surgical power point presentation on neck dissection

1. NECK DISSECTION
AKANA MOHAN PHANEENDRA
Final M.B.B.S part-2
8th SEMESTER
26th JULY , 2016

2. Academy’s committee for head & neck
surgery & oncology.
• Radical neck dissection (RND) is the standard basic
procedure for cervical lymphadenopathy against
which all other modifications are compared
• Modifications of RNDpreservation of any non-
lymphatic structuresmodified radical neck
dissection (MRND)

3. • Any neck dissection that preserves one or more
groups or levels of lymphnodes Selective neck
dissection (SND)
• Extended radical neck dissection (ERND)removal
of additional lymphnode groups or non lymphatic
structures relative to the RND.

4. TYPES OF NECK DISSECTION
• Classic radical neck dissection (RND)
• Modified radical neck dissection (MRND)
• Selective neck dissection (SND)
– Supra omohyoid block
– Postero lateral neck dissection
– Lateral neck dissection
– Anterior (central) dissection
• Commando operation
• Bilateral neck dissection
• Extended radical dissection (ERND)

5. Classical radical neck dissection
• Resection of:
Fascia
Fat
Gland : Sub-mandibular , Lower part of
parotid
Muscle :Sternomastoid , Omohyoid
Vein : Internal & External jugular
Nerve: Spinal accesory
Lymph nodes(Level 1 to 5)
En-block(Crile’s operation)

6. Mc fee incision
• Also called “Fischel T or modified Crile’s incision”
• Only incision with bony landmarks.
• It has two components namely:
• SUBMANDIBULAR COMPONENT :
1st limb begins over mastoid ,goes down
to hyoid, again superiorly to submental area.
• SUPRACLAVICULAR COMPONENT :
2nd limb – 2cm above clavicle , laterally
from anterior border of trapezius to mid line.

8. Mc fee incision
• ADVANTAGES:
• Good blood supply from
medial & lateral aspects
• Flap necrosis chances
are rare
• Central bipedicled flap
has good vascularity &
covers most length
carotid vessels & protect
carotid artery, easy to
repair
• DISADVANTAGES:
• Difficult to perform in
short neck patients
• Dissection under central
bipedicled flap is tedious
with intensive retration
required by assistant for
proper exposure

9. Crile’s incision
• ADVANTAGES:
• Easy to perform
• Maximum exposure to
repair field
• DISADVANTAGES:
• Trifurcation point is
prone for delayed
healing
• Vertical limb of this
incision overlies carotid
artery.compromised
healing results in
exposure of carotid
vessels
• Unsightly scar later
forms contracture band

10. Other incisions for RND / MRND
• SCHOBINGER
• CONLEY / SCHECHTER
• HOCKEY STICK
• HAYES MARTIN
• TRIRADIATE
• APRON
• FISCHEL T-J / CIRCLES

13. MODIFIED RADICAL
NECKDISSECTION(MRND)
• Also called Conservative Functional Block Dissection
• Well-differentiated & less aggressive tumor(like
PAPILLARY CARCINOMA OF THYROID with lymph
node secondaries)
• Structures preserved :
Spinal accessory nerve (SAN)
Sternocleido mastoid muscle (SCM)
Internal jugular vein (IJV)

14. • MRND type-1 : only Spinal accessory nerve is
preserved(only N)
• MRND type-2 : Accessory nerve & Sternocleido
mastoid(NM-preserved)
• MRND type-3 : Accessory nerve ,
Stenocleidomastoid muscle , Internal jugular vein
(NMV-Preserved) functional neck dissection

16. SELECTIVE NECK DISSECTION:
• SUPRA OMOHYOID BLOCK :Fat , Fascia , Lymph nodes ,
Muscles , Sub-Mandibular Salivary Gland + OMO-HYOID
MUSCLE
• Well-differentiated tumor & involvement of few sub-
mandibular lymph nodes(levels-1,2,3)
• LATERAL NECK DISSECTION(ANTERO-LATERAL ALND
JUGULAR) :
LEVELS 2 , 3 , 4 are removed Bilaterally
Laryngeal and pharyngeal primaries with clinically
negative nodes

17. • POSTERO-LATERAL DISSECTION:
LEVELS- 2 , 3 , 4 , 5 are removed for cutaneous
malignancies , with sub occipital nodes
• ANTERIOR(CENTRAL) DISSECTION :Level 6 (pre-
tracheal , para-tracheal) are removed

20. COMMANDO OPERATION (Combined
mandibular dissection & neck dissection)
• Wide excision of primary tumor with hemi-
mandibulectomy and neck block dissection (en-
block removal)
• Composite resection of primary tumor , mandible &
radical neck dissection (RND)
• Ex: carcinoma of tongue or floor of mouth

22. BILATERAL NECK DISSECTION
• IJV is preserved on one side
• Always the side where preserved operated first
• Ligating one IJV increases ICP by 3 fold
• Both IJV ligation increases ICP by 5 fold
• ICP gradually falls over 8-10 days

23. EXTENDED RADICAL DISSECTION
• Removal of one or more additional group of
lymphatics or removal of non lymphatic structures
with RND

24. COMPLICATIONS OF BLOCK DISSECTION
• HEMORRHAGE
• INFECTION
• LYMPHATIC OOZE
• CAROTID BLOW OUT
• SEROMA & FLAP NECROSIS
• FROZEN SHOULDER IS COMMON
• RARELY PNEUMOTHORAX & CHYLOUS FISTULA
• DROOPING OF SHOULDER DUE TO PARALYSIS OF
TRAPEZIUS IN RADICAL NECK DISSECTION