Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.014
Warren C. Swegal MD
Metastasis to the retropharyngeal lymph nodes is not common for malignancies of the upper aerodigestive tract, salivary glands or thyroid. However, retropharyngeal metastasis is not a rare occurrence either and lymph node dissection may be required for therapeutic purposes. Prompt identification and management is paramount for disease control. Evidence of nodal involvement is the main indication for surgical dissection if radiotherapy is not available or effective. Significant extranodal extension with carotid or prevertebral involvement are considered contraindications to dissection. Surgical approach selection is vital as access can be limited. Both transcervical and transoral routes are available for appropriately experienced surgeons. Each approach has its advantages and disadvantages in set up, safety, and postoperative complications. These factors, along with need for concurrent tumor treatment should be considered when dissecting these lymph nodes.
{"title":"Retropharygneal node dissection","authors":"Warren C. Swegal MD","doi":"10.1016/j.otot.2024.08.014","DOIUrl":"10.1016/j.otot.2024.08.014","url":null,"abstract":"<div><div>Metastasis to the retropharyngeal lymph nodes is not common for malignancies of the upper aerodigestive tract, salivary glands or thyroid. However, retropharyngeal metastasis is not a rare occurrence either and lymph node dissection may be required for therapeutic purposes. Prompt identification and management is paramount for disease control. Evidence of nodal involvement is the main indication for surgical dissection if radiotherapy is not available or effective. Significant extranodal extension with carotid or prevertebral involvement are considered contraindications to dissection. Surgical approach selection is vital as access can be limited. Both transcervical and transoral routes are available for appropriately experienced surgeons. Each approach has its advantages and disadvantages in set up, safety, and postoperative complications. These factors, along with need for concurrent tumor treatment should be considered when dissecting these lymph nodes.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 325-330"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.008
Alyssa K. Givens MD, Neerav Goyal MD, MPH, FACS, David Goldenberg MD, FACS
Cervical lymph nodes are the most common site of metastasis from head and neck cancer and are the single most important prognostic factor in treating head and neck cancer. Neck dissection is the standard treatment for clinical and occult metastasis of head and neck cancer to the cervical nodal basins. This review will discuss the evolution of neck dissection over the past 2 centuries, highlighting the surgeons and articles credited with the major advancements of the procedure.
{"title":"Evolution of the Neck Dissection","authors":"Alyssa K. Givens MD, Neerav Goyal MD, MPH, FACS, David Goldenberg MD, FACS","doi":"10.1016/j.otot.2024.08.008","DOIUrl":"10.1016/j.otot.2024.08.008","url":null,"abstract":"<div><div>Cervical lymph nodes are the most common site of metastasis from head and neck cancer and are the single most important prognostic factor in treating head and neck cancer. Neck dissection is the standard treatment for clinical and occult metastasis of head and neck cancer to the cervical nodal basins. This review will discuss the evolution of neck dissection over the past 2 centuries, highlighting the surgeons and articles credited with the major advancements of the procedure.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 290-296"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.015
Madelyn N. Stevens MD , Alexandra E. Kejner MD FACS
Radical neck dissection was originally developed as an “en bloc” lymphadenectomy technique for malignancies of the head and neck and is sometimes utilized in current management for bulky disease not otherwise amenable to preservation therapy and for salvage disease. Although the majority of neck dissections are no longer radical, optimal technique is important as is the understanding of postoperative care. Historic and current literature was reviewed in order to provide the most up-to-date descriptions and considerations when performing this operating. Surgical technique is described as well as modern indications and contraindications. Common complication and options for minimizing postoperative morbidities are discussed. While the paradigm for en bloc resection of head and neck malignancy has changed, radical neck dissection remains a useful tool in the armamentarium of the contemporary head and neck surgeon for select cases.
{"title":"Radical neck dissection","authors":"Madelyn N. Stevens MD , Alexandra E. Kejner MD FACS","doi":"10.1016/j.otot.2024.08.015","DOIUrl":"10.1016/j.otot.2024.08.015","url":null,"abstract":"<div><div>Radical neck dissection was originally developed as an “en bloc” lymphadenectomy technique for malignancies of the head and neck and is sometimes utilized in current management for bulky disease not otherwise amenable to preservation therapy and for salvage disease. Although the majority of neck dissections are no longer radical, optimal technique is important as is the understanding of postoperative care. Historic and current literature was reviewed in order to provide the most up-to-date descriptions and considerations when performing this operating. Surgical technique is described as well as modern indications and contraindications. Common complication and options for minimizing postoperative morbidities are discussed. While the paradigm for en bloc resection of head and neck malignancy has changed, radical neck dissection remains a useful tool in the armamentarium of the contemporary head and neck surgeon for select cases.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 338-341"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.016
Eric H. Abello MD, Yarah Haidar MD, Tjoson Tjoa MD
The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.
