Block Dissections of Neck in India

What is Neck Dissection?

The surgical procedure is performed for the removal of the neck lymph node groups for treating cancer that has spread from a major site to elsewhere in the region of head and neck.  The removal of the number of lymph nodes and on the quantity of tissue depends upon the spread of the cancer. The alternative names for neck dissection are Modified Radical Dissection, Lymph Node Removal- Neck. Selective Neck Dissection and Radical Neck Dissection. Lump in the neck is another problem that is caused by swelling in the neck due to enlarged lymph nodes.

Types of Block Neck Dissection

There are different types of neck dissection –

Radical Neck Dissection : In this, all the neck side tissues are removed ( jawbone till the collar bone). It involves the removal of a major blood vessel, nerve, salivary glands and the muscles.

Extended Radical Neck Dissection (level 1to 4) : It includes one or more removal of non-lymphatic structures or lymph node groups that are not encompassed by the radical neck dissection.

Modified Radical Neck Dissection : This most regular type which removes all the lymph nodes. In comparison to radical neck dissection, less neck tissues are taken out. Sometimes the blood vessels, muscles and the nerves (neck) are spared.

Lateral Neck Dissection (level 2 to 4) : In this there is a removal of internal jugular vein along with lymph nodes.

Selective Neck Dissection :  Very few lymph nodes are removed if the cancer hasn’t spread that much. The blood vessel, nerve and the muscle can also be saved.

Posterolateral Neck Dissection (level 2 to 5) : In this there is a removal of retroauricular lymph nodes, suboccipital lymph nodes.

Central Compartment Neck Dissection (level 6) : In this there is a bilateral neck dissection removal of lymph nodes that surrounds the visceral structure’s mid line of the anterior neck.

Supraomohyoid Neck Dissection (level 1 to 3) : In this there is a removal of level 1 to 3 lymph nodes.

Extended Supraomohyoid Neck Dissection (level 1 to 4 ) : It adds both level 4 and level 5 nodes from superior to the inferior belly of the omohyoid.

Principles

The surgery of neck dissection is performed in two cases. First, when it is certain that lymph nodes are involved with cancer (therapeutic neck dissection). Second, when there are higher chances of lymph nodes involved depending upon the site and type of primary cancer (elective neck dissection) when no nodes are involved.

Importance of the Procedure

To fight injection, the white blood cells of the body are carried by the lymph system. The cancer cells present either in the throat or in mouth can go in the lymph fluid. The lymph nodes trap these cancer cells. In order to prevent the cancer from being spread in the different body parts, the removal of lymph nodes is crucial.

The procedure is recommended when –

  • When the cancer has spread to the lymph nodes.
  • When the cancer spreads in different body parts.
  • When there is a cancer of the tongue, areas of the neck or throat, mouth and the thyroid glands.

Primary Tumors

The head and neck cancers that spread to neck lymph nodes –

  • Certain types of Salivary Gland Cancers
  • Melanoma and Skin Cancers
  • Thyroid Cancers
  • Larynx, Mouth and Throat Cancers

Neck Dissection Procedure

The surgical procedure is performed either in connection or in isolation with resection of the main lesion. The surgery takes place under local anesthesia. Along the crease of the skin in the neck, an incision is made. The vertical incision to collarbone is frequently required by modified and radical neck dissections along with the incision in the crease of the skin. The incisions help to recognize the neck structures and heals with minimal scarring. The underlying fat, a thin layer of muscle and beneath the skin, the dissection starts recognizing and also removes the envelope of tissue containing the nearby tissues and the lymph nodes. The surgeon only removes sternocleidomastoid muscle and it involves no long term neck weakness.

Head and Neck Cancer

The cancers which arise either in the head or neck region and starts in the oral cavity pharynx, nasal cavity, lip and in the paranasal sinuses. About 90 % of these cancers are squamous cell carcinomas.

Symptoms

Some major neck cancer symptoms include-

  • 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 cancer starts in the immune system cells known as lymphocytes. It occurs when there is uncontrolled growth of the cells and multiplication. The white blood cells which travel throughout the body in a fluid (lymph) are known as Lymphocytes. These cells are transmitted by an association of vessels which makes lymphatic system a part of the immune system. B cells and T cells are the two types of Lymphocytes that are specifically designed to identify and destroy the abnormal cells and infections.

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