal Drainage PatternsCommon Nodal Drainage Patterns
    • 31. Nasal Cavity Posterior Retropharyngeal, II, VNasopharynx Retropharyngeal, II, III, VOropharynx IIb > IIa, III, IV, VLarynx Supraglottic IIa > IIb, III, IVSubglottic VI, IVCervicalesophagus IV, VIThyroid VI, IV, V, MediastinalTongue Tip Ia, Ib, IIa > IIb, III, IVLateral Ib, IIa > IIb, III, IVCommon Nodal Drainage PatternsCommon Nodal Drainage Patterns
    • 32. StagingStaging Nx: Regional lymph nodes cannot beNx: Regional lymph nodes cannot beassessed.assessed. N0: No regional lymph node metastases.N0: No regional lymph node metastases. N1: Single ipsilateral lymph node,N1: Single ipsilateral lymph node, << 3 cm3 cm
    • 33. StagingStaging N2a: Single ipsilateral lymph node 3 toN2a: Single ipsilateral lymph node 3 to6 cm6 cm N2b: Multiple ipsilateral lymph nodesN2b: Multiple ipsilateral lymph nodes<< 6 cm6 cm N2c: Bilateral or contralateral nodesN2c: Bilateral or contralateral nodes <<6cm6cm N3: Metastases > 6 cmN3: Metastases > 6 cm
    • 34. StagingStaging Nasopharyngeal CarcinomaNasopharyngeal Carcinoma– N1 – Unilateral < 6cmN1 – Unilateral < 6cm– N2 – Bilateral < 6 cmN2 – Bilateral < 6 cm– N3a > 6 cmN3a > 6 cm– N3b – Extension toN3b – Extension tosupraclavicular fossasupraclavicular fossa ThyroidThyroid– N1 – Regional node metsN1 – Regional node mets N1a - IpsilateralN1a - Ipsilateral N1b - Bilateral, midline,N1b - Bilateral, midline,contralateral cervical orcontralateral cervical ormediastinal LNmediastinal LN
    • 35. ClassificationClassification RadicalRadical– Gold standard operationGold standard operation Modified radicalModified radical– Preservation of non lymphatic structuresPreservation of non lymphatic structures SelectiveSelective– Preservation of lymph node groupsPreservation of lymph node groups ExtendedExtended– Removal of additional lymph nodeRemoval of additional lymph nodegroups or non lymphatic structuresgroups or non lymphatic structures
    • 36. Radical Neck DissectionRadical Neck Dissection RemovesRemoves– Nodal groups I-VNodal groups I-V– SCM, IJV, XISCM, IJV, XI– Submandibular gland,Submandibular gland,tail of parotidtail of parotid PreservesPreserves– Posterior auricularPosterior auricular– SuboccipitalSuboccipital– RetropharyngealRetropharyngeal– PeriparotidPeriparotid– PerifacialPerifacial– Paratracheal nodesParatracheal nodes
    • 37.  RemovesRemoves– Nodal groups I-VNodal groups I-V PreservesPreserves– SCM, IJV, XI (anySCM, IJV, XI (anycombination)combination) Notate according toNotate according towhich structures arewhich structures arepreservedpreservedModified Radical Neck DissectionModified Radical Neck Dissection
    • 38. Selective Neck DissectionSelective Neck Dissection Remove high risk lymph node groupsRemove high risk lymph node groupsbased on tumor site.based on tumor site. SupraomohyoidSupraomohyoid– Levels I-IIILevels I-III LateralLateral– Levels II-IVLevels II-IV
    • 39. Selective Neck DissectionSelective Neck Dissection PosterolateralPosterolateral– Levels II-VLevels II-V– Postauricular nodesPostauricular nodes– Suboccipital nodesSuboccipital nodes
    • 40. Selective Neck DissectionSelective Neck Dissection AnteriorAnterior– Level VILevel VI– RLN injuryRLN injury– HyperparathyroidismHyperparathyroidism
    • 41. Extended Neck DissectionExtended Neck Dissection Removal of any structures that areRemoval of any structures that areroutinely preserved in a neckroutinely preserved in a neckdissection.dissection. Notated by naming the structure(s)Notated by naming the structure(s)removed.removed.
    • 42. Sentinel Lymph NodeSentinel Lymph Node OverviewOverview NN00 NeckNeck TechniquesTechniques ResultsResults
    • 43. Sentinel Lymph Node HistorySentinel Lymph Node History 1955  First echelon node 1960  “Sentinel node” 1977  Demonstrated in penilecancer 1992  Morton reintroduced conceptin N0 melanoma Currently widely used in melanomaand breast cancer therapy.
