There are different types of modified radical neck dissection. The surgeon attempts to preserve the important neck structures as far as possible in modified neck dissection. Depending on the tumor invasion, the doctor may either remove most of the lymph nodes between jawbone and collarbone on one side of the neck and may or may not remove one or more of the following:
- A muscle on the side of your neck called the sternocleidomastoid muscle
- A nerve called the accessory nerve
- A vein called the internal jugular vein
- Sometimes, a combination of either of these structures may be removed
Modified radical neck dissection is usually considered for:
- Oral cavity cancers: Level I, II, III
- Oropharyngeal, hypopharyngeal, and laryngeal cancers: Level II, III, IV
This type of neck dissection is performed when there is evidence of more extensive involvement of lymph node metastasis. Modified radical neck dissection preserves the structures that are usually sacrificed in the standard radical surgery, such as the spinal accessory nerve, the internal jugular vein, or sternocleidomastoid muscle.
Further, only specific groups of lymph nodes rather than all the lymph nodes on the side of the neck are dissected. These result in a better postoperative quality of life.
What is neck dissection?
Surgery to remove the lymph nodes in the neck is called a neck dissection. Surgeons don't routinely do a neck dissection on everyone because it can have long-term side effects. They have to carefully consider who will benefit from it. The different types of neck dissection are classified based on the site (zones I-V) from where nodes are being removed and whether the following three important surrounding structures are removed:
- The internal jugular vein
- The accessory nerve (cranial nerve XI)
- The sternocleidomastoid muscle
Apart from modified radical dissection, the other types include:
- Radical neck dissection: This refers to the removal of lymph nodes in groups I to V, as well as the sternocleidomastoid muscle (SCM), internal jugular vein, and spinal accessory nerve. An extended radical neck dissection includes the removal of all these structures along with additional lymph node groups or non-lymphatic structures, which are not accounted for in the radical neck dissection definition. Radical neck dissections are rarely performed in the present day because the SCM, internal jugular vein and the spinal accessory nerve can usually be preserved.
- Selective neck dissection: This is the removal of a selected group of lymph nodes in the neck with or without sacrificing additional non-lymphatic structures. This is the most common type of neck dissection that is performed. Some examples of selective neck dissections are listed below:
- Supraomohyoid neck dissection: This is the removal of lymph node Groups I, II, and III.
- Lateral neck dissection: This is the removal of lymph node Groups II, III, and IV.
- Poster lateral neck dissection: This is the removal of lymph node Groups II, III, IV, and V.
- Central compartment lymph node dissection: The central compartment (Level VI) is not included in the typical “lateral” neck dissection. Level VI is most commonly removed in cases of thyroid cancer and sometimes laryngeal cancer.
- Salvage neck dissection: This procedure is done in patients who have received previous treatment to the neck (usually non-operative treatments, such as radiation and chemotherapy), yet they have persistent, recurrent, or remaining cancer in the neck lymph nodes despite the previous treatment.
- Removal of skin and carotid artery: In some cases of very advanced tumors, the surgeon may need to remove the skin as part of the neck dissection. Even more rarely, the common carotid artery (or internal carotid artery) could be involved with the tumor, requiring removal.
The goal of neck dissection is to remove all cancer while preserving as much healthy tissue as possible.
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