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Questions and Answers
In a radical neck dissection, which of the following carcinomas is typically an indication for the procedure, considering the exception mentioned in the content?
In a radical neck dissection, which of the following carcinomas is typically an indication for the procedure, considering the exception mentioned in the content?
- Carcinoma of the larynx (correct)
- Carcinoma of the lip
- Carcinoma of the oral cavity
- Carcinoma of the thyroid
During a radical neck dissection, removal of the internal jugular vein simplifies the removal of which of the following?
During a radical neck dissection, removal of the internal jugular vein simplifies the removal of which of the following?
- Submandibular lymph nodes
- Parotid gland lymph nodes
- Spinal accessory nerve
- Upper and lower deep cervical lymph nodes (correct)
What is the primary reason for removing the sternomastoid muscle during a radical neck dissection?
What is the primary reason for removing the sternomastoid muscle during a radical neck dissection?
- To access the submandibular salivary gland
- To simplify the identification of cervical fascia
- To expose the internal jugular vein (correct)
- To facilitate removal of the spinal accessory nerve
Which of the following structures are preserved in a modified radical neck dissection, but would be removed in a radical neck dissection?
Which of the following structures are preserved in a modified radical neck dissection, but would be removed in a radical neck dissection?
A surgeon performs a modified radical neck dissection Type II. According to the content, which structure is preserved?
A surgeon performs a modified radical neck dissection Type II. According to the content, which structure is preserved?
In a functional neck dissection, which set of structures are preserved?
In a functional neck dissection, which set of structures are preserved?
A patient undergoing a neck dissection develops sloughing and necrosis at the center of the incision postoperatively. Which incision type is most likely to be associated with this complication?
A patient undergoing a neck dissection develops sloughing and necrosis at the center of the incision postoperatively. Which incision type is most likely to be associated with this complication?
In a supraomohyoid neck dissection, the removal of lymph nodes from Levels I, II, and III is performed. What anatomical structure defines the inferior limit of this dissection?
In a supraomohyoid neck dissection, the removal of lymph nodes from Levels I, II, and III is performed. What anatomical structure defines the inferior limit of this dissection?
A patient diagnosed with cancer of the larynx undergoes a neck dissection involving removal of lymph nodes in levels II, III, and IV. Which type of neck dissection does this describe?
A patient diagnosed with cancer of the larynx undergoes a neck dissection involving removal of lymph nodes in levels II, III, and IV. Which type of neck dissection does this describe?
What is the primary characteristic that defines a selective neck dissection?
What is the primary characteristic that defines a selective neck dissection?
Which anatomical landmark serves as the inferior limit for a supraomohyoid neck dissection?
Which anatomical landmark serves as the inferior limit for a supraomohyoid neck dissection?
What is the primary rationale behind performing a bilateral block dissection in two stages separated by 4-6 weeks?
What is the primary rationale behind performing a bilateral block dissection in two stages separated by 4-6 weeks?
Which of the following best describes a selective neck dissection?
Which of the following best describes a selective neck dissection?
A patient presents with cutaneous melanoma on the posterior scalp and neck. Which type of neck dissection would most appropriately address the regional lymph node basins at risk?
A patient presents with cutaneous melanoma on the posterior scalp and neck. Which type of neck dissection would most appropriately address the regional lymph node basins at risk?
Which of the following correctly pairs a specific neck dissection type with its corresponding levels?
Which of the following correctly pairs a specific neck dissection type with its corresponding levels?
After a Crile's incision, a patient exhibits sloughing and necrosis at the central portion of the incision. What is the most concerning potential complication directly resulting from this necrosis?
After a Crile's incision, a patient exhibits sloughing and necrosis at the central portion of the incision. What is the most concerning potential complication directly resulting from this necrosis?
In an extended radical neck dissection, which of the following non-lymphatic structures might be removed, in addition to those removed in a standard radical neck dissection?
In an extended radical neck dissection, which of the following non-lymphatic structures might be removed, in addition to those removed in a standard radical neck dissection?
A patient with oral cavity malignancy undergoes a supraomohyoid neck dissection. What anatomical structure could potentially be encountered as the posterior limit of the dissection?
A patient with oral cavity malignancy undergoes a supraomohyoid neck dissection. What anatomical structure could potentially be encountered as the posterior limit of the dissection?
In a functional neck dissection, which of the following structure is intentionally preserved?
In a functional neck dissection, which of the following structure is intentionally preserved?
Which of the following is a characteristic of the incision used in a suprahyoid block dissection (visor incision)?
Which of the following is a characteristic of the incision used in a suprahyoid block dissection (visor incision)?
Flashcards
Neck Dissection
Neck Dissection
Surgery to examine and remove lymph nodes of the neck.
Modified Radical Neck Dissection
Modified Radical Neck Dissection
Excision of all lymph node groups removed by radical neck dissection with preservation of one or more of the following structures: Spinal accessory nerve, Internal jugular vein, and Sternomastoid muscle.
Functional Neck Dissection
Functional Neck Dissection
Excision of all lymph node groups removed by radical neck dissection with preservation of all of the following structures: Spinal accessory nerve, Internal jugular vein, and Sternomastoid muscle.
