Question

Briefly discuss its different types and indications for each type.

Hint:

The choice of neck dissection type depends on the location and extent of cancer spread, with the goal of removing as much lymphatic tissue as needed while preserving function.

Answer 1

Selective neck dissection involves the removal of lymph nodes from specific levels of the neck, depending on the type of cancer and its spread. The different types of selective neck dissection are:
1. Type I – Supraomohyoid Neck Dissection:
- Description: This dissection removes lymph nodes from levels I, II, and III (along the jawline and upper neck), including the submental, submandibular, and upper jugular nodes.
- Indications: Typically performed for cancers of the oral cavity, oropharynx, and hypopharynx with limited lymph node involvement.
- Advantages: Preserves the important structures such as the spinal accessory nerve, the sternocleidomastoid muscle, and the internal jugular vein.
2. Type II – Lateral Neck Dissection:
- Description: Involves the removal of lymph nodes from levels II, III, and IV (mid to lower jugular levels).
- Indications: Indicated for cancers of the oropharynx, larynx, and hypopharynx, where lymph nodes from these areas are suspected to have metastasized.
3. Type III – Modified Radical Neck Dissection:
- Description: Involves removal of lymph nodes from levels I-V (entire neck), but crucial structures like the spinal accessory nerve, sternocleidomastoid muscle, and internal jugular vein are preserved.
- Indications: Used when more extensive disease is suspected, such as for cancers of the oropharynx, larynx, and thyroid, with extensive lymph node involvement. It is often used when the cancer has spread beyond the expected levels of lymph node metastasis.
4. Type IV – Comprehensive Neck Dissection:
- Description: This is a more extensive surgery where lymph nodes from all levels of the neck (I-V) are removed, including the pre-auricular, retroauricular, and submandibular areas. This is considered a more aggressive approach than other selective neck dissections.
- Indications: Often performed when the cancer is extensive or in cases of recurrent disease, or when the spread of the cancer to more distant nodes is suspected.