Surgical technique--unwrapping the neck node levels around a sternocleidomastoid muscle bar: a systematic way of performing (modified) radical neck dissection.
OBJECTIVE
Description of a systematic approach to the neck for removal of lymph node bearing tissues in levels I-V.


METHODS
A (modified) radical neck dissection is divided in three steps: (1) Dissection of levels I-IV, (2) dissection of level V and (3) transection of SCM bar and finalisation of the dissection. The sternocleidomastoid muscle (SCM) is used as a "bar", around which the different neck levels can be systematically unwrapped, warranting permanent cranio-caudal tension of the neck specimen, while anatomical relations remain intact.


RESULTS
In a group of 115 (modified) radical en bloc neck dissections with or without post-operative radiotherapy 10% regional recurrences, 2% post-operative chylous fistulas and < 5% post-operative wound infections occurred. The overall 5 years survival was 45% (95% confidence interval: 36-54%).


CONCLUSIONS
A systematic unwrapping of lymph node levels around the sternocleidomastoid bar provides a reliable systematic method for performing (modified) radical neck dissections without a negative influence on clinical outcome.
Balm
A J M
AJ
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. a.balm@nki.nl
Lohuis
P J F M
PJ
Copper
M P
MP
D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging