title: Surgical technique--unwrapping the neck node levels around a sternocleidomastoid muscle bar: a systematic way of performing (modified) radical neck dissection.
abstract: 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.
authors.affiliation: 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
authors.forename: A J M
authors.initials: AJ
authors.lastname: Balm
authors.forename: P J F M
authors.initials: PJ
authors.lastname: Lohuis
authors.forename: M P
authors.initials: MP
authors.lastname: Copper
mesh_terms: D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging