Index

A lesser occipital nerve, 40 sternohyoid muscle, 39 levator scapulae muscle, 42 sternothyroid muscle, 39 American Academy of lingual , 47, 52 strap muscles, 37 Otolaryngology — Head and lingual nerve, 46 stylohyoid muscle, 45 Surgery, 5 lingual , 47, 49 stylomandibular ligament, 48 American approach to neck lymphatics, 26 sublingual artery, 47 dissection, 1 deep, 26 submandibular ganglion, 48 American Society for Head and Neck deep anterior chain, 28 submandibular gland, 47 Surgery, 5 internal jugular chain, 26 submandibular nodes, 26 Anatomy jugular trunk, 28 submandibular triangle, 33, 45 ansa cervicalis, 40 left thoracic duct, 28 submental nodes, 26 anterior jugular nodes, 26 right lymphatic duct, 28 , 33 anterior , 36 spinal accessory chain, 28 superficial temporal artery, 52 anterior triangle, 33 superficial, 26 superior laryngeal artery, 52 ascending pharyngeal artery, 52 transverse cervical chain, 28 superior thyroid artery, 52 brachial plexus, 44 marginal nerve, 40, 48 superior thyroid , 49 brachiocephalic trunk, 50 mastoid nodes, 26 supraclavicular nerve, 40 carotid artery, 50 maxillary artery, 52 surgical, 35 carotid sheath, 24, 49 , 49 sympathetic trunk, 54 carotid sinus, 50 muscular triangle, 35 thyrohyoid muscle, 39 carotid triangle, 35 mylohyoid muscle, 45 thyrolinguofacial trunk, 49 cervical fascia, 23 nodal groups, 28 topographic, 33 deep, 24 disadvantages, 31 vagus nerve, 50, 53 superficial, 24 subzones, 30 Anesthesia, 64 cervical plexus, 39 occipital artery, 52 Ansa cervicalis, 39, 123 chorda tympani nerve, 47 occipital nodes, 26 surgical anatomy, 40 cricothyroid artery, 52 occipital triangle, 35 Ansa hypoglossi. See Ansa cervicalis omoclavicular triangle, 35 Anterior jugular nodes, 26 deep layer, 24 omohyoid muscle, 39 superficial layer, 24 parotid nodes, 26 division, 100 Delphian node, 28 phrenic nerve, 44 ligation, 77 digastric muscle, 45 platysma muscle, 35 surgical anatomy, 36 external carotid artery, 51 Poirier’s node, 28 Anterior neck dissection, 56 external jugular nodes, 26 posterior auricular artery, 52 Anterior scalene muscle , 36, 110 posterior triangle, 35, 41 surgical anatomy, 42 facial artery, 52 recurrent laryngeal nerve, 54 Anterior triangle , 48, 49 retropharyngeal nodes, 28 topographic anatomy, 33 geniohyoid muscle, 45 scalene muscles, 42 Apron flap, 68 great auricular nerve, 40 skin Area VI hypoglossal nerve, 46, 48 vascular supply, 35 surgical limits, 102 , 49 spinal accessory nerve, 43 Artery infrahyoid artery, 52 splenius capitis muscle, 41 ascending cervical internal carotid artery, 50 sternocleidomastoid artery, 52 surgery, 120 , 49 sternocleidomastoid muscle, ascending pharyngeal Ku¨ ttner’s node, 28 41, 49 surgical anatomy, 52

155 156 FUNCTIONAL AND SELECTIVE NECK DISSECTION

Artery (cont.) Carotid sinus Conley carotid surgical anatomy, 50 skin incision, 69 surgical anatomy, 50 Carotid triangle Cricothyroid artery cricothyroid topographic anatomy, 35 surgical anatomy, 52 surgical anatomy, 52 Central compartment Crile, George, 1 external carotid dissection, 101 surgical anatomy, 51 surgical limits, 102 D facial Cerebral edema surgery, 79–80 complications, 135 Deep anterior chain, 28 surgical anatomy, 52 Cervical fascia Deep cervical fascia, 24 infrahyoid carotid sheath, 24 Deep lymphatics, 26 surgical anatomy, 52 deep, 24 anterior chain, 28 internal carotid deep layer, 24 internal jugular chain, 26 surgical anatomy, 50 prevertebral layer, 24 retropharyngeal nodes, 28 lingual superficial layer, 24 spinal accessory chain, 28 surgical anatomy, 47, 52 surgery, 92 transverse cervical chain, 28 maxillary superficial, 24 Delphian node, 28 surgical anatomy, 52 Cervical