Applications of Robotics in Head and Neck Practice
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The neck dissection has undergone significant changes from the radical neck dissections to functional and selective neck dissections without compromising oncologic principles and outcomes. This has led to a decrease in the morbidity of neck dissection. Now, authors have demonstrated minimally invasive combined endoscopic-robotic approaches to neck dissection in human cadaver models.35 In 2004, Werner et al.36 successfully demonstrated management of cervical lymphadenopathy using an endoscopic approach for squamous cell carcinoma in the setting of sentinel lymph node biopsy. Also, Kang et al. demonstrated the feasibility of robot-assisted neck dissection for well-differentiated thyroid carcinoma.37 Furthermore, in 2010 Moore et al. demonstrated the use of transoral robotic surgery for retropharyngeal lymphadenectomy in papillary thyroid carcinoma.38 Comparative studies of open and robotic neck dissections via a retroauricular/facelift route have shown equivalent functional and oncologic outcomes, with the robotic approach taking greater time, which could be ascribed to the learning curve.39–41
The Head and Neck
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Radical neck dissection is carried out prophylactically or therapeutically to remove regional lymph nodes. The indications for radical cervical lymphadenectomy have been discussed under each site. It includes removal of all lymph bearing area between the two layers of the deep cervical fascia. Certain muscles, such as the sternocleidomastoid and omohyoid muscles, may be sacrificed, as these lie within the space. Other muscles, such as the strap muscles and the thyroid gland, are to be resected as in the case of translaryngeal carcinomas. The digastric muscle may be resected for large tumors of the oral cavity. In a standard radical neck dissection, the internal jugular vein is removed. The only structures to be preserved are the muscles that form the floor of the neck, the carotid artery, the vagus and phrenic nerves, and the lingual and hypoglossal nerves. The accessory nerve can be preserved if the neck dissection is carried out prophylactically or electively, i.e., if there is no gross evidence of lymph node metastases. However, controversy continues with regard to the preservation of the accessory nerve in therapeutic neck dissection, i.e., with gross lymph node metastases.
Case 2.2
Monica Fawzy in Plastic Surgery Vivas for the FRCS(Plast), 2023
You’ve mentioned the morbidity of a neck dissection. How will you counsel a patient due to undergo this?Specific risks depend on the type of the neck dissection, but assuming that I will counsel the patient for a selective level I–III neck dissection as would be expected here, then I will explain that the lymph glands need to be removed from the neck as there is evidence of cancer spread.I will warn them regarding the risks of bleeding and infection, nerve injury to the spinal accessory nerve, marginal mandibular and great auricular nerves most commonly affected, numbness of the skin flap of the neck, as well as the risks of a seroma collection. Chyle leaks are rare with this type of neck dissection but still possible.
Emerging tyrosine kinase inhibitors for head and neck cancer
Published in Expert Opinion on Emerging Drugs, 2022
Zhen Long, Jennifer R. Grandis, Daniel E. Johnson
Surgical resection with curative intent remains the primary therapeutic approach for oral cavity cancers [1]. Most cancers that arise in the mouth can be removed with minimal morbidity with the exception of resections that involve the root of the tongue (such as a total glossectomy) and/or vascularized flap reconstruction. Neck dissection to remove the cervical lymph nodes (generally a selective or functional dissection to preserve other anatomic structures) is usually performed in conjunction with resecting the primary tumor to more accurately stage the tumor and remove any metastatic deposits in the neck. Despite extensive investigation of radiographic imaging and sentinel lymph node biopsy to avoid surgery for clinical N0 necks, neck dissections are still commonly performed in conjunction with primary tumor resection [15,16].
Low-phase angle in body composition measurements correlates with prolonged hospital stay in head and neck cancer patients
Published in Acta Oto-Laryngologica, 2019
Marie Lundberg, Amy Dickinson, Pia Nikander, Helena Orell, Antti Mäkitie
Sixty-one patients with a mean age of 61 years (range, 39–88) were included in the study. Patient and tumour characteristics are presented in Table 1. Oropharynx was the most common location of the cancer. Ninety per cent (n = 55) of the patients had a neck dissection: 19 (31%) a radical or modified radical type and 36 (59%) a selective dissection. Almost half of the patients had reconstructive surgery (n = 28, 46%). The most common flap type used was an anterolateral thigh flap (n = 11) followed by a latissimus dorsi transfer. Patients treated with extensive surgery were treated in the ICU for a median of 4 d (range, 1–22; n = 26, 43%). The total hospital stay varied from 2 to 56 d (median 12 d). Ten of the patients (16%) were referred to smaller hospitals for further care. Follow-up time ranged from 0.3 mo (for a patient who died of complications) to 29 mo (mean 8 mo).
Clinical outcome and comparison between squamous and non-squamous cell carcinoma of the larynx
Published in Acta Oto-Laryngologica, 2020
Le Chen, Weiye Deng, Cai Li, Huiching Lau, Lei Tao, Shuyi Wang, Liang Zhou, Ming Zhang
NECs of the larynx have been recognized as the most common nSCC type arising in this area, accounting for 0.3–0.5% of all laryngeal neoplasms [12]. Atypical carcinoid tumors are the most common histopathological type and are generally considered to be aggressive. Surgical excision is the main treatment of choice for typical and atypical carcinoid tumors, and selective neck dissection should also be performed in the latter. Small-cell NEC is a highly aggressive malignancy, and it must be approached as a systemic disease, as the absence of regional or distant metastasis does not preclude the presence of micrometastasis [13]. These tumors are mainly treated by surgery and systemic multi-agent chemotherapy and radiotherapy [14], and the therapeutic approach may likely vary to a certain degree according to the stage of the disease at diagnosis. Early metastases are exceedingly common and >90% patients with laryngeal small-cell NEC develop metastatic disease. Once the diagnosis is established, a full metastatic workup is mandatory. The most common sites of metastatic spread of this aggressive neoplasm are the cervical lymph nodes, liver, lungs, bones and bone marrow. Among the 9 cases of small cell carcinoma, 4 cases were accompanied by cervical lymph node metastasis. In our study, the average survival time was 141.6 months.
Related Knowledge Centers
- Accessory Nerve
- Internal Jugular Vein
- Lymph Node
- Metastasis
- Pharynx
- Surgery
- Parotid Gland
- Thyroid
- Larynx
- Squamous-Cell Carcinoma