Neck dissection, also known as cervical lymphadenectomy, is the surgical procedure for the management of metastatic cervical lymphadenopathy. There are multiple types of neck dissection that vary by the structures removed 1. This article reflects the 2001 classification by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery 1,2.
Radical neck dissection
Radical neck dissection is the historical standard by which subsequent approaches are compared and defined. The radical neck dissection involves removal of all ipsilateral cervical lymph nodes from levels I through V, as well as the submandibular gland.
Three key extranodal structures are also removed:
Modified radical neck dissection
Modified radical neck dissection involves removal of levels I through V, as in classical radical neck dissection, but with preservation of one or more of the key extranodal structures (spinal accessory nerve, sternocleidomastoid muscle, and internal jugular vein). Although previously grouped by types (I through III), variation in practice makes it advisable to name explicitly the structures spared in a modified radical neck dissection (e.g. modified radical neck dissection with preservation of the spinal accessory nerve).
Selective neck dissection
Selective neck dissection involves removal of some but not all of the lymph node groups removed in the radical neck dissection.
Historically, there were named subtypes of selective neck dissections:
- supraomohyoid: levels I-III
- extended supraomohyoid (anterolateral): levels I-IV
- posterolateral: levels II-V, suboccipital, postauricular
- lateral (jugular): levels II-IV
- anterior (central): level VI
Due to evolving practices, the 2001 classification omitted the named subtypes in favor of precise description with "SND" and parentheses denoting the levels removed, e.g. SND (I-IV).
The lymph nodes groups/levels typically removed depends on expected patterns of metastatic spread from a given primary site 2:
- oral cavity: levels I-III
- some surgeons also include some or all of level IV
- oropharynx, hypopharynx, larynx: levels II-IV
- excluding level IIB in some cases of laryngeal or hypopharyngeal cancer
- plus retropharyngeal nodes if the primary lesion involves the pharyngeal wall
- plus level VI if the primary lesion extends below the glottis level
- plus superior mediastinal nodes if the primary lesion extends below the suprasternal notch level
- thyroid: level VI
- skin of posterior scalp and upper neck: levels II-V, suboccipital, postauricular
- skin of preauricular, anterior scalp, temporal region: levels II-III, level VA, parotid, facial, external jugular
- skin of anterior and lateral face: levels I-III, parotid, facial
Dissections are performed bilaterally if the primary lesion crosses the midline.
Extended radical neck dissection
Extended radical neck dissection involves removal of levels I through V and key nonnodal structures (spinal accessory nerve, sternocleidomastoid muscle, and internal jugular vein), as in classical radical neck dissection, but with removal of one or more additional lymph node groups and/or non-lymphatic structures.
Such nodal groups include:
- suboccipital nodes
- retropharyngeal nodes
- parotid nodes
- facial nodes (e.g. buccinator nodes)
- level VI (e.g. paratracheal nodes, Delphian node, perithyroidal nodes)
- superior mediastinal nodes
Possible nonlymphatic structures include:
- 1. Harish K. Neck dissections: radical to conservative. (2005) World journal of surgical oncology. 3 (1): 21. doi:10.1186/1477-7819-3-21 - Pubmed
- 2. Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. (2002) Archives of otolaryngology--head & neck surgery. 128 (7): 751-8. doi:10.1001/archotol.128.7.751 - Pubmed