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TITLE: Neck Dissection and Sentinel Lymph Node Biopsy SOURCE: Grand Rounds Presentation, UTMB, Dept. ... - page 7 / 9





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Radical Neck Dissection

The radical neck dissection is the gold standard for oncologic treatment of lymph node metastasis in the neck. It involves removal of all lymphatics from levels I-V. In addition, removal of non-lymphatic structures including the spinal accessory nerve, the sternocleidomastoid muscle and the internal jugular vein is carried out. It does not include removal of the postauricular and suboccipital nodes, periparotid nodes except for a few nodes located in the tail of the parotid gland, the perifacial and buccinator nodes, the retropharyngeal nodes, and the paratracheal nodes.

Modified Radical Neck Dissection

Modified radical neck dissection involves excision of the same lymph node bearing tissues from one side of the neck as is performed in a RND with the preservation of one or more non-lymphatic structure including the spinal accessory nerve, the IJV, or the SCM.

Selective Neck Dissection

There are several types of selective neck dissection. They focus on removing the highest risk nodal groups depending on the site of the primary tumor. The Supraomohyoid neck dissection (SOHND) removes levels I-III and is performed in patients with oral cavity primaries, Merkel cell carcinoma, some melanoma of the face and SCCA of the parotid. Bilateral SOHND are considered with anterior oral cavity and cutaneous lesions along with lateral lesions that approach or cross the midline. The lateral neck dissection removes levels II-IV. It is performed for patients with oropharyngeal, hypopharyngeal or laryngeal primaries. The posterolateral neck dissection removes levels II-IV, suboccipital and postauricular nodes. It is performed primarily for patients with cutaneous lesions on the posterior scalp or neck. Then anterior neck dissection removes the anterior compartment (level VI) and is indicated in some types of differentiated thyroid carcinoma, parathyroid carcinoma, subglottic carcinoma, and lesions of the cervical esophagus.

Extended Neck Dissection

The extended neck dissection removes any lymphatic or non-lymphatic structure that is usually preserved in a RND or MRND. Examples include removal of parapharyngeal nodes along with a pharyngectomy specimen. Removal of the carotid artery with reconstruction may be attempted in some circumstances. Preoperative balloon occlusion may be performed to determine if the patient can tolerate carotid ligation without reconstruction.

Sentinel Lymph Node Biopsy

The role of sentinel lymph node biopsy in head and neck carcinoma is still being established. It has been effective in the treatment of melanoma of the head and neck but its role in the treatment of squamous cell carcinoma of the oral cavity or pharynx is still being developed.

The central tenet of sentinel lymph node biopsy is that a primary tumor will spread via lymphatics to a primary node. Examination of the primary node for tumor then directs the need

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