{"title":"Robotic-assisted neck dissection","authors":"Eric H. Abello MD, Yarah Haidar MD, Tjoson Tjoa MD","doi":"10.1016/j.otot.2024.08.016","DOIUrl":"10.1016/j.otot.2024.08.016","url":null,"abstract":"<div><div>The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 342-346"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.011
Mac Kenzie Reece DO , Milena D. Fabry DO , Estelle M. Viaud-Murat MS , Sameep P. Kadakia MD FACS
In this article, the indications for performing the supraomohyoid, lateral, and anterolateral selective neck dissections will be discussed. Super selective neck dissections, though not included with a specific technique section, will also be briefly examined. An emphasis of the authors’ techniques will be illustrated with pertinent anatomy as well as postoperative care and complications to consider. Photographs will accompany the write-up in order to provide the reader with an anatomic operative reference.
{"title":"Selective neck dissection-the supraomohyoid, lateral, and anterolateral dissection techniques","authors":"Mac Kenzie Reece DO , Milena D. Fabry DO , Estelle M. Viaud-Murat MS , Sameep P. Kadakia MD FACS","doi":"10.1016/j.otot.2024.08.011","DOIUrl":"10.1016/j.otot.2024.08.011","url":null,"abstract":"<div><div>In this article, the indications for performing the supraomohyoid, lateral, and anterolateral selective neck dissections will be discussed. Super selective neck dissections, though not included with a specific technique section, will also be briefly examined. An emphasis of the authors’ techniques will be illustrated with pertinent anatomy as well as postoperative care and complications to consider. Photographs will accompany the write-up in order to provide the reader with an anatomic operative reference.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 312-319"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.010
Luis T. Ortiz-Figueroa MD, Yilmarie Mercado-Vargas MD, Thomas Zacharia MD
Imaging of neck and skull base has significantly improved the diagnosis and management of neck conditions. Prior to the use of CT, MRI, and PET imaging, the value of plain radiographs of the neck was limited. Today, modern imaging techniques are an essential adjunct to the physical examination of the neck, can confidently limit the differential, and in many clinical scenarios yield a specific diagnosis. In addition, the value of imaging cannot be understated in surgical planning and surveillance. This article will review the techniques used in neck lymph node imaging and cover several of the most common conditions that result in malignant lymphadenopathy in the neck.
{"title":"Radiology of malignant cervical adenopathy","authors":"Luis T. Ortiz-Figueroa MD, Yilmarie Mercado-Vargas MD, Thomas Zacharia MD","doi":"10.1016/j.otot.2024.08.010","DOIUrl":"10.1016/j.otot.2024.08.010","url":null,"abstract":"<div><div>Imaging of neck and skull base has significantly improved the diagnosis and management of neck conditions. Prior to the use of CT, MRI, and PET imaging, the value of plain radiographs of the neck was limited. Today, modern imaging techniques are an essential adjunct to the physical examination of the neck, can confidently limit the differential, and in many clinical scenarios yield a specific diagnosis. In addition, the value of imaging cannot be understated in surgical planning and surveillance. This article will review the techniques used in neck lymph node imaging and cover several of the most common conditions that result in malignant lymphadenopathy in the neck.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 304-311"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.013
Vivian Xu MD, Bryan Renslo MD, Elizabeth E. Cottrill MD
This article aims to describe the indications, pertinent anatomy, and surgical technique of the central neck dissection (CND) as it pertains to carcinomas of the thyroid gland. Further discussed are major complications of the procedure and factors considered in surgical decision making. Therapeutic CND is strongly recommended and widely performed in patients with clinically or radiographically evident nodal disease; however, elective/prophylactic CND requires an informed decision that should be based upon patient specific disease and risk factors. If able, CND should be performed concurrently at the time of thyroidectomy to minimize risk of injury to critical structures such as the recurrent laryngeal nerve and parathyroid glands. When indicated, CND performed by a skilled surgeon reduces the risk of locoregional recurrence and is associated with low overall morbidity.
{"title":"Central neck dissection: updates on indications and surgical technique","authors":"Vivian Xu MD, Bryan Renslo MD, Elizabeth E. Cottrill MD","doi":"10.1016/j.otot.2024.08.013","DOIUrl":"10.1016/j.otot.2024.08.013","url":null,"abstract":"<div><div>This article aims to describe the indications, pertinent anatomy, and surgical technique of the central neck dissection (CND) as it pertains to carcinomas of the thyroid gland. Further discussed are major complications of the procedure and factors considered in surgical decision making. Therapeutic CND is strongly recommended and widely performed in patients with clinically or radiographically evident nodal disease; however, elective/prophylactic CND requires an informed decision that should be based upon patient specific disease and risk factors. If able, CND should be performed concurrently at the time of thyroidectomy to minimize risk of injury to critical structures such as the recurrent laryngeal nerve and parathyroid glands. When indicated, CND performed by a skilled surgeon reduces the risk of locoregional recurrence and is associated with low overall morbidity.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 331-337"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.019
Hari Jeyarajan MD, FRACS , Susan McCammon MD, PhD, FACS, FAAHPM
Neck dissections remain a crucial aspect of surgical oncological care of the head and neck cancer patient and remain associated with a range of functional consequences that profoundly affect patients’ quality of life. Understanding these functional consequences is essential as it allows clinicians to make informed decisions, counsel patients effectively, and develop strategies to optimize postoperative rehabilitation. This article embarks on a comprehensive exploration of the functional consequences of neck dissections, drawing upon a wealth of research and clinical experience. We delve into the diverse aspects of this complex issue, examining the impact of neck dissections on patients’ daily lives, the factors influencing these consequences, and the evolving strategies to mitigate their effects. From considerations of lymphedema, shoulder mobility, and speech outcomes to the critical role of preoperative evaluation and postoperative rehabilitation, this article strives to shed light on a multifaceted subject of paramount importance in the realm of head and neck cancer care. We will aim to provide insights that guide clinical practice, stimulate further research, and ultimately enhance the overall well-being of patients undergoing these pivotal procedures.
