Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
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It has been proposed that neck dissectionsbe more logically and precisely describedand classified by naming the structures andthe nodal levels that have been resected.(Ferlito A, Robbins KT, Shah JP, et al.Proposal for a rational classification <strong>of</strong>neck dissections. Head <strong>Neck</strong> 2011 Mar;33(3): 445-50)skin incision can be extended across to theopposite side with bilateral SND, or can beextended superiorly to split the lower lip inthe midline to gain access to the oralcavity, or preauricularly for a parotidectomy(Figure 3). Figure 4 demonstratesthe hockey stick incision.<strong>Selective</strong> <strong>Neck</strong> <strong>Dissection</strong>Anaesthesia, positioning and drapingThe operation is done under generalanaesthesia without muscle relaxation aseliciting muscle contraction on mechanicalor electrical stimulation <strong>of</strong> the marginalmandibular, hypoglossal (XIIn) andaccessory nerves assists with locating andpreserving these nerves. It is a cleanoperation and antibiotics are therefore notrequired unless the upper aerodigestivetract is entered. With an experiencedsurgeon, blood transfusion is rarelyrequired.The patient is placed in a supine positionwith the neck extended and head turned tothe opposite side. Surgical draping mustpermit monitoring for movement <strong>of</strong> thelower lip with irritation <strong>of</strong> the marginalmandibular nerve, and must provide accessto the clavicle inferiorly, the trapeziusmuscle posteriorly, the tip <strong>of</strong> the earlobesuperiorly and the midline <strong>of</strong> the neckanteriorly. The drapes are sutured to theskin.Figure 3: Incision for SND (Red)compared to MND (Yellow); dotted linesindicate extensions for parotidectomy andoral tumour resectionsIncisions and flapsIncisions should take into considerationaccess that may be required to resect theprimary tumour, cosmetic factors, and theblood supply to the flaps. A transverse skincrease incision is placed more inferiorlythan with a MND so as to avoid a verticalskin incision and to facilitate dissection <strong>of</strong>levels III and IV (Figure 3). The transverseFigure 4: Hockey-stick incision forposterolateral SND combined withparotidectomy2