Neck-Dissection

The English term neck dissection (Eng. " neck dissection " ) referred to in medicine radical surgery with removal of all lymph nodes of the neck in tumor surgery in the head and neck region. The aim is to remove the tumor metastases and to prevent further spread of tumor cells in the body.

  • 3.1 Radical neck dissection
  • 3.2 Modified radical neck dissection
  • 3.3 Functional neck dissection
  • 3.4 Selective neck dissection
  • 3.5 sentinel nodes

Molding

After the therapeutic target, a distinction the following forms:

Prophylactic neck dissection

There are also without a proven metastasis to the lymph nodes removed. This can ensure that you also may be present invisible micrometastases with removed.

Therapeutic neck dissection

From a therapeutic neck dissection occurs when metastases are detected in the lymph nodes already.

Anatomical classification

The individual lymph node groups of the neck are in six ( according to Robbins, 1991; modified by Robbins 2001) different levels with 6 sublevels divided. The layout is now widely used as a decision on the operating expenses and the prognosis of tumor Distances:

Level I: Submental / submandibular lymph node group

Level II: kraniojuguläre lymph node group

Level III: mediojuguläre lymph node group:

Level IV: kaudojuguläre lymph node group:

Level V: The Akzessoriusgruppe of the posterior cervical triangle:

Level VI: front compartment, para- and retropharyngeal lymph node group:

Surgical techniques

Radical neck dissection

The lymph nodes are removed along with the following anatomical structures:

  • Internal jugular vein
  • Sternocleidomastoid muscle
  • Musculus sternohyoideus
  • Musculus sternothyroideus
  • Musculus omohyoideus
  • Submandibular gland
  • Accessory nerve

The loss of lymph node, fat and connective tissue, blood vessels, salivary glands, and muscle portions is therefore accompanied by a great loss of tissue, and thus the functional restrictions on the patient.

Modified radical neck dissection

How radical neck dissection with preservation of at least one nichtlymphatischen structure, such as the accessory nerve and thus less movement restriction in the head / shoulder area.

The Modified radical neck dissection is divided into: Type I: remove Level IV, obtained structure: accessory nerve; Type II: removal Level IV, obtained structures: accessory nerve, internal jugular vein; Type III: remove Level IV, obtained structures: accessory nerve, internal jugular vein, sternocleidomastoid muscle.

Functional neck dissection

The functional neck dissection has a better cosmetic and functional results and has, for example, when thyroid carcinoma no worse life expectancy than the classical neck dissection. The functional neck dissection muscles, accessory nerve and internal jugular vein are obtained. Are lymph nodes baked to the jugular vein, it is removed, otherwise "only" the resected lymph nodes.

Selective neck dissection

There are selective regions of a side of the neck removed, in which lymph node metastasis of a primary tumor are detected or suspected. The selective neck dissection is divided into: Supraomohyoidal: Level I -III; Lateral: Level II -IV; Posterolateral: Level II - V; Anterior: Level VI and Anterolateral: Level I -IV.

Sentinel node

The first Lymphstation after an organ is called the sentinel lymph node ( sentinel lymph node ). This lymph node is also removed during cancer surgery in general. If this initial lymph node free of metastases, a more distant metastasis via the lymphatic system is unlikely. The removal of the sentinel node is not a form of neck dissection, it is rather of prophylactic and diagnostic significance.

Suprasternal notch
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