1. Neck dissection involves removing lymph nodes from different levels in the neck to stage and treat head and neck cancers. 2. The extent of neck dissection, such as radical or modified radical, depends on how many non-lymphatic structures like the spinal accessory nerve are preserved. 3. Selective neck dissections remove nodes from only certain levels, while comprehensive dissections are used to treat cancer that has spread to lymph nodes.

1. Neck dissectionDr. Mansoor Khan Resident Plastic Surgery

2. IntroductionStatus of the cervical lymph nodesimportant prognostic factor in the head and neck tumors

3. IntroductionCure rates drop into half when there is regional lymph node involvement

4. Emil Theodor KocherEarned Nobel Prize in 1909 for his work in thyroid and neck surgery — the first ever awarded to a surgeon.1880 – Kocher proposed removing nodalmetastases

5. 1906 – George Criledescribed the classic radical neck dissection (RND)

6. 1967 - Bocca and Pignatarodescribed the “functional neck dissection” (FND)

8. Level - I

9. Level - II

10. Level - III

11. Level - IV

12. Level - V

13. Level - VI

14. Subzones of Levels I-V

15. Level IAFloor of mouth, anterior oral tongue, anterior mandibularalveolar ridge, lower lipLevel IBOral cavity, anterior nasal cavity, softtissue of midface, submandibular gland

16. Level IIA & IIBOral cavity, nasal cavity, nasopharynx, oropharynx,, hypopharynx, larynx, parotid gland

17. Level IIIOral cavity, nasopharynx, oropharynx, hypopharynx, larynx

18. Level IVHypopharynx, thyroid, cervical esophagus, larynx

19. Level VA & VBNasopharynx, oropharynx, posterior scalp/neck skin

20. Level VIThyroid gland, glottic and subglotticlarynx, apex of piriform sinus, cervical esophagus

21. “N” classification – AJCC (1997)Consistent for all mucosal sites except the nasopharynxStaging of the neckThyroid and nasopharynx have different staging based on tumor behavior and prognosis

22. Single ipsilateral lymph node 3 to 6 cmSingle ipsilateral lymph node, < 3 cmNo regional lymph node metastasesMultiple ipsilateral lymph nodes < 6 cmBilateral or contralateral nodes < 6cmMetastases > 6 cmLymph node staging

23. Classification

24. Extent of Radical Neck Dissection Radical Neck Dissection All lymph nodes in Levels I-V including spinal accessory nerve (SAN), SCM, and IJV

25. Modified Radical NeckExcision of same lymph node bearing regions as RND with preservation of one or more nonlymphatic structures (SAN, SCM, IJV)

26. MRND Type IPreservation of SAN

27. MRND Type IIPreservation of SAN and IJV

28. MRND Type IIIPreservation of SAN, IJV, and SCM ( “Functional neck dissection”)

29. Supraomohyoid neck dissectionSelective Neck Dissections

30. Selective Neck DissectionsLateral neck dissection

31. Extended Neck DissectionAny dissection which includesremoval of one or more additional lymph node groups and/or non-lymphatic structures.

32. Algorithm for treating an N0

33. T3 or T4 Oral cavity tumors and tumor thickness (>3 mm) supraomohyoidneck dissection.Increasing stage of the oropharynx, hypopharynx, and supraglottic larynx needs lateral neck dissection.Algorithm for treating an N0

34. N+ disease needs Comprehensive neck dissection

35. “Surgical approach”Incisions

36. A p r o n I n c i s i o n

37. H a l f A p r o n I n c i s i o n

38. C o n l e y I n c i s i o n

39. Y - I n c i s i o n

40. D o u b l e – Y I n c i s i o n

41. H -I n c i s i o n

42. M a c F e e I n c i s i o n

43. S c h o b i n g e rI n c i s i o n

44. M o d i f i e d S c h o b i n g e rI n c i s i o n

45. Steps of Radical Neck Dissection