eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Radical Neck Dissection: Multimedia

Author: Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Coauthor(s): Juan Trinidad Pinedo, MD, FACS, Ad-Honorem Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical School
Contributor Information and Disclosures

Updated: Sep 15, 2009

Multimedia

(Enlarge Image)

Media file 1: The skin incision is made through the platysma, and the flap is elevated in the subplatysmal plane. In the superior lateral aspect of the flap, leaving the greater auricular nerve and the external jugular vein on the sternocleidomastoid muscle is important. The posterior flap is elevated toward the trapezius muscle.

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The skin incision is made through the platysma, and the flap is elevated in the subplatysmal plane. In the superior lateral aspect of the flap, leaving the greater auricular nerve and the external jugular vein on the sternocleidomastoid muscle is important. The posterior flap is elevated toward the trapezius muscle.

(Enlarge Image)

Media file 2: The sternocleidomastoid muscle is exposed and incised above the clavicle with Bovie electrocautery.

[ CLOSE WINDOW ]

The sternocleidomastoid muscle is exposed and incised above the clavicle with Bovie electrocautery.

(Enlarge Image)

Media file 3: The anterior and posterior belly of the omohyoid is identified. Note that the omohyoid crosses the internal jugular vein laterally.

[ CLOSE WINDOW ]

The anterior and posterior belly of the omohyoid is identified. Note that the omohyoid crosses the internal jugular vein laterally.

(Enlarge Image)

Media file 4: The internal jugular vein is identified in the lower aspect of the neck, and a 2-0 silk suture is then passed around the vein and tied.

[ CLOSE WINDOW ]

The internal jugular vein is identified in the lower aspect of the neck, and a 2-0 silk suture is then passed around the vein and tied.

(Enlarge Image)

Media file 5: 2-0 silk sutures and suture ligatures are placed as shown.

[ CLOSE WINDOW ]

2-0 silk sutures and suture ligatures are placed as shown.

(Enlarge Image)

Media file 6: The supraclavicular fatty tissue is opened using blunt dissection with identification of the phrenic nerve. The phrenic nerve appears as a white cord down the midline of the anterior scalenus muscle. The internal jugular vein has been ligated and transected. The carotid artery is seen on the top of the image. The transverse cervical artery is seen at the bottom of the image.

[ CLOSE WINDOW ]

The supraclavicular fatty tissue is opened using blunt dissection with identification of the phrenic nerve. The phrenic nerve appears as a white cord down the midline of the anterior scalenus muscle. The internal jugular vein has been ligated and transected. The carotid artery is seen on the top of the image. The transverse cervical artery is seen at the bottom of the image.

(Enlarge Image)

Media file 7: The submental fatty tissue, the submandibular nodes, and the submandibular gland have been removed and displaced inferiorly together with the specimen.

[ CLOSE WINDOW ]

The submental fatty tissue, the submandibular nodes, and the submandibular gland have been removed and displaced inferiorly together with the specimen.

(Enlarge Image)

Media file 8: The internal jugular vein is identified superiorly, medial to the posterior belly of the digastric muscle. The ligation of the internal jugular vein at this point is performed with a 2-0 silk suture and a distal suture ligature.

[ CLOSE WINDOW ]

The internal jugular vein is identified superiorly, medial to the posterior belly of the digastric muscle. The ligation of the internal jugular vein at this point is performed with a 2-0 silk suture and a distal suture ligature.

(Enlarge Image)

Media file 9: Final aspect of the surgical wound after removal of the operative specimen.

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Final aspect of the surgical wound after removal of the operative specimen.

(Enlarge Image)

Media file 10: Axial contrast-enhanced neck CT showing an extensive mass of the left side of the neck.

[ CLOSE WINDOW ]

Axial contrast-enhanced neck CT showing an extensive mass of the left side of the neck.

