SELECTIVE NECK DISSECTION
(I-III) FOR NODE NEG AND
NODE POSITIVE NECKS

INDIAN DENTAL ACADEMY
Leader in continuing dental ...
INTRODUCTION
 Oral cancer accounts for 10.7% of all the solid tumors
in males & 5.4% in females in Mumbai.
 Unlike the w...
PATIENTS & METHODS
 The study was performed on 398pts,297
males & 101 females (3:1).In 24-83yrs age
range (mean52.6yrs).
...
RESULTS
SITE

NO (%)

Buccal mucosa

229 (58%)

Lower alveolus

84 (21%)

Tongue

61 (15%)

Retromolar trigone

15 (4%)

F...
 GB complex was commenest site of primary tumor in
79% .
 SOHND was performed for clinically node –ve neck in
259 (65%) ...
 As expected in GB cancer level I was the
most commonest site 38 (9.5%) followed by
level II 23 (6%) ,level III 6 (1.3%)....
 Out of 52,42(81%) had radiation .In addition 12(3%)
pts had received prior radiotherapy and 7(2%) had
prior chemotherapy...
REGIONAL FAILURE
 Of 23 pure regional recurrences 19( 83%) were
ipsilateral and 4 (17%) were contra lateral .
 Of 19,16 ...
 However, node positivity and presence of and extra
capsular spread of nodal disease did not have
significant impact on t...
DISCUSSION


Gingivobuccal sulcus being the most common SCC had
nodal mets. Only in 46% of cases even in T3 & T4 stages.
...


Medina et all reported 5% failure in node –ve neck,10% in
single node with out extra capsular spread ,24% in multiple
n...
 In GB cancers the incidence of pure regional failure (
primary controlled) were reported from this institution
as 3% wit...
 At the end of 5yr followup the GB
cancer had 6.5% regional failure as
compared to 12.3% for tongue
cancers. This trend R...
CONCLUSION
 SND (I II III ) is an oncologically
sound procedure for node –ve and a
for a select group of low volume node
...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Selective neck dissection (i iii) for node /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Selective neck dissection (i iii) for node /certified fixed orthodontic courses by Indian dental academy

