Selective Neck Dissection for Oral Cancer

Dissection of levels II and III

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This segment describes the dissection of levels II and III.

Keywords

  • Head and neck cancer
  • Supraomohyoid neck dissection
  • Nodal metastasis
  • Oral squamous cell cancer
  • Cervical lymph nodes
  • Level II
  • Level III

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Robbins KT (2000) Indications for selective neck dissection: when, how, and why. Oncology (Williston Park) 14(10):1455–1464Google Scholar
  2. 2.
    Robbins KT, Ferlito A, Shah JP, Hamoir M et al (2013) The evolving role of selective neck dissection for head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 270(4):1195–1202CrossRefGoogle Scholar
  3. 3.
    Lucioni M (2007) Practical guide to neck dissection. Springer, Berlin.  https://doi.org/10.1007/978-3-540-71639-6 CrossRefGoogle Scholar
  4. 4.
    Grénman R (2010) Principles and techniques of neck dissection. In: Anniko M, Bernal-Sprekelsen M, Bonkowsky V, Bradley P, Iurato S (eds) Otorhinolaryngology, head and neck surgery. European manual of medicine. Springer, BerlinGoogle Scholar

About this video

Author(s)
Krishnakumar Thankappan
First online
02 March 2019
DOI
https://doi.org/10.1007/978-3-030-15259-8_3
Online ISBN
978-3-030-15259-8
Publisher
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

Attention is now to elevate the lower skin flap subplatysmally, the lower limit of which is the superior belly of the omohyoid muscle. This lower skin flap is retracted with the help of a skin stitch. The external jugular vein and the retromandibular vein is being dissected and preserved.

The level IIA nodal tissue is seen being dissected off. The spinal accessory nerve is seen being exposed and preserved. The fibrofatty tissue, posterior-superior to the spinal accessory we nerve– that’s the level IIB– is dissected of carefully, without much traction on the nerve.

The superior belly of omohyoid is being delineated, which is the lower limit of dissection. Level IIA tissue is further being dissected. Posteriorly, the dissection is over the plane of the branches of the deep cervical plexus. These branches can be preserved. The dissection is seen here over the deep cervical plexus.

The next step is the sharp dissection with a 15-number surgical blade to separate the tissue of the internal jugular vein. It’s very important to preserve the anterior tributaries of the internal jugular vein.

The specimen is finally being separated off, and that finishes the level II and III neck dissection. The anatomical structures are being demonstrated– the spinal accessory nerve, the internal jugular vein, the anterior tributaries, the deep cervical plexus, and the superior thyroid artery.

The procedure is completed, and the wound closed in layers. A suction drain was kept for drainage.

To summarize, selective neck dissection is done in early-stage oral cancer. It is an elective prophylactic surgical procedure done along with the primary dissection. The video demonstrated the removal of neck nodal levels I, II, and III. Thank you.