Neck Dissection
1880 Kocher proposed removing nodal metastasis using Y shaped incision
Crile described classical radical neck dissection popularized by Hayes Martin.
CLASSIFICATIONS
Academy’s Committee for Head and Neck Surgery and Oncology publicized standard
classification system which included
Based on 4 concepts
RND is the standard basic procedure for cervical lymphadenectomy against which all other
modifications are compared.
Modifications of the RND which include preservation of any non-lymphatic structures are
referred to as modified radical neck dissection (MRND)
Any neck dissection that preserves one or more groups or levels of lymph nodes is referred to
as a selective neck dissection (SND)
An Extended Neck Dissection refers to the removal of additional lymph node groups or non-
lymphatic structures relative to the RND
ACADEMY CASSIFICATION
1) Radical neck dissection (RND) – Level I to V + SCM + SAN + IJV
2) Modified radical neck dissection (MRND) – Type I(Save SAN), II(Save SAN and IJV), III (all 3)
3) Selective neck dissection (SND)
Supra-omohyoid type
Lateral type
Posterolateral type
Anterior compartment type
4) Extended radical neck dissection
Other Classifications include
Medina Classification
Spiro’s Classification
Remember type I, II, III of MRND was not specifically named by committee but by Medina.
Type III also known as Functional Neck Dissection. Neck dissection of choice for N0 neck
PREOP ASSESSMENT
Patient informed about the possible complications of neck dissection.
Elective tracheostomy not needed if unilateral neck dissection carried out unless combined with
removal of primary.
POSITION
Sand bag and head ring placed with head turned to opposite side.
INCISIONS
McFee is only incision with bony landmarks – Submandibular Component i.e. First limb begins
over mastoid, goes down to hyoid, again superiorly to submental area.
Supraclavicular Component i.e. Second limb – 2cm above clavicle, laterally from anterior border of
trapezius to midline.
Utility Incision
1) Crile’s or Y shaped incision – Patient not irradiated previously, MC used incision
2) Schobinger incision – Lazy S at vertical limb (reduces scar contracture), MC used
3) McFee Incision – If patient previously irradiated (not used now)
4) Horizontal T or Hetter’s Incision
5) Modified Schobinger’s
6) Utility incision
7) Apron incision
8) Half Apron
9) Conley’s incision
10) Double Y incision
11) H incision
MC FEE INCISION
ADVANTAGES DISADVANTAGES
Good blood supply from medial and lateral Difficult to perform in short neck patients
aspects
Flap necrosis chances rare (Used for irradiated Dissection under central bipedicled flap is tedious
necks) with intensive retraction required by assistant for
proper exposure
Central bipedicled flap has good vascularity and
covers most length carotid vessels and protect
