Abstract

July 2004

Section 2 Head and Neck

Since 1906, the radical neck dissection has evolved from an extensive procedure used to treat metastatic disease to a variety of more limited procedures. Metastatic lymphadenopathy is currently treated with a comprehensive neck dissection, but structures are preserved if they are not involved with tumor. Extended neck dissections are performed as needed on the basis of tumor type. Selective neck dissections are performed targeting at-risk nodal basins in patients who have no evidence of cervical metastases on clinical examination and who are undergoing surgery at the primary tumor site. Preoperative evaluation of patients undergoing neck dissection is dicussed, and operative planning (including staging of head and neck cancer, indications for and contraindications to neck dissection, neck dissection and chemoradiation, and reconstruction and cancer recurrence) is decribed. Operative technique for radical, modified radical, and selective neck dissection is outlined. Intraoperative and postoperative complications are discussed. Figures illustrate key anatomic considerations. This chapter contains 26 references.

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