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Neck Dissections
Chintamani
CHAPTER 1:
Introduction
HISTORICAL EVOLUTION OF NECK DISSECTIONS1–6
MODIFICATIONS OF NECK DISSECTIONS7–13
Modifications to the Radical Neck Dissection
PRESENT CONCEPTS AND CONTROVERSIES IN THE MANAGEMENT OF THE NECK NODES5–13
Factors that Contribute to the Risk of Neck Metastases
Incidence and Frequency of Neck Metastases
Predicting the Development of Neck Metastases in N0 Necks (Table 1.1)13–19
CHAPTER 2:
Surgical Anatomy of Neck
SALIENT POINTS IN THE ANATOMY OF THE NECK
TRIANGLES OF THE NECK
FASCIAL NECK SPACES
LAYERS OF DEEP CERVICAL FASCIA (Fig. 2.4)
Investing or Outer Layer
Visceral or Middle Layer
Internal Layer
LYMPHATIC DRAINAGE OF THE HEAD AND NECK
Waldeyer's Internal Ring
Superficial Lymph Node System (Waldeyer's External Ring)
Deep System (Cervical Lymph Nodes Proper)
CLASSIFICATION OF THE LYMPH NODES IN THE NECK BASED ON THE LOCATION (Fig. 2.5)
Level I: Submental and Submandibular Groups
Level II: Upper Jugular Group
Level III: Middle Jugular Group
Level IV: Lower Jugular Group
Level V: Posterior Triangle Group
Level VI: Anterior Compartment Group (Visceral Group)
Level VII
ORGAN–SPECIFIC DRAINAGE
CHAPTER 3:
Staging the Disease in the Neck
CLINICAL STAGING (BASED ON JOINT INTERNATIONAL UNION AGAINST CANCER (UICC)/AMERICAN JOURNAL OF CANCER (AJC)
TNM CLASSIFICATION OF REGIONAL NODES
DISTANT METASTASES
CRITICISM AND LIMITATIONS OF CURRENT STAGING SYSTEM
ASSESSMENT OF CERVICAL LYMPHADENOPATHY
Factors Influencing the Sensitivity of Clinical Detection of Neck Nodes (Metastases)
INVESTIGATIONS
Imaging
SUSPICIOUS NODES ON CROSS-SECTIONAL IMAGING
Fine-Needle Aspiration Cytology
Other Diagnostic Procedures while Assessing the Neck Nodes
HISTOLOGICAL EXAMINATION
CHAPTER 4:
Management of the Neck Nodes
MANAGEMENT OF NODE NEGATIVE (N0) NECK
THE CONTROVERSIES !!1–6
EVALUATION OF PATIENTS WITH N0 NECK STATUS1,6–9
TREATMENT OPTIONS FOR N0 NECK5,6
Expectant Management
Radiation Therapy
Surgery
Arguments for Elective Neck Dissections
Arguments against Elective Neck Dissections
Recommendations for Surgical Management of N0 Neck in Head and Neck Cancers1–6,9
Terminology and the Confusion
Radiation Therapy in N0 Necks1–6
The Summary of Recommendations1–6, 8,9
OPTIMUM NUMBER OF NODES IN SND
INDICATIONS FOR ELECTIVE NECK TREATMENT IN N0 NECK
RECENT ADVANCES AND EMERGING TRENDS IN THE MANAGEMENT OF PATIENTS WITH N0 NECK STATUS1–6
Sentinel Node Biopsy (SNB)
Endoscopic Neck Dissections1
Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT)1
CHAPTER 5:
Techniques of Neck Dissection
TREATMENT OPTIONS FOR NODE POSITIVE (N+) NECK1–6
Reinforcing Certain Important and Salient Points
NECK DISSECTIONS–HISTORY AND EVOLUTION1–5
Important Points Reinforced
NECK DISSECTIONS (TYPES) AND INDICATIONS7–16
Radical Neck Dissection (RND)
Nodal Levels Dissected (Levels I-V)
Justification for RND as a Gold Standard for Positive Necks
The Current Indications for Classical RND2–7
MODIFIED RADICAL NECK DISSECTIONS2–7
Modified Radical Neck Dissections
Type-I (MRND-I)
MRND-II
MRND-III
Selective Neck Dissections
Conventional Nomenclature
NEW RECOMMENDED NOMENCLATURE FOR SND
CHAPTER 6:
Modified Radical Neck Dissection (MRND)
JUSTIFICATIONS FOR MRND7,8
CAN THESE STRUCTURES BE PRESERVED—FUNCTIONALLY AND ANATOMICALLY?10–12
Internal Jugular Vein
Sternocleidomastoid Muscle
Spinal Accessory Nerve
INDICATIONS OF MRND
CONTRAINDICATIONS OF MRND
SURGICAL TECHNIQUE
Conventional (Posteroanterior) Approach
ANTERIOR APPROACH (POPULARIZED BY BALLANTYNE)13
CASE 1
CASE - 2
CASE - 3
CASE - 4
CASE - 5
CASE - 6
CASE - 7
6(A) STEP BY STEP NECK DISSECTIONS
CHAPTER 7:
Selective Neck Dissections
JUSTIFICATIONS FOR SELECTIVE NODE DISSECTIONS6–9
CLASSIFICATION AND TYPES
The 1991 Classification Divided Elective Neck Dissections into the Following Categories:1–5
The 2002 (Committee for Head and Neck Surgery and Oncology) Classification3, 4
SELECTING THE NECK DISSECTION BASED ON THE PRIMARY SITE1–6
Oral Cavity Cancer
Oropharyngeal, Hypopharyngeal, and Laryngeal Cancer
Cancers of the Midline Structures of the Anterior Lower Neck (Figs 7.3 to 7.5)
Selective Neck Dissection for Cutaneous Malignancies
TECHNIQUES OF SELECTIVE NECK DISSECTIONS8–10
Supra-omohyoid Neck Dissection (SOHND)
Steps
Lateral Selective Neck Dissection
Technique (Figs 7.4 and 7.5)
Posterolateral Selective Neck Dissection (Fig. 7.6)
Anterior Compartment Selective Neck Dissection (Figs 7.7 and 7.8)
Extended Neck Dissections
CASE - 1
CASE - 2
CASE - 3
CASE - 4
INDEX
TOC
Index
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