Single transverse extended incision for radical neck dissection.
OBJECTIVE
to assess the efficacy of the single transverse extended cervical incision in radical neck dissection.


METHODS
we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections.


RESULTS
as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence.


CONCLUSIONS
the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.


OBJECTIVE
verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical.
estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais.


RESULTS
como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura.
a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
José Francisco Sales
JF
Chagas
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
Maria Beatriz Nogueira
MB
Pascoal
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
José Luís Braga
JL
Aquino
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
Luís Antônio
LA
Brandi
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
Evandro Von Zuben
EV
Previtale
- Department of Head and Neck Surgery, Hospital of the Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
Ana Sofia Pontes
AS
Trillo
- Department of Head and Neck Surgery and Otorhinolaryngology, Heliópolis Hospital, São Paulo, SP, Brazil.
Otávio Alberto
OA
Curioni
- Department of Head and Neck Surgery and Otorhinolaryngology, Heliópolis Hospital, São Paulo, SP, Brazil.
Abrão
A
Rapoport
- Department of Head and Neck Surgery and Otorhinolaryngology, Heliópolis Hospital, São Paulo, SP, Brazil.
Rogério Aparecido
RA
Dedivitis
D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies