Neck Block Dissections
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What is Neck Block Dissection?
Neck dissection is surgery to remove the lymph nodes in the neck. Neck dissection is a major surgery done to remove lymph nodes that have cancer. It is done in the hospital. Before surgery, you will receive general anesthesia. This will make you sleep and unable to feel pain.
The amount of tissue and the number of lymph nodes that are removed depend on how far the cancer has spread. There are three main types of neck dissection surgery.
The lymph system carries white blood cells around the body to fight infection. Cancer cells in the mouth or throat can travel in the lymph fluid and get trapped in the lymph nodes. The lymph nodes are removed to prevent cancer from spreading to other parts of the body and to decide if any more treatment is needed.
Your doctor may recommend this procedure if:
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How do cancers spread?
Most cancers which start in the head and neck region have the ability to spread to other parts of the body; these are called metastases ('mets') or 'secondaries'. Cancers can spread in a number of different ways, most often by the lymph system to lymph nodes and sometimes by the blood to other distant organs like the liver. In the head and neck region, localised lymphatic spread is quite common, but spread by blood to distant parts of the body is uncommon.
Lymph nodes (also called lymph glands) catch bacteria, viruses or cancer cells in the body. Each node drains a particular area of the body. The nodes in the neck drain the skin of the head and neck and all the swallowing and breathing tubes. Once one cancer cell has been 'caught' by a lymph node it can grow and multiply there, and in time can spread to the next node down the chain and so on.
Types of Block Neck Dissection
There are different types of neck dissection:
Radical neck dissection - Refers to the removal of all lymph node groups extending from the inferior border of the mandible superiorly to the clavicle inferiorly, from the lateral border of the sternohyoid muscle, hyoid bone, and contralateral anterior belly of the digastric muscle medially, to the anterior border of the trapezius muscle laterally. Included are all lymph nodes from levels I-V with sacrifice of internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve.
Extended Radical Neck Dissection - Refers to the removal of one or more additional lymph node groups or non-lymphatic structures or both, not encompassed by the radical neck dissection.
Modified radical neck dissection - Refers to the removal of all lymph nodes by radical neck dissection with preservation of one or more of the non-lymphatic structures: i.e., the spinal accessory nerve, internal jugular vein and the sternocleidomastoid muscle.
Selective neck dissection - Refers to any type of cervical lymphadenectomy where there is preservation of one or more of the lymph node groups removed by the radical neck dissection. The types of selective dissections are described below.
Supraomohyoid Neck Dissection - Refers to the removal of lymph nodes contained in levels I-III. The posterior limit of the dissection is marked by the cutaneous branches of the cervical plexus and the posterior border of the sternocleidomastoid muscle. The inferior limit is the superior belly of the omohyoid muscle where it crosses the internal jugular vein.
Extended Supraomohyoid Neck Dissection - Adds level IV nodes as well as the nodes in Level V superior to the inferior belly of the omohyoid.
Posterolateral Neck Dissection - Refers to removal of the suboccipital lymph nodes, retroauricular lymph nodes and lymph nodes in levels II-V. Basically, all nodal groups except levels IA and IB.
Lateral Neck Dissection - Refers to the removal of lymph nodes in levels II-IV, along the internal jugular vein. Excludes nodes in Level IA, IB and V.
Central Compartment Neck Dissection - Refers to the bilateral removal of lymph nodes surrounding the midline visceral structures of the anterior neck - level VI. The lymph nodes include the pre- and paratracheal, pre-cricoid (Delphian) and perithyroidal. The superior limit of the dissection is the hyoid bone; the inferior limit is the suprasternal notch; and the lateral limits are the carotid arteries.
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