Neck Dissections Chintamani
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1Jaypee Gold Standard Mini Atlas Series®: NECK DISSECTIONS
2Jaypee Gold Standard Mini Atlas Series®: NECK DISSECTIONS
Chintamani MS FRCS (Edin) FRCS (Glas) FICS FIMSA Associate Professor of Surgery Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi India
3Published by
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Jaypee Gold Standard Mini Atlas Series® Neck Dissections
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2009
9788184485776
Typeset at JPBMP typesetting unit
Printed at
4
To My mother and my patients for being my ultimate teachers and Mrinal for being a selfless and inspiring companion
5FOREWORD
I was fascinated going through this manuscript entitled ‘Atlas of Neck Dissections’ authored by Professor Chintamani. It is, like Professor Chintamani's previous treatise, a masterpiece which can only come from the pen of an Oncologic Surgeon of great experience in this field.
This lucid piece of work on Neck Dissections can match any known national or international pictorial operative surgery textbook. The vivid illustrations, both drawings and pictures taken during operations, will immensely help the postgraduate students and I daresay the practicing surgeons as well. I am sure it will be an asset for the library of any Medical Institution and as usual, will find a prominent place in many personal collections of Surgical Works.
I would like to congratulate Professor Chintamani for this book and wish him all the best for his future endeavors.
Prof Sandip Mukerjee
FRCS (Eng) FRCS (Edin) FRCS FAIS FIMSA
Consultant Surgeon
Honorary Surgeon to the President of India (1973–2002)
President—Delhi State Chapter, Association of Surgeons of India (2004–2007)
President—“Aatam Swasthya”, Peripheral Vascular Health Society
Trustee—International Medical Sciences Academy (IMSA)
6FOREWORD
Indeed it is a great privilege to get an opportunity to write for an excellent academic work. In an era when you find scores of publications framed on western population and practices, Prof Chintamani's Atlas of Neck Dissections is an exemplary effort and praiseworthy.
We all come to encounter the disease in advanced stage where we face resource constraints in investigating and managing the cases. This book is an excellent handbook which has been customised to help counter all the constraints. The step-by-step selection of chapters has made the book an easy reading. The elaborate decription of staging, planning and execution of therapeutic modality are based on contemporary surgical principles.
Dr Chintamani since the time I came to know him, has been seen to involve in academics at the cutting edge. His concern for upliftment in medical education in our homeland is of great importance. He is a natural teacher and loves to involve himself in dissemination of updated surgical knowledge.
I recommend this work of Dr Chintamani and has a profound belief that this book would definitely be a handy reference for every aspiring as well as practicing surgeon dealing with neck node diseases.
On my behalf and on behalf of the Association of Surgeons of India, I wish Prof Chintamani and his work a great success.
Rakesh Srivastava
President—Association of Surgeons of India
7PREFACE
The most significant predictor of outcome in neck cancers is the presence of positive neck nodes and the survival drops significantly in node positive patients. Inspite of various advancements in the imaging techniques, it is very difficult to accurately detect the presence of occult metastases, therefore neck dissections continue to remain an essential part of management of neck cancers. There are not many books on neck dissections inspite of the fact that one of the most common male cancers is oral cancer caused due to addictions to various smokeless forms of tobacco. Therefore, it indeed is a privilege and I feel very blessed that I could bring out my second book on neck dissections.
The better understanding of the surgical anatomy and the patterns of lymphatic spread in the neck has contributed towards a paradigm shift in the philosophy of management of these cancers. Organ preservation in cancer has replaced the previously popular and extensively radical neck dissections that were associated with high morbidity. Modified and selective neck dissections are increasingly being performed these days even for N1 necks. The intention is to provide the reader with a comprehensive and real life step-by-step scenario in neck surgery.
The atlas includes figures that would cover up all aspects of neck dissections and are live from various surgeries performed by the author over a period of time.8
Neck Dissections
I am grateful to all my students for keeping my faith alive in the thought from Rig Veda …”Sharing your knowledge is the only way to achieve immortality”. They have always given me the opportunity to share my knowledge and ignorance at all times and I owe this and my other books to them. As is often said, “Always is always wrong in surgery and never is never right”. There will always be issues pertaining to variations in the techniques of surgeons for performing neck dissections and the techniques described in this atlas are by no means the “only” way but “one” such way of performing these surgeries. This atlas is expected to benefit all postgraduate and undergraduate students, general surgeons, head and neck surgeons and practicing surgeons with interest in the field of surgical oncology.
Chintamani
9ACKNOWLEDGEMENTS
I would specially like to thank my Head of the Department of Surgery, Prof Dinesh Bhatnagar, Additional Director General of Health Services who is an eminent surgeon and an inspiring leader.
I would also like to thank Dr RS Mohil, a truly gifted surgeon and above all a gentleman and all my departmental colleagues for being a constant source of motivation to write this book which always felt like swimming against the tide.
My special thanks are due to all my postgraduate students, senior residents and all students (in India and abroad) for being the very reason for writing this book.