plexus Digastric muscle occipital connections to spinal accessory surgery, 115 surgery, 86 nerve, 77, 123 surgical anatomy, 45 surgical anatomy, 52 deep branches, 94 Dissection posterior auricular superficial branches, 39 blunt surgical anatomy, 52 surgery, 90, 94, 123 supraclavicular fossa, 90 sternocleidomastoid surgical anatomy, 123 sharp, 107 surgery, 86 Chorda tympany nerve Duct surgical anatomy, 52 surgical anatomy, 47 right lymphatic sublingual Chylous leak, 129, 133 chylous leak, 130 surgical anatomy, 47 conservative management, 133 surgery, 98 superficial temporal Classification submandibular surgical anatomy, 52 American Academy, 7 surgery, 80 superior laryngeal other, 7 thoracic surgical anatomy, 52 personal approach, 60 ligation, 130 superior thyroid Clinical evaluation surgery, 98, 129 surgery, 100 imaging techniques, 9 surgical repair, 130, 133 surgical anatomy, 52 negative neck, 8 Wharton’s transverse cervical Complications surgery, 80 surgery, 92, 120 general, 137 Ascending cervical artery pneumonia, 138 E surgery, 120 pulmonary, 138 Economic factors Ascending pharyngeal artery pulmonary embolism, 138 and neck dissection in the US, 6, surgical anatomy, 52 pulmonary insufficiency, 138 10 Atlas stress ulcer, 138 Elective neck dissection, 8 transverse process local, 131 Erb’s point, 39, 43, 75, 86, 90, 92, 110, surgical landmark, 77 chylous leak, 133 118, 120, 136 hematoma, 131 Extended neck dissection, 57 infection, 131, 132 B External carotid artery pharyngocutaneous fistula, 131, Bleeding, 133 surgical anatomy, 51 134 Blunt dissection External jugular nodes, 26 serohematoma, 131 supraclavicular fossa, 90 External jugular vein seroma, 131 surgical steps, 107 division, 82, 110, 113 wound dehiscence, 132 Brachial plexus ligation, 90 neural, 135 surgery, 92 surgical anatomy, 36, 110 hypoglossal nerve, 136 surgical anatomy, 44 marginal nerve, 137 Brachiocephalic trunk phrenic nerve, 136 F surgical anatomy, 50 spinal accessory nerve, 135 Facial artery sympathetic trunk, 137 division, 79–80 C vagus nerve, 137 surgery, 79 Carotid artery vascular, 133 surgical anatomy, 52 surgical anatomy, 50 bleeding, 133 Facial vein Carotid sheath blowout, 134 division, 113 dissection, 94 cerebral edema, 135 surgery, 98, 101 surgical anatomy, 49 hemorrhage, 133 surgical anatomy, 48–49 INDEX 157

Fascia Hematoma, 131 L carotid sheath, 24, 49 Hemorrhage, 133 La Paz Hospital, 16 deep cervical, 24 postoperative Lateral neck dissection, 56 deep layer, 24 identification, 134 Latin approach superficial layer, 24 management, 134 to neck dissection, 15 prevertebral layer, 24 sources, 133 Left thoracic duct, 28 superficial cervical, 24 Hypoglossal nerve Lesser occipital nerve Fascial anatomy, 23 complications, 136 surgical anatomy, 40 Fascial system, 57 relations to , 116 Levator scapulae muscle Functional neck dissection surgery, 80, 83, 115 innervation, 42 after radiotherapy, 141 surgical anatomy, 46, 48 surgery, 86 bilateral, 142 innervation, 123 borderline cases, 142 surgical anatomy, 42 conceptual approach, 57 I Level I, 28 evolution, 20 Imaging techniques, 9 removal, 77 indications, 61 Incision Level II, 30 internal jugular vein apron flap, 68 surgery bilateral resection, 142–143 Conley, 69 relation to level V, 85 contacting nodes, 143 double-Y, 68 Level III, 30 limitations, 62 Gluck, 68 Level IV, 30 open biopsy, 141 H incision, 69 Level V, 30 origins, 17 Hayes Martin, 68 surgery rationale, 17, 23 Mac Fee, 69 relation to level II, 85 relation to selective neck dissection, Schobinger, 69 Level VI, 30 58 single-Y, 69 dissection, 101 salvage procedure, 141 skin, 67 surgical limits, 102 staging the operation, 142–143 tracheostomy, 