**Part 1**

**History of Neck Dissection** 

4 Neck Dissection – Clinical Application and Recent Advances

mediate the pathway of apoptosis and this pathways mediated by Bcl-2 family protein and the final excursion of cell death is performed by caspace cascade which is triggered by release cytochrome C from mitochondria. Most of the activity in the development of apoptosis drugs was concentrated on apoptosis inducers for treatment of malignancies. The future might be very promising for the control of lymph node deposits by using different methods of accessing neck dissection as well as the recent application of robot surgery (the da Vinci surgical robot system) which is more widely used in prostatic eradication than in any other specialty and which might be used in general surgery. However, this technique is limited in its application in all fields and even in head and neck malignancies. Expanding the role of DXT and chemotherapy as the first line of treatment and as a curative therapy without the need for radical neck dissection, either as an adjuvant with surgery or without as in jaw lymphoma (which is the only line of treatment for such a

highly malignant tumour, being a fast spreading and fatal tumour).

Fig. 2. Post-therapy after 2 years of treatment of jaw lymphoma by 6 courses of

Medical City Baghdad.

chemotherapy, with the collaboration with Prof. Selma Al Hadad, Paediatric Oncologist,

**1** 

*USA* 

Jeremiah C. Tracy *Tufts Medical Center,* 

**A Brief History of Cervical Lymphadenectomy** 

Head and neck cancer is an aggressive disease with substantial morbidity associated with local invasion and regional lymphatic spread. Local spread through lymphatic channels is the most common course of disease progression; and nodal disease is often regarded as the most important prognostic factor in malignancy of the head and neck. [Ferlito 2006, Shah] It has been estimated that the presence of lymphatic metastases indicates a 50% decrease in survival;

Neck dissection describes a procedure involving the en bloc removal of some or all of the lymphatic organs of the head and neck. In current practice the procedure is often performed simultaneously with resection of a primary tumor of the head and neck. The scope of the resection is quite variable and, throughout history, has been a source of some debate. In 1988 the American Head and Neck Society formed a task group to synthesize a standard nomenclature regarding neck dissection, their recommendations have gained near universal acceptance throughout North America and internationally as well. [Robbins 1991, 2002,

Currently the American Head and Neck Society classifies cervical lympadenectomy into 4

A radical neck dissection is defined as en bloc excision of lymph node levels I-V (Figure 1) along with the internal jugular vein (IJV), sternocleidomastoid muscle (SCM), and spinal accessory nerve (SAN). A modified radical neck dissection also involves the complete removal of levels I-V but with sparing of one or more of the nonlymphatic structures (IJV, SCM, SAN). A selective neck dissection is defined as a procedure that removes anything other than levels I-V. The nomenclature of selective neck dissection assumes that IJV, SCM, and SAN are all preserved unless otherwise noted. The specific levels removed are listed in parentheses (ie. SND [I-III]). Finally, an extended neck dissection is any procedure that removes additional structures beyond those involved in a radical neck dissection, for example superior mediastinal lymph nodes, or the external carotid artery. Very complete and specific recommendations regarding classification and terminology are clearly laid out

with contralateral nodal disease indicating another 50% decrease. [Leemans 1993, 1994]

**1. Introduction** 

2008]

categories:

1. Radical neck dissection

3. Selective neck dissection 4. Extended neck dissection

2. Modified radical neck dissection

in publications by Robbins et al. [Robbins 1991, 2002, 2008]

 *Department of Otolaryngology – Head and Neck Surgery* 