  1. 1. SELECTIVE NECK DISSECTION (I-III) FOR NODE NEG AND NODE POSITIVE NECKS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION  Oral cancer accounts for 10.7% of all the solid tumors in males & 5.4% in females in Mumbai.  Unlike the western world gingivobuccal complex is the commonest oral subsite involved in our study group because of the use of smokeless tobacco  These tumours show early bone invasion and the cervical node metastasis takes place late.  Even in T3 & T4 tumors less than half the tumors have nodal metastasis ,The nodal metastasis in the oral cancer follows a fairly predictable pattern with levels I II III being most commonly involved. www.indiandentalacademy.com
  3. 3. PATIENTS & METHODS  The study was performed on 398pts,297 males & 101 females (3:1).In 24-83yrs age range (mean52.6yrs).  Pts were called for follow up examination at 3month interval for 2yrs ,at 6months interval for 3yrs and yearly thereafter.  Any regional failure was documented in terms of its location and salvage treatment. www.indiandentalacademy.com
  4. 4. RESULTS SITE NO (%) Buccal mucosa 229 (58%) Lower alveolus 84 (21%) Tongue 61 (15%) Retromolar trigone 15 (4%) Floor of the mouth 9 (2%) Total 398 (100%) www.indiandentalacademy.com
  5. 5.  GB complex was commenest site of primary tumor in 79% .  SOHND was performed for clinically node –ve neck in 259 (65%) pts and rest had palpable nodes .  Clinically 118 (30%) had N1 and 21 (5%) had N2 disease.  However histologically only52 (13%) showed +ve nodes.In 11 %(28/259) which are clinically No was upstaged as node +ve and only17% (24/139) of clinically +ve necks were actually histologically +ve. www.indiandentalacademy.com
  6. 6.  As expected in GB cancer level I was the most commonest site 38 (9.5%) followed by level II 23 (6%) ,level III 6 (1.3%).  Isolated level I involvement was seen in 54% of node +ve neck. Skip metastasis to Level II,III was seen only in 12 (3%) cases.  Of all node +ve cases ,extracapsular spread of the disease is seen in 19 (5%).  132 (33%) had well differentiated tumour,228(57%) moderately diff,38 (10%) had poorly diff. www.indiandentalacademy.com
  7. 7.  Out of 52,42(81%) had radiation .In addition 12(3%) pts had received prior radiotherapy and 7(2%) had prior chemotherapy before their first visit.  During follow-up 114 recurrences were observed in 93 (23%)pts and 7 (2%) pts had a secondary primary tumor.  Of 114 recurrences 80(70%) were local site failures , 23(20%) neck failure and 2 (2%) distant mets. to lungs and skeleton.  At the time of last follow-up 316(80%) were disease free,69(17%) were alive with unsalvageable disease and 13 (3%) were dead because of unrelated cause.  Two yr and five yr disease free survival rates were 80% & 69% www.indiandentalacademy.com
  8. 8. REGIONAL FAILURE  Of 23 pure regional recurrences 19( 83%) were ipsilateral and 4 (17%) were contra lateral .  Of 19,16 (84%) were with in the field of dissection at the ipsilateral levels I II III, of these 4.8% were identified at 2yrs and 5.8% at 5 yrs. Another 5pts failed in neck after successful salvage of a prior local recurrence  Thus overall neck failure were seen in 5% at 2yrs and 8% at 5yrs.Neck failure rates were similar for node +ve (5.8%) and node –ve neck (5.5%). www.indiandentalacademy.com
  9. 9.  However, node positivity and presence of and extra capsular spread of nodal disease did not have significant impact on the regional failure, possibly because of the use of adjuvant radiotherapy in all these pts.  7/167 (4.2%) pts who received radiation failed in neck as compared to 15/231 (6.5%) of those who did not receive it.  These failure pts were treated with neck dissections, radiation and chemotherapy .  At the time of last follow only 4pts who developed regional failure were alive and free of disease following salvage treatment. www.indiandentalacademy.com
  10. 10. DISCUSSION  Gingivobuccal sulcus being the most common SCC had nodal mets. Only in 46% of cases even in T3 & T4 stages.  Comprehensive neck dissection has been a standard treatment for metastatic neck nodes but various studies have shown its morbidity to be significantly higher than that of selective neck dissection.  Pinoselle et all found considerable shoulder dysfunction in radical (51%) ,functional (34%),SOND 7%.  Pts undergoing MRND are reported to have significantly worse shoulder dysfunction than the pts with SND.  SOHND is a recommended procedure for node –ve neck and for selected node +ve neck with limited nodal disease. www.indiandentalacademy.com
  11. 11.  Medina et all reported 5% failure in node –ve neck,10% in single node with out extra capsular spread ,24% in multiple nodes or nodes with extra capsular spread without postoperative radiotherapy and 15% with post operative radiotherapy.  In this study there was no significant difference in the regional failures in path. Node +ve (5.8%) and node –ve (5.5%)  Adjuvant radiotherapy has been shown to have significant influence in reducing neck failure.  In this study the diff in neck failures between radiotherapy treated and untreated was not significant (4.2% & 6.5%), this difference was not significant even on subset analysis in both n0 and n+ groups.  This suggests that SND (I-III) is adequate treatment for nodeve and even selected node +ve pts in in judicious combination with radiotherapy. www.indiandentalacademy.com
  12. 12.  In GB cancers the incidence of pure regional failure ( primary controlled) were reported from this institution as 3% with RND ,12% with suprahyoid and 5% with SOHND in pts with N-O necks  In N +ve category RND 18% supra hyoid 34% and SOHND 19% .  Recurrence after SOHND can be either in the field of dissection or out of the field.carvalho et al found 57.1% of them inside the limits of dissection .in this study it is 70%  These guys found out the grade of tumor differentiation to be the most significant predictor of nodal failure, site of the primary tumor seemed to be an independent factor influencing neck failure . www.indiandentalacademy.com
  13. 13.  At the end of 5yr followup the GB cancer had 6.5% regional failure as compared to 12.3% for tongue cancers. This trend Reiterates the observation that oral cancers per se are a diverse group of tumors and individual subsides behave differently from one another. www.indiandentalacademy.com
  14. 14. CONCLUSION  SND (I II III ) is an oncologically sound procedure for node –ve and a for a select group of low volume node +ve. Oral cancer in general and GB cancer in particular.  It meets the combined goal of optimal neck treatment with minimal morbidity. www.indiandentalacademy.com
  15. 15. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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