68 Level VII, 30 surgical technique, 19, 63 Y, 69 Ligament Infection, 131 stylomandibular surgery, 82 G symptoms, 132 Inferior petrosal sinus surgical anatomy, 48 Ganglion surgical anatomy, 49 Lingual artery inferior sympathetic cervical Infrahyoid artery surgical anatomy, 47, 52 surgical anatomy, 54 surgical anatomy, 52 Lingual nerve middle sympathetic cervical Innervation surgery, 79 surgical anatomy, 54 shoulder, 116 surgical anatomy, 46 submandibular Internal carotid artery Lingual vein surgical anatomy, 48 surgical anatomy, 50 surgery, 98 superior sympathetic cervical Internal jugular lymphatic chain, 26 surgical anatomy, 47, 49 surgical anatomy, 54 Internal jugular vein Lingual veins General complications, 137 initial folds, 98, 126 relations to hypoglossal nerve, 116 Geniohyoid muscle knife dissection, 126 surgery, 83 surgical anatomy, 45 lower fold, 127 surgical management, 136 Gland relations to spinal accessory nerve, Local complications, 131 submandibular 84, 118, 136 Lymph node groups, 10 preservation, 113 surgery Lymphatic chains, 26 surgical anatomy, 47 danger points, 98, 126 Lymphatic drainage surgical approach, 77 surgical anatomy, 49 normal, 55 Glands upper fold, 127 Lymphatics parathyroid deep, 26 surgery, 104 anterior chain, 28 Gluck J internal jugular chain, 26 skin incision, 68 retropharyngeal nodes, 28 Great auricular nerve Jugular lymphatic trunk, 28 spinal accessory chain, 28 surgery, 110 transverse cervical chain, 28 surgical anatomy, 40 major ducts, 28 K jugular trunk, 28 Knife dissection, 72, 107 right lymphatic duct, 28 H basic principles, 107 thoracic duct, 28 H surgical steps, 107 superficial, 26 skin incision, 69 Kocher’s vein anterior jugular nodes, 26 Hayes Martin surgery, 101 external jugular nodes, 26 skin incision, 68 Ku¨ ttner’s node, 28 mastoid nodes, 26 158 FUNCTIONAL AND SELECTIVE NECK DISSECTION

Lymphatics (cont.) sternohyoid, 39 lateral, 56 occipital nodes, 26 sternothyroid, 39 oncological safety, 59 parotid nodes, 26 stylohyoid personal experience, 59 submandibular nodes, 26 surgery, 115 posterolateral, 56 submental nodes, 26 surgical anatomy, 45 practical considerations, 10 thyrohyoid, 39 supraomohyoid, 56 Muscles type M scalene, 42 number of nodes, 140 Mac Fee strap, 37 primary tumor, 139 skin incision, 69 surgery, 100 Negative neck Maneuver Muscular triangle evaluation, 8 marginal nerve, 113, 137 topographic anatomy, 35 Nerve spinal accessory, 86, 120 Mylohyoid muscle ansa cervicalis, 39–40 Marginal nerve surgery, 78 surgery, 123 complications, 137 surgical anatomy, 45 chorda tympani maneuver, 77, 113, 137 surgical anatomy, 47 preservation, 77 great auricular, 40 surgery, 112 N surgery, 110 surgical anatomy, 40, 48 Neck dissection hypoglossal Martin, Hayes, 2 American approach, 1, 55 complications, 136 Mastoid nodes, 26 classification, 7 surgery, 80, 83, 115–116 Maxillary artery American Academy, 7 surgical anatomy, 46, 48 surgical anatomy, 52 other, 7 lesser occipital, 40 Mayo Clinic, 4 personal approach, 60 lingual Mayo stand, 63 elective, 3, 8 surgery, 79 MD Anderson Cancer Center, 4, 9, extended, 57 surgical anatomy, 46 10 functional marginal, 40 Medial scalene muscle after radiotherapy, 141 complications, 137 surgical anatomy, 42 bilateral, 142 maneuver, 113, 137 Memorial Hospital, 2, 9, 10 borderline cases, 142 preservation, 77 Metastatic pattern, 55 conceptual approach, 57 surgery, 112 Middle thyroid vein evolution, 20 surgical anatomy, 48 surgical anatomy, 49 indications, 61 phrenic Modified radical neck dissection limitations, 62 complications, 136 after radiotherapy, 141 open biopsy, 141 identification, 136 classification, 8 origins, 17 surgery, 92, 94, 123, 