    • 44. Sentinel lymph node conceptSentinel lymph node concept Tumor spreads via lymphatics to aTumor spreads via lymphatics to aprimary node.primary node. Examination of primary echelonExamination of primary echelonnodes for tumor direct the need fornodes for tumor direct the need forsurgical management of the nodalsurgical management of the nodalbasins.basins.
    • 45. Sentinel lymph node conceptSentinel lymph node concept Difficulties of lymphatic mapping in headDifficulties of lymphatic mapping in headand neck (Oand neck (O’’Brien).Brien).1.1. It is difficult to visualize lymphatic channelsIt is difficult to visualize lymphatic channelsusing lymphoscintigraphy because ofusing lymphoscintigraphy because ofproximity to the injection site.proximity to the injection site.2.2. The radiotracer travels fast in the lymphaticThe radiotracer travels fast in the lymphaticvessels.vessels.3.3. If more than one node is visible, it can beIf more than one node is visible, it can bedifficult to distinguish first echelon nodes fromdifficult to distinguish first echelon nodes fromsecond-echelon nodes.second-echelon nodes.4.4. The SLN may be small and not easilyThe SLN may be small and not easilyaccessible (eg, in the parotid gland).accessible (eg, in the parotid gland).
    • 46. NN00 NeckNeck Occult neck diseaseOccult neck disease– Head and neck cancerHead and neck cancer  30%30%– Oral cavity CAOral cavity CA  20% to 45%20% to 45% Factors that indicate > 20% chanceFactors that indicate > 20% chanceof subclinical metastasesof subclinical metastases– Tumor thickness > 4mmTumor thickness > 4mm– Size > 2 cmSize > 2 cm– Anatomic locationAnatomic location
    • 47. SensitivitySensitivity% (range)% (range)SpecificitySpecificity% (range)% (range)PalpationPalpation 35 (30-40)35 (30-40) 35 (27-42)35 (27-42)CTCT 45 (17-86)45 (17-86) 11 (3-21)11 (3-21)USUS 46 (42-50)46 (42-50) 21 (11-33)21 (11-33)MRIMRI 42 (20-70)42 (20-70) 14 (5-26)14 (5-26)US FNACUS FNAC 42 (27-50)42 (27-50) 00Accuracy of diagnostic methods in detecting occultAccuracy of diagnostic methods in detecting occultcervical metastases.cervical metastases.A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role ofA new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role ofsentinel node biopsy and positron emission tomographysentinel node biopsy and positron emission tomography
    • 48. NN00 Neck TreatmentNeck Treatment T1/T2 N0 oral SCCAT1/T2 N0 oral SCCA– Better 10-year survival in pts who hadBetter 10-year survival in pts who hadelective neck dissection.elective neck dissection. T1/T2 N0 tongue SCCAT1/T2 N0 tongue SCCA– 5-year actuarial benefit for elective neck5-year actuarial benefit for elective neckmanagementmanagement
    • 49. Sentinel Lymph Node Biopsy andSentinel Lymph Node Biopsy andNN00 Oral Cavity SCCAOral Cavity SCCA Multiple small case series display theMultiple small case series display thefeasibility of SLNB in oral SCCAfeasibility of SLNB in oral SCCA Majority of lesions T1/T2Majority of lesions T1/T2 No standardized techniquesNo standardized techniques All series compareAll series compare– Pre op lymphoscintigraphyPre op lymphoscintigraphy– Intra-op localizationIntra-op localization– Post op pathologyPost op pathology
    • 50. Pre op TechniquePre op Technique TechnetiumTechnetium– Day before surgeryDay before surgery– Submucosal injectionsSubmucosal injections– 10-30 MBq Tc 99m per10-30 MBq Tc 99m perquadrantquadrant– +/- local anesthesia+/- local anesthesia– Avoid spillageAvoid spillage– Rinse mouthRinse mouth Dosage does not correlateDosage does not correlatewith ability to identifywith ability to identifynodesnodes
    • 51. Pre op TechniquePre op Technique LymphoscintigraphyLymphoscintigraphy– DynamicDynamic 45 -60 minutes45 -60 minutes Necessary to clearly identifyNecessary to clearly identifysentinel nodessentinel nodes SLNs seen within 15 minutesSLNs seen within 15 minutes– StaticStatic Confirms dynamic imagesConfirms dynamic images AP / Lateral / ObliqueAP / Lateral / Oblique Delayed images for nonDelayed images for nonrevealing dynamic studiesrevealing dynamic studies– Cobalt pencilCobalt pencil Labels anatomical pointsLabels anatomical points– Left / right mandibleLeft / right mandible– ChinChin– Cricoid cartilageCricoid cartilage– Sternal notchSternal notch
    • 52. Oral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection HistopathologyOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection Histopathology