More on Radical Neck Dissection

Overview: Radical Neck Dissection

Workup: Radical Neck Dissection

Treatment: Radical Neck Dissection

Follow-up: Radical Neck Dissection

Multimedia: Radical Neck Dissection

References

Adams S, Baum RP, Stuckensen T, Bitter K, Hor G. Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med. Sep 1998;25(9):1255-60. [Medline].
Argiris A, Eng C. Epidemiology, staging, and screening of head and neck cancer. Cancer Treat Res. 2003;114:15-60. [Medline].
Aygun N, Oliverio PJ, Zinreich SJ. Overview of diagnostic imaging of the head and neck. In: Cummings Otolaryngology Head and Neck Surgery. Vol 1. 4^th ed. Elsevier Mosby; 2005:25-92.
Bier-Laning CM. Surgical complications of the neck. In: Cummings Otolaryngology Head and Neck Surgery. Vol 3. 4^th ed. Elsevier Mosby; 2005:2646-2657.
Bocca E, Pignataro O. A conservation technique in radical neck dissection. Ann Otol Rhinol Laryngol. Dec 1967;76(5):975-87. [Medline].
Charron M, Beyer T, Bohnen NN, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner. Clin Nucl Med. Nov 2000;25(11):905-10. [Medline].
Crile G. Excision of Cancer of the Head and Neck. JAMA. 1906;47:1780-1786.
Dedo HH. Surgery of the Larynx and Trachea. BC Decker; 1990:373-424.
Farber LA, Benard F, Machtay M, et al. Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2-18F-fluoro-2-deoxy-D-glucose positron emission tomography. Laryngoscope. Jun 1999;109(6):970-5. [Medline].
Gavilan Alonso C, Blanco Galdin A, Suarez Nieto C. [Cervical lymph node functional-radical dissection. Surgical anatomy. Technic and results]. Acta Otorinolaryngol Iber Am. 1972;23(5):703-817. [Medline].
Gil-Carcedo LM, Roman L. Vaciamiento ganglionar cervical radical. Vaciamientos modificados, Capítulo XXV, El Abordaje en el Tratamiento Quirúrgico de los tumores cabeza y cuello. In: Gil-Carcedo LM, ed. Ponencia Oficial de la Sociedad Espanola de Otorrinolaringología. 1992;373-388.
Hanasono MM, Kunda LD, Segall GM, Ku GH, Terris DJ. Uses and limitations of FDG positron emission tomography in patients with head and neck cancer. Laryngoscope. Jun 1999;109(6):880-5. [Medline].
Johnson J. Cervical metastases. In: Gluckman, Gullane, Johnson, eds. Practical Approach to Head and Neck Tumors. Raven Book; 1994.
Lonneux M, Lawson G, Ide C, Bausart R, Remacle M, Pauwels S. Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient. Laryngoscope. Sep 2000;110(9):1493-7. [Medline].
Lore JM, Jr. An Atlas of Head and Neck Surgery. WB Saunders Company; 1988:650-669.
Lowe VJ, Boyd JH, Dunphy FR, et al. Surveillance for recurrent head and neck cancer using positron emission tomography. J Clin Oncol. Feb 2000;18(3):651-8. [Medline].
Lowe VJ, Stack Jr. BC, Watson Jr. RE. (Ensley JF, Gutkind JS., Jacobs J Lippman SM, editors). Head and Neck Cancer Imaging, chapter 3. Head and Neck Cancer, Emerging Perspectives: Academic Press; 2003:23-33.
Martin H. Surgery of Head and Neck Tumors. Hoeber-Harper; 1957:119-130.
Medina JE, Weisman RA. Management of the neck in head and neck cancer, part I. Otolaryngol Clin North Am. August 1998;585-686.
Medina JE, Weisman RA. Management of the neck in head and neck cancer, part II. Otolaryngol Clin North Am. October 1998;759-856.
Medina JE, Lore Jr, JM. (Lore & Medina, editors). The Neck, chapter 16 in An Atlas of Head and Neck Surgery,. Fourth Edition. Elsevier Saunders; 2005:780-817.
Montgomery WW, Varvares MA. (Montgomery W.W., editor). Surgery of the Neck, chapter 2 in Surgery of the Larynx, Trachea, Esophagus and Neck,. Saunders; 2002:43-114.
Myers EN. Operative Otolaryngology Head and Neck Surgery, Chapter 78, Neck Dissection. Vol 1. 2nd Edition. Elsevier; 2008:679-708.
Myers LL, Wax MK, Nabi H, Simpson GT, Lamonica D. Positron emission tomography in the evaluation of the N0 neck. Laryngoscope. Feb 1998;108(2):232-6. [Medline].
Robbins KT. Pocket Guide to Neck Dissection Classification and TNM Staging of Head and Neck Cancer. American Academy of Otolaryngology-Head and Neck Surgery Foundation; 1991:7-29.
Robbins KT. Pocket Guide to Neck Dissection and Classification and TNM Staging of Head and Neck Cancer. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. 2001;8-38.
Robbins KT. Neck Dissection, chapter 116 in Cummings Otolaryngology Head and Neck Surgery, Fourth Edition. Volume Three. Fourth Edition. 2005:2614-2645.
Shockley WW, Pillsbury III HC. The Neck: Diagnosis and Surgery. Mosby; 1994:573-588.
Stokkel MP, Terhaard CH, Hordijk GJ, van Rijk PP. The detection of local recurrent head and neck cancer with fluorine-18 fluorodeoxyglucose dual-head positron emission tomography. Eur J Nucl Med. Jul 1999;26(7):767-73. [Medline].
Suarez O. El problema de las metástasis linfáticas y alejadas del cáncer de laringe e hipofaringe. Rev Otorrinolaringol. 1963;23:83-99.
Medina JE. Chapter 113: Neck Dissection. In: Bailey BJ and Johnson JT. Head & Neck Surgery-Otolaryngology. 2. 4^th ed. Lippincoott Williams & Wilkins; 2006:1585-1609.
Cooper JS, Pajak TF, Forastiere A, et al. Precisely defining high-risk operable head and neck tumors based on RTOG #85-03 and #88-24: targets for postoperative radiochemotherapy?. Head Neck. Oct 1998;20(7):588-94. [Medline].
Porceddu SV, Jarmolowski E, Hicks RJ, et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer. Head Neck. Mar 2005;27(3):175-81. [Medline].
Schechter NR, Gillenwater AM, Byers RM, et al. Can positron emission tomography improve the quality of care for head-and-neck cancer patients?. Int J Radiat Oncol Biol Phys. Sep 1 2001;51(1):4-9. [Medline].
Pfister DG, Laurie SA, Weinstein GS, Mendenhall WM, Adelstein DJ, Ang KK, et al. American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer. J Clin Oncol. Aug 1 2006;24(22):3693-704. [Medline].