125 indications, 7 rationale, 17, 23 surgical anatomy, 44 Muscle removal of both internal jugular recurrent laryngeal anterior scalene, 42 veins, 142, 143 surgery, 103 digastric removal of internal jugular vein, surgical anatomy, 54 surgery, 115 142 spinal accessory surgical anatomy, 45 salvage procedure, 141 complications, 135 geniohyoid staging the operation, 142, 143 entrance into sternocleidomastoid surgical anatomy, 45 surgical technique, 19, 63 muscle, 74 levator scapulae, 42 Latin approach, 15, 57 identification, 77 innervation, 42 modifications, 6 posterior triangle, 90, 136 surgery, 86 modified radical, 8 shoulder innervation, 116 medial scalene, 42 after radiotherapy, 141 surgery, 84, 116 mylohyoid indications, 7–8 surgical anatomy, 43 surgery, 78 number of nodes, 140 supraclavicular, 40 surgical anatomy, 45 origins of functional neck sympathetic trunk omohyoid, 39 dissection, 17 surgical anatomy, 54 dissection, 92 postoperative radiotherapy, 140 transverse cervical, 40 platysma, 35 primary tumor, 139 vagus posterior scalene, 42 prophylactic, 3 complications, 137 splenius capitis, 41 radiation and chemotherapy, 11 relations to thoracic duct, 137 sternocleidomastoid, 41 radical, 7 surgery, 96 dissection, 112 selective, 9–10 surgical anatomy, 50, 53 fascial incision, 72 anterior, 56 surgical management, 137 innervation, 41 conceptual approach, 55, 58 Neural complications, 135 surgery, 89 disadvantages, 60 Nodal groups, 28 surgical anatomy, 49 functional approach, 60 disadvantages, 32 INDEX 159

Level I, 28 surgical identification, 77 disadvantages, 60 Level II, 30 Pneumonia, 138 functional approach, 60 Level III, 30 Poirier’s node, 28 oncological safety, 59 Level IV, 30 Position personal experience, 59 Level V, 30 surgical, 63 practical considerations, 10 Level VI, 30 Posterior auricular artery relation to functional neck Level VII, 30 surgical anatomy, 52 dissection, 58 subzones, 30 types Node division, 82 anterior, 56 Delphian, 28 surgical anatomy, 36 lateral, 56 Ku¨ ttner, 28 Posterior facial vein posterolateral, 56 Poirier, 28 surgical anatomy, 36 supraomohyoid, 56 Nodes Posterior scalene muscle Serohematoma, 131 anterior jugular, 26 surgical anatomy, 42 Seroma, 131 external jugular, 26 Posterior triangle, 41 Setup mastoid, 26 dissection, 86 operating room, 63 occipital, 26 spinal accessory nerve, 89, 136 Shoulder innervation, 116 parotid, 26 surgical anatomy, 41 Shoulder syndrome, 9, 135 retropharyngeal, 28 surgical boundaries, 90 Single-Y submandibular, 26 topographic anatomy, 35 skin incision, 69 submental, 26 Posterolateral neck dissection, 56 Skin Postoperative hemorrhage incision O identification, 134 apron flap, 68 management, 134 Conley, 69 Occipital artery sources, 133 double-Y, 68 surgery, 86 Postoperative radiotherapy, 140 Gluck, 68 surgical anatomy, 52 Preoperative preparation, 63 H incision, 69 Occipital nodes, 26 Pretracheal nodes Hayes Martin, 68 Occipital triangle dissection, 101 Mac Fee, 69 topographic anatomy, 35 Pulmonary complications, 138 Schobinger, 69 Omoclavicular triangle Pulmonary embolism, 138 single-Y, 69 topographic anatomy, 35 symptoms, 138 tracheostomy, 68 Omohyoid muscle Pulmonary insufficiency, 138 Y, 69 dissection, 92 surgical anatomy, 35 surgical anatomy, 39 vascular supply, 35 Oncological premises, 142 R Skin flaps, 69 Operating room setup, 63 Radiation, chemotherapy, and neck raising, 108 dissection, 11 Skin incision, 67 P Radical neck dissection, 7 Society Parathyroid glands Radiotherapy American Society for Head and autotransplant, 105 postoperative Neck Surgery, 5 þ surgery, 104 N patients, 140 Head and Neck Surgeons, 4 Paratracheal nodes Raising the flaps, 108