{"title":"Functional complications of neck dissections","authors":"Hari Jeyarajan MD, FRACS , Susan McCammon MD, PhD, FACS, FAAHPM","doi":"10.1016/j.otot.2024.08.019","DOIUrl":"10.1016/j.otot.2024.08.019","url":null,"abstract":"<div><div>Neck dissections remain a crucial aspect of surgical oncological care of the head and neck cancer patient and remain associated with a range of functional consequences that profoundly affect patients’ quality of life. Understanding these functional consequences is essential as it allows clinicians to make informed decisions, counsel patients effectively, and develop strategies to optimize postoperative rehabilitation. This article embarks on a comprehensive exploration of the functional consequences of neck dissections, drawing upon a wealth of research and clinical experience. We delve into the diverse aspects of this complex issue, examining the impact of neck dissections on patients’ daily lives, the factors influencing these consequences, and the evolving strategies to mitigate their effects. From considerations of lymphedema, shoulder mobility, and speech outcomes to the critical role of preoperative evaluation and postoperative rehabilitation, this article strives to shed light on a multifaceted subject of paramount importance in the realm of head and neck cancer care. We will aim to provide insights that guide clinical practice, stimulate further research, and ultimately enhance the overall well-being of patients undergoing these pivotal procedures.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 368-378"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otot.2024.08.018
Jumin Sunde MD, Mauricio A. Moreno MD, Emre A. Vural MD
Salvage neck dissection describes removing cervical lymph nodes and disease following definitive radiation. Unique challenges include a fibrotic field with disease that is frequently more advanced than surgery in the primary setting. The surgical approach may vary depending on the extent of locoregional disease. Review of clinical data is necessary to design a surgical plan. Special considerations include having a reconstructive plan, if needed, for soft tissue reconstruction and great vessel coverage.
{"title":"Salvage neck dissection following definitive radiation","authors":"Jumin Sunde MD, Mauricio A. Moreno MD, Emre A. Vural MD","doi":"10.1016/j.otot.2024.08.018","DOIUrl":"10.1016/j.otot.2024.08.018","url":null,"abstract":"<div><div>Salvage neck dissection describes removing cervical lymph nodes and disease following definitive radiation. Unique challenges include a fibrotic field with disease that is frequently more advanced than surgery in the primary setting. The surgical approach may vary depending on the extent of locoregional disease. Review of clinical data is necessary to design a surgical plan. Special considerations include having a reconstructive plan, if needed, for soft tissue reconstruction and great vessel coverage.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 356-367"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sentinel lymph node biopsy (SLNB) continues to evolve as a technique to detect occult metastases in early head and neck cancers. Patients without clinical evidence of neck metastasis have historically been treated with observation or elective neck dissection (END). However, for those patients with clinically negative necks who do not have occult metastases, performing an END results in overtreatment and increased morbidity. Therefore, SLNB has emerged as a way to evaluate for occult metastases to help guide further treatment and the need for a neck dissection. The purpose of this article is to provide an overview of SLNB and the operative techniques involved in head and neck cancers.
{"title":"Sentinel lymph node biopsy","authors":"Kimberly Chan MD , Larissa Sweeny MD , Karen Y. Choi MD, FACS","doi":"10.1016/j.otot.2024.08.017","DOIUrl":"10.1016/j.otot.2024.08.017","url":null,"abstract":"<div><div>Sentinel lymph node biopsy (SLNB) continues to evolve as a technique to detect occult metastases in early head and neck cancers. Patients without clinical evidence of neck metastasis have historically been treated with observation or elective neck dissection (END). However, for those patients with clinically negative necks who do not have occult metastases, performing an END results in overtreatment and increased morbidity. Therefore, SLNB has emerged as a way to evaluate for occult metastases to help guide further treatment and the need for a neck dissection. The purpose of this article is to provide an overview of SLNB and the operative techniques involved in head and neck cancers.</div></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"35 4","pages":"Pages 347-355"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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