Otolaryngology: Neck Dissection

Definitions

• Extent of Dissection:
  • Radical Neck Dissection (RND) – Removes All Ipsilateral Cervical Lymph Node Levels I-V (Spares Level VI)
    • Modified Radical Neck Dissection (MRND) – Modified Version of RND to Reduce Morbidity
  • Selective Neck Dissection (SND) – Removes Only the Lymph Node Levels at Highest Risk for Metastases
    • Levels Removed Depend on the Location of the Primary Tumor
• Based on Clinical Node Status:
  • Therapeutic Neck Dissection – For Clinically Positive Metastatic Cervical Lymphadenopathy
  • Elective Neck Dissection – For Clinically Negative Metastatic Cervical Lymphadenopathy but Increased Risk of Occult Disease
• Other Terms:
  • Planned Neck Dissection – Done for High-Risk Residual Cancer 6-8 Weeks After Other Neck Treatment (Chemoradiotherapy)
  • Salvage Neck Dissection – Done for Clinically Evident Metastatic Disease After Previous Treatment

Selective Neck Dissection (SND)

• Supraomohyoid Neck Dissection
  • Removes Cervical Lymph Node Levels I-III
  • Indications: Oral Cavity Cancer
• Lateral Neck Dissection
  • Removes Cervical Lymph Node Levels II-IV
  • Indications: Oropharyngeal, Hypopharyngeal & Laryngeal Cancer
  • Most Common Injured Nerve: Spinal Accessory Nerve
• Posterolateral Neck Dissection
  • Removes Cervical Lymph Node Levels II-V
• Central (Anterior) Neck Dissection
  • Removes Cervical Lymph Node Level VI
  • Indications: Midline Cancers of the Anterior Lower Neck
    • Commonly Used for Thyroid Cancers

Radical Neck Dissection (RND)

• Radical Neck Dissection (RND)
  • Components of Resection:
    • Cervical Lymph Node Levels I-V (Spares Level VI)
    • Spinal Accessory Nerve (SAN/CN-XI) – Highest Morbidity of the Dissection
    • Sternocleidomastoid Muscle (SCM)
    • Internal Jugular Vein (IJV)
  • Rarely Used in Modern Practice Due to High Morbidity
• Modified Radical Neck Dissection (MRND)
  • Components of Resection:
    • Cervical Lymph Node Levels I-V (Spares Level VI)
  • Spares At Least One of (Compared to RND):
    • Spinal Accessory Nerve (SAN/CN-XI) – Highest Morbidity of the Dissection
    • Sternocleidomastoid Muscle (SCM)
    • Internal Jugular Vein (IJV)
  • Reduces the Morbidity from RND with No Difference in Mortality

Complications

• Air Leak
• Bleeding
• Chylous Fistula
• Facial Edema
• Cerebral Edema
• Blindness
• Carotid Artery Injury
• Nerve Injury