Block Neck Dissection in India
What is Neck Dissection?
The surgical procedure involves the removal of neck lymph node groups to treat cancer that has spread from a primary site to other areas in the head and neck region. The extent of lymph node removal and tissue quantity depends on the extent of cancer spread.
Neck dissection is also known by alternative names such as Modified Radical Dissection, Lymph Node Removal-Neck, Selective Neck Dissection, and Radical Neck Dissection. Another issue associated with swelling in the neck is the presence of a lump, caused by enlarged lymph nodes.
Types of Block Neck Dissection
There are different types of neck dissection :
Radical Neck Dissection : In this procedure, all tissues on the sides of the neck, from the jawbone to the collarbone, are excised. It includes the extraction of significant components such as blood vessels, nerves, salivary glands, and muscles.
Extended Radical Neck Dissection (level 1to 4) : It encompasses the extraction of one or more non-lymphatic structures or groups of lymph nodes, distinct from those included in radical neck dissection.
Modified Radical Neck Dissection : The most common form involves the removal of all lymph nodes, but in contrast to radical neck dissection, fewer neck tissues are excised. Occasionally, the preservation of blood vessels, muscles, and neck nerves may be considered.
Lateral Neck Dissection (level 2 to 4) : This procedure involves the extraction of the internal jugular vein in addition to the lymph nodes.
Selective Neck Dissection : If the cancer hasn't spread significantly, only a small number of lymph nodes need to be removed. Additionally, there's the option to preserve the blood vessels, nerves, and muscles.
Posterolateral Neck Dissection (level 2 to 5) : This procedure involves the extraction of retroauricular and suboccipital lymph nodes.
Central Compartment Neck Dissection (level 6) : In bilateral neck dissection, lymph nodes surrounding the midline of the anterior neck, encompassing visceral structures, are removed.
Supraomohyoid Neck Dissection (level 1 to 3) : This procedure entails the extraction of lymph nodes from levels 1 to 3.
Extended Supraomohyoid Neck Dissection (level 1 to 4 ) : It involves the removal of both level 4 and level 5 nodes, extending from the superior to the inferior belly of the omohyoid.
Principles
Neck dissection surgery is conducted in two scenarios: firstly, when it is confirmed that lymph nodes are affected by cancer (therapeutic neck dissection), and secondly, when there is a higher likelihood of lymph node involvement based on the site and type of primary cancer (elective neck dissection) even when no nodes are currently affected.
Importance of the Procedure
The body's white blood cells, transported through the lymph system, combat infections. Cancer cells in the throat or mouth can enter the lymph fluid, where lymph nodes act as traps, capturing these cancer cells. To prevent the spread of cancer to other parts of the body, the removal of lymph nodes becomes crucial. The procedure is recommended when :
- When the cancer has metastasized to the lymph nodes.
- When the cancer disseminates to various parts of the body.
- When there is cancer affecting the tongue, areas of the neck or throat, mouth, and the thyroid glands.
Primary Tumors
Cancers in the head and neck that metastasize to the lymph nodes in the neck :
- Certain types of Salivary Gland Cancers.
- Melanoma and Skin Cancers
- Thyroid Cancers
- Larynx, Mouth and Throat Cancers
Neck Dissection Procedure
The surgical procedure is conducted either in conjunction or independently with the resection of the primary lesion. The surgery is performed under local anesthesia. An incision is made along the crease of the skin in the neck, often necessitating a vertical cut to the collarbone in the case of modified and radical neck dissections. These incisions aid in identifying neck structures and typically result in minimal scarring upon healing. The dissection begins beneath the skin, involving the underlying fat, a thin layer of muscle, and the removal of the tissue envelope containing nearby tissues and lymph nodes. The surgeon selectively removes the sternocleidomastoid muscle, ensuring no long-term neck weakness.
Head and Neck Cancer
Cancers originating in the head or neck region, beginning in areas such as the oral cavity, pharynx, nasal cavity, lip, and paranasal sinuses, are predominantly squamous cell carcinomas, accounting for approximately 90% of such cases.
Symptoms
Following are the major symptoms of the neck cancer :
- Constant sore throat
- Soreness or swelling which does not heal
- Foul mouth odor
- White or red patches in the mouth
- Persistent nasal congestion
- Unusual nasal discharge
- Difficulty in breathing
- Mass, bump, or lump in the neck or head area
Lymphoma Cancer
This type of cancer initiates in the immune system cells called lymphocytes. It occurs when these cells undergo uncontrolled growth and multiplication. Lymphocytes, white blood cells that travel throughout the body in a fluid known as lymph, constitute the lymphatic system—a crucial part of the immune system. B cells and T cells, two specific types of lymphocytes, are designed to identify and eliminate abnormal cells and infections.
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