title: Neck Dissection Technique Commonality and Variance: A Survey on Neck Dissection Technique Preferences among Head and Neck Oncologic Surgeons in the American Head and Neck Society.
abstract: IntroductionNeck dissection (ND) technique preferences are not well reported.ObjectiveThe objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND.MethodsOnline survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences.ResultsIn our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32-77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year. ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND.ConclusionsThe commonalities and variances reported for the ND technique may help put individual preferences into context.
authors.affiliation: School of Medicine, UCSF, San Francisco, California, United States.
authors.forename: Shirin M
authors.initials: SM
authors.lastname: Hemmat
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Arizona, Tucson, Arizona, United States.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology - Head and Neck Oncologic/Endocrine/Salivary Surgery, University of California San Francisco, San Francisco, California, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Ryan
keywords: graduate medical education; neck dissection; surgical instruments; survey and questionnaires