Neck Dissections

Abstract

During selective neck dissection, one or more lymph node groups are removed. The removal of lymph nodes contained in the submental and submandibular triangles (level I), the upper jugular lymph nodes (level II), and midjugular lymph nodes (level III) is referred to as supraomohyoid neck dissection. The posterior limit of this dissection is the cutaneous branches of the cervical plexus and the posterior border of the sternocleidomastoid muscle. The inferior limit of the supraomohyoid neck dissection is the superior belly of omohyoid muscle.

During radical neck dissection, all lymph nodes from level I to level V are removed. The tissues between mandible and clavicle are included during the dissection. The spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are also removed. All lymph nodes removed during radical neck dissection are included in modified radical neck dissection; spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are preserved.

Lymph nodes from the suboccipital and posterior triangle are removed during posterolateral neck dissection; it is necessary for primary carcinoma or melanoma of the posterior scalp. Central compartment neck dissection is indicated for metastatic thyroid carcinoma.

The 10th, 11th, and 12th cranial nerve must be protected and the chylous leak be avoided during different types of neck dissection.