    • 53. Oral Cancer: Correlation of Sentinel LympOral Cancer: Correlation of Sentinel Lymp
    • 54. Pre op TechniquePre op Technique Blue DyeBlue Dye– Submucosal injectionSubmucosal injection– 2.5% Patent Blue dye2.5% Patent Blue dye– No more than 20 minNo more than 20 minpre incisionpre incisionOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection HistopathologyOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection Histopathology
    • 55. Operative TechniqueOperative Technique Limited incision guided byLimited incision guided bylymphoscintigraphy and gammalymphoscintigraphy and gammaprobeprobe Frozen section analysisFrozen section analysis
    • 56. Operative TechniqueOperative Technique Gamma probeGamma probe– Examine operativeExamine operativebed for increasedbed for increasedsignalsignal– Tumor extirpationTumor extirpation– Lead shieldLead shield– Removal of highRemoval of highsignal nodessignal nodes– Examine removedExamine removednode and comparenode and compareto operative bedto operative bed
    • 57. ComplicationsComplications Reported complication rates < 1%Reported complication rates < 1%– Cutaneous malignancy casesCutaneous malignancy cases Injury of VII, XI due to limitedInjury of VII, XI due to limitedexposureexposure
    • 58. ResultsResults Sentinel nodes found in > 90% ofSentinel nodes found in > 90% ofcases.cases.– Experience mattersExperience matters– Surgeons with less than 10 casesSurgeons with less than 10 cases 56% success in SLNB56% success in SLNB Lymphoscintigraphy revealedLymphoscintigraphy revealedunexpected bilateral or contralateralunexpected bilateral or contralateraldisease in about 14% of ptsdisease in about 14% of pts About 2-3 SLN per patientAbout 2-3 SLN per patient
    • 59. ResultsResults Up to 46% of SLN harbor metastasesUp to 46% of SLN harbor metastases– Fine section frozen analysisFine section frozen analysis Increases sensitivity to about 95%Increases sensitivity to about 95%– Immunohistochemical stainingImmunohistochemical staining False negative ratesFalse negative rates– 10%10%– Grossly involved nodes less likely to take upGrossly involved nodes less likely to take uptracertracer Better sensitivity for T1/T2 lesionsBetter sensitivity for T1/T2 lesions– Most false negative results associated withMost false negative results associated withlarger T3 lesionslarger T3 lesions
    • 60. BibliographyBibliography1.1. Lymphatic Mapping and Sentinel Lymphadenectomy for 106Lymphatic Mapping and Sentinel Lymphadenectomy for 106Head and Neck Lesions: Contrasts Between Oral Cavity andHead and Neck Lesions: Contrasts Between Oral Cavity andCutaneous Malignancy Laryngoscope, 116(Suppl. 109):1–15,Cutaneous Malignancy Laryngoscope, 116(Suppl. 109):1–15,200620062.2. Oral Cancer: Correlation of Sentinel Lymph Node Biopsy andOral Cancer: Correlation of Sentinel Lymph Node Biopsy andSelective Neck Dissection HistopathologySelective Neck Dissection Histopathology3.3. The value of frozen section analysis of the sentinel lymph nodeThe value of frozen section analysis of the sentinel lymph nodein clinically N0 squamous cell carcinoma of the oralin clinically N0 squamous cell carcinoma of the oralcavity and oropharynx LAURENT TSCHOPP, MD, MICHELcavity and oropharynx LAURENT TSCHOPP, MD, MICHELNUYENS, MD, EDOUARD STAUFFER, MD, THOMAS KRAUSE, MD,NUYENS, MD, EDOUARD STAUFFER, MD, THOMAS KRAUSE, MD,and PETER ZBÄREN, MD, Bern, Switzerland Otolaryngol Headand PETER ZBÄREN, MD, Bern, Switzerland Otolaryngol HeadNeck Surg 2005;132:99-102.Neck Surg 2005;132:99-102.4.4. A new approach to pre-treatment assessment of the N0 neck inA new approach to pre-treatment assessment of the N0 neck inoral squamous cell carcinoma: the role of sentinel node biopsyoral squamous cell carcinoma: the role of sentinel node biopsyand positron emission tomography N.C. Hydea,*, E.and positron emission tomography N.C. Hydea,*, E.Prvulovichb, L. Newmanc, W.A. Waddingtonb, D. Visvikisb, P.Prvulovichb, L. Newmanc, W.A. Waddingtonb, D. Visvikisb, P.Ellb Oral Oncology 39 (2003) 350–360Ellb Oral Oncology 39 (2003) 350–3605.5. The Accuracy of Head and Neck Carcinoma Sentinel LymphThe Accuracy of Head and Neck Carcinoma Sentinel LymphNode Biopsy in the Clinically N0 Neck Taimur Shoaib1 CANCERNode Biopsy in the Clinically N0 Neck Taimur Shoaib1 CANCERJune 1, 2001 / Volume 91 / Number 11June 1, 2001 / Volume 91 / Number 11

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