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Keywords

radical neck dissection, complete neck dissection, block neck dissection, classic neck dissection, neck tumor, metastatic neck disease, neck lymph node metastasis, cervical lymphatic metastasis, head and neck squamous cell carcinoma, neck metastasis, classic neck dissection, neck cancer, oral cavity cancer, pharyngeal cancer, laryngeal cancer, thyroid cancer, thyroid carcinoma, skin cancer of the head and neck, nasopharyngeal carcinoma, neck mass, metastatic neck mass, cervical lymphadenopathy, modified radical neck dissection, cervical adenopathy, selective neck dissection, neck node cancer, metastatic cervical lymphatic spread, squamous cell carcinoma of the upper aerodigestive tract, radical neck dissection

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Contributor Information and Disclosures

Author

Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Antonio Riera March, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, and Society for Ear, Nose and Throat Advances in Children
Disclosure: Nothing to disclose.

Coauthor(s)

Juan Trinidad Pinedo, MD, FACS, Ad-Honorem Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical School
Juan Trinidad Pinedo, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Puerto Rico Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Benoit J Gosselin, MD, FRCSC, Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center
Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, North American Skull Base Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Karen Hall Calhoun, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position

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eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Radical Neck Dissection: Multimedia

Multimedia

The sternocleidomastoid muscle is exposed and incised above the clavicle with Bovie electrocautery.

The anterior and posterior belly of the omohyoid is identified. Note that the omohyoid crosses the internal jugular vein laterally.

The internal jugular vein is identified in the lower aspect of the neck, and a 2-0 silk suture is then passed around the vein and tied.

2-0 silk sutures and suture ligatures are placed as shown.

The submental fatty tissue, the submandibular nodes, and the submandibular gland have been removed and displaced inferiorly together with the specimen.

The internal jugular vein is identified superiorly, medial to the posterior belly of the digastric muscle. The ligation of the internal jugular vein at this point is performed with a 2-0 silk suture and a distal suture ligature.

Final aspect of the surgical wound after removal of the operative specimen.

Axial contrast-enhanced neck CT showing an extensive mass of the left side of the neck.

More on Radical Neck Dissection

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor