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Homepage > Personal Stories > Duckman3333 > Radical Neck Dissection
Radical neck dissection
Definition
Radical neck dissection is a group of surgical operations used to treat cancers in the head and neck.
Purpose
Radical neck dissection is a method of treating cancer, mainly in the neck. The purpose of radical neck dissection is to remove as much cancer as possible. In attempting to remove as much cancer as possible, much of the local lymphatic system and some muscles, arteries, veins, and glands are removed. The operation should not be performed if the cancer has spread beyond the head and neck region, when surgery will not control the primary tumor, or if the cancer has invaded the bones of the cervical vertebrae or skull. In these cases, the surgery will be unable to contain the cancer.
Description
Radical neck dissection is a major operation. There are several forms of radical neck dissection, depending on how much tissue is removed. Generally, a significant amount of neck tissue is removed during the operation. This is particularly true when invasive cancers such as squamous cell carcinoma (a slow-growing malignant tumor with cells of a distinctive shape) are involved.
In a regular radical neck dissection, many neck organs and structures are removed, including the sternocleidomastoid muscle (one of the muscles that functions to flex the head), internal jugular (neck) vein, submandibular gland (one of the salivary glands), and the spinal accessory nerve (a nerve that helps control speech, swallowing and certain movements of the head and neck). A "functional" radical neck dissection removes the superficial and deep cervicalis fascias (fibrous tissue at the neck, below the skin) and the lymph nodes, but leaves most of the muscles that are removed during a regular radical neck dissection. Since the lymph system is one of the major methods of cancer spread, more lymph gland may be removed during surgery than listed here. During surgery, the surgeon can palpate (use touch) for detectable lymph nodes. If the cancer is advanced, these lymph nodes can be removed. In primary neck dissection, only the primary tumor and clinically obvious lymph node metastases (tumors that have developed away from the original one) are removed. Which form of neck dissection is used depends on the extent of the cancer.
Risks
The outcome of neck dissection depends on the stage of cancer, type of metastasis, and the quality of the surgery. Many neck cancers can be treated with radical neck surgery. However, the long term success rate for some cancers is only average. Patients with bilateral (on both sides) metastases or multiple metastases have lower long term survival rates. The long term survival rate is also lower for patients requiring neck dissection after radiation has failed to stop the cancer. The extent of the surgery also determines the patients mobility after surgery. The more extensive the neck dissection the more physical handicaps the patient will have. For example, it is not uncommon following radical neck dissection for the person to have stooped shoulders and limited head and neck rotation as a consequence of nerves cut during surgery.
Terms:
Cancer
Abnormal new growths of tissue in the body; characterized by uncontrolled growth of abnormal cells that tend to invade surrounding tissue and spread (metastasize) to other parts of the body.
Lymph nodes
A part of the lymph system; they are oval structures which filter lymph and help to fight infection.
Metastasis
The process by which cancer cells spread to other parts of the body from the original site; or a tumor that has developed as a result of this process.
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Resources:
BOOKS
Ballenger, J.J., and J.B. Snow, Jr. Otorhinolaryngology: Head and Neck Surgery. Baltimore, MD: Williams and Wilkins, 1996.
Way, L.W. Current Surgical Diagnosis and Treatment. Norwalk, CT: Appleton and Lange, 1994.
Youngson, Robert M. with the Diagram Group. The Surgery Book. New York: St. Martin's Griffin, 1993.