Neck Dissection Comprehensive Neck Dissection Applied to all surgical procedures in the lateral part of the neck that comprehensively remove cervical lymph nodes from levels I to V. The world “radical” is used only for the description of classical radical neck dissection. The following operative procedures are included under this broad category: • Classic radical neck dissection • Extended radical neck dissection • Modified neck dissection type I (MND-I) • Modified neck dissection type III (MND-III) Selective Neck Dissection Operations remove only select groups of lymph nodes at risk of micrometastasis in the clinically N0 neck. • Supraomohyoid neck dissection • Jugular node dissection • Anterolateral neck dissection • Posterolateral neck dissection • Central compartment neck dissection Selective Neck Dissections Supraomohyoid Neck Dissection Supraomohyoid neck dissection may be performed in conjunction with excision of the primary tumor from the oral cavity, either in continuity where the primary tumor and lymph nodes Extended Supraomohyoid Neck Dissection Patients with primary carcinoma of the lateral border of the oral tongue have a small risk of having skip metastasis to level IV of the ipsilateral neck. Therefore an elective operation being undertaken for primary carcinomas of the oral tongue should include level IV in addition to the standard supraomohyoid neck dissection. This extended supraomohyoid neck dissection is an operative procedure very similar to the standard supraomohyoid neck dissection • Jugular Node Dissection Usually performed in conjunction with resection of the primary tumor of the larynx or hypopharynx. may be performed on the ipsilateral side for lesions that are unilateral in its mucosal extent, or it may be performed bilaterally for lesions that cross the midline to involve both sides of the laryngopharyngeal mucosa. • Central Compartment Node Dissection A therapeutic central compartment node dissection is undertaken for dissection of regional lymph nodes involved by metastases from primary diļ¬erentiated carcinomas of the thyroid gland. • Posterolateral Neck Dissection Posterolateral neck dissection is recommended for clearance of regional lymph nodes from the suboccipital triangle and the posterior triangle of the neck at level V in conjunction with deep jugular lymph nodes at levels II, III, and IV. Comprehensive Neck Dissection Modified Neck Dissection Type I A modified neck dissection type I (MND-I) provides comprehensive clearance of cervical lymph nodes at all five levels in the neck but selectively preserves only one anatomic structure: the spinal accessory nerve Modified Neck Dissection Type II The MND-II is similar to the MND-III in that it preserves the sternocleidomastoid muscle and the spinal accessory nerve but selectively sacrifices the internal jugular vein. The indications for this operation are massive metastatic disease from a diļ¬erentiated carcinoma of the thyroid gland grossly involving the internal jugular vein or from a metastatic squamous cell carcinoma selectively invading the internal jugular vein in the midcervical or lower cervical region. All the steps of the operative procedure are otherwise essentially similar to those described for the MND-III procedure. Modified Neck Dissection Type III The MND-III operation comprehensively clears lymph nodes from all five levels in the lateral neck while preserving the sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein. Classical Radical Neck Dissection The classical radical neck dissection has been the gold standard for surgical treatment of clinically apparent, metastatic cervical lymph nodes. This procedure comprehensively clears lymph nodes from levels I, II, III, IV, and V; however, it also requires sacrifice of the sternocleidomastoid muscle, spinal accessory nerve, internal jugular vein, and the submandibular salivary gland. Extended Radical Neck Dissections An extended radical neck dissection is an operation in which all five nodal levels are dissected and additional nodes, tissues, or structures are excised. Thus an extended radical neck dissection may include removal of additional lymph nodes from the parapharyngeal and retropharyngeal areas, from the superior mediastinum, and from the apex of the axilla, or nonlymphatic structures may be resected, such as skin, cranial nerves, the carotid artery, or musculature of the floor of the posterior triangle of the neck. •
