Abstract
Three hundreds and twenty-six cases of malignant neoplasm of the head and neck were investigated clinically with special reference to the clinical significance of neck dissection. An anatomical investigation of the accssory nerve was combined in order to establish a new technic to prevent postoperative trapezius paralysis, one of the greatest troubles after neck dissection.
The conclusions are as follows:
1. Cervical lymphoadenopathy was found in 67% of epipharynx cacinoma, 50% of carcinoma of the hypopharynx and cervical esophagus, 50% of mesophaynx carcinoma, 48% of carcinoma of the tongue, 33% of laryngeal carcinoma, 24% of maxillary carcinoma, and 6% of carcinoma of the thyroid gland, before treatments.
2. Cervical recurrence occurred after therapeutic neck dissection in 37.5% for carcinoma of the tongue, 15.4% for carcinoma of the hypopharynx and cervical esophagus, 14.3% for maxillary carcinoma, and 10.8 % for laryngeal carcinoma without local recurrence. The rate of cervical recurrence with local recurrence was 66.7% for carcinoma of the tongue, 40% for carcinoma of the hypopharynx and cervical esophagus, and 30% for cancer of the maxillary sinus, repectively.
3. Lethal cervical recurrence after therapeutic neck dissection was found most frequently in paratracheal lymph nodes for subglottic type of laryngeal carcinoma and carcinoma of the hypopharynx and esophagus and submandibular lymph nodes for carcinoma of the tongue.
4. Cervical recurrence was developed after preventive neck dessection in 37.5% for cancer of the tongue, 13.9% for cancer of the larynx, 7.7% forcancer of the maxillary sinus, and none for cancer of the hypopharynx and cervical esophagus, without local recurrence. The rate of cervical recurrence with local recurrence was 75 for cancer of the larynx, 18.7 for cancer of the maxillary sinus, and 25% for carcinoma of the hypopharynx and cervical esophagus, respectively.
5. In general, neck dissection is not necessary for cases with no palpable cervical lymph nodes, except for cases with cancer of the tongue, in which preventive neck dissection should be done on the affected side. When local recurrence has been developed, preventive neck dissection must be performed simultaneously with treatments of the primary pathology.
6. For cancer of the maxillary sinus or epipharynx which is difficult to be treated with en bloc operation, surgery can be done with less recurrence rate after inactivation of the cancer cells.
7. In 56 of 90 cases (62%) functionally investigated, disorders of the trapezius muscle was developed after ordinary neck dissection.
8. In order to maintain the function of the trapezius muscle, accessoriocervical plexus and ramus trapezoideus of the C4 should be preserved in the lateral cervical triangle. With this technic only three cases in twenty-nine developed functional disorders.
