CONSERVATIVE NECK DISSECTION

INDICATIONS AND SURGICAL TECHNIQUE

Abstract

Conservative neck dissection is now considered to be a modified radical neck dissection (MRND). The MRND preserves one or more non-lymphatic structures routinely removed in a radical neck dissection. All of the lymph node groups (level I-V) are comprehensively removed. Preservation of the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle improves the cosmetic result and usually maintains function.
When selecting a MRND as treatment, we must be very careful to adhere strictly to proper indications. The MRND type I, in which the spinal accessory nerve is preserved, is indicated in patients without fixed nodes in level II and V nodes; the MRND type II, in which the spinal accessory nerve and internal jugular vein are preserved, is indicated in patients without adhesive nodes in levels II, III, IV, and V; and the MRND type III, in which the spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle are preserved, is indicated in patients with high malignancy and only level I disease.
Between 1991 and 2000, 259 patients with oral squamous cell carcinoma, whose primary lesion had been controlled, underwent various types of neck dissections. A MRND was performed on 159 sides of the neck (MRND type I, 117 sides; MRND type II, 38 sides; MRND type III, 4 sides). The recurrence rate in the neck with MRND type I was 3.4%, with MRND type II it was 5.3%, and with MRND type III it was 0%.
A MRND requires careful selection of patients, additional operative time, and skill. Although preservation of those anatomical structures does not necessarily guarantee complete preservation of function, the benefits of the MRND make it a reasonable treatment choice when possible.
In this paper, the surgical technique for the MRND type III is described in detail.