Selective Neck Dissection
Selective Neck Dissection
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Lymph Nodes Removal
Lymph Nodes Removal
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Sternomastoid Removal
Sternomastoid Removal
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Internal Jugular Vein Removal
Internal Jugular Vein Removal
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Submandibular Salivary Gland Removal
Submandibular Salivary Gland Removal
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Lower part of parotid gland Removal
Lower part of parotid gland Removal
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Radical block dissection
Radical block dissection
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Radical Block Dissection Indications
Radical Block Dissection Indications
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Goblet incision problems
Goblet incision problems
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Suprahyoid block dissection
Suprahyoid block dissection
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Supraomohyoid Neck Dissection
Supraomohyoid Neck Dissection
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Lateral Neck Dissection
Lateral Neck Dissection
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Posterolateral Neck Dissection
Posterolateral Neck Dissection
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Anterior Compartment Neck Dissection
Anterior Compartment Neck Dissection
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Study Notes
- Neck dissection refers to surgery to examine and remove lymph nodes of the neck.
Types of Neck Dissections
- Radical block dissection
- Modified radical neck dissection
- Functional neck dissection
- Extended radical neck dissection
- Bilateral block dissection
- Selective neck dissection
Selective Neck Dissections:
- Suprahyoid block dissection: Levels I-II
- Supraomohyoid neck dissection: Levels I-III
- Extended supraomohyoid dissection: Levels I-IV
- Lateral neck dissection: Levels II-IV
- Posterolateral neck dissection: Levels II-V
- The anterior compartment neck dissection: Level VI
- Superior mediastinum dissection: Level VII
Radical Block Dissection
- Indicated for all carcinomas of the head and neck, except lip cancer.
- Lymph nodes of the anterior and posterior triangles of the neck are removed.
- Structures removed to simplify removal of lymph glands include:
- Sternomastoid: to expose the internal jugular vein
- Internal jugular vein: to simplify removal of upper and lower deep cervical lymph nodes
- Spinal accessory nerve
- Cervical fascia from the jaw to the clavicle
- Submandibular salivary gland: for easier removal of submandibular lymph nodes
- Lower part of parotid gland: contains lymph glands
- Structures preserved:
- Carotid arteries
- Vagus nerve
- Sympathetic trunk
- Phrenic nerve
- Hypoglossal nerve
Incisions:
- Goblet incision (Crile's incision)
- Hockey stick (Apron) incision
- Ladder incision
- Macfee incision (2 incisions 2cm in between)
- Inverted L shaped incision
Goblet Incision (Crile's Incision):
- Transverse incision from the angle of the jaw forwards and downwards to the level of the hyoid bone, then forward and upwards to the chin.
- Vertical incision from the center of the transverse incision downward to the clavicle
- This incision is disfavored because sloughing and necrosis can occur at the center part of the incision, leading to exposure of the internal carotid artery, infection, hemorrhage, and death.
Modified Radical Neck Dissection
- Excision of all lymph node groups removed by radical neck dissection., but preserves one or more of the following structures:
- Spinal accessory nerve
- Internal jugular vein
- Sternomastoid muscle
- Type I: Spinal accessory nerve preserved.
- Type II: Spinal accessory nerve and internal jugular vein are preserved.
- Type III: Spinal accessory nerve, internal jugular vein, and sternomastoid muscle are preserved, also known as functional neck dissection
Functional Neck Dissection
- Excision of all lymph node groups removed by the radical neck dissection with preservation of all of the following structures:
- Spinal accessory nerve
- Internal jugular vein
- Sternomastoid muscle
Extended Radical Neck Dissection
- Radical neck dissection with removal of lymphatic and non-lymphatic structures.
- Lymphatic structures removed include the parapharyngeal lymph nodes, superior mediastinal lymph nodes, and paratracheal lymph nodes.
- Non-lymphatic structures removed include carotid artery, hypoglossal nerve, vagus nerve, and para-spinal muscles.
Bilateral Block Dissection
- Second side is carried out 4-6 weeks after the first to allow venous collaterals to develop.
Selective Neck Dissection
- Any type of lymph node removal where there is preservation of one or more lymph node groups removed by radical neck dissection.
Suprahyoid Block Dissection (Level I-II)
- Removes:
- Upper deep cervical lymph nodes
- Parotid lymph nodes with lower part of parotid gland
- Submandibular lymph nodes and salivary glands
- Submental lymph node with fat and deep fascia as one block
- Indicated for carcinoma of the lower lip.
- Incision: Curved incision from mastoid process of one side to opposite mastoid reaching down to hyoid (Visor incision).
Supraomohyoid Neck Dissection (Level I-III)
- Removal of lymph nodes from levels I, II, and III.
- Posterior limit: cutaneous branches of cervical plexus & posterior border of sternomastoid muscle
- Inferior limit: superior belly of omohyoid muscle where it crosses internal jugular vein
- Indicated for oral cavity malignancy.
Extended Supraomohyoid Dissection
- Includes levels I-IV.
Lateral Neck Dissection (Levels II-IV)
- Lymph nodes in levels II, III, and IV are removed.
- Indicated for cancer of the larynx.
Posterolateral Neck Dissection (Level II-V)
- Lymph nodes in levels II, III, IV, and V are removed.
- Indicated for Cutaneous melanoma of posterior scalp & neck.
Anterior Compartment Neck Dissection (Level VI)
- Lymph nodes from the anterior triangle of the neck are removed, i.e., level VI.
Superior Mediastinum Dissection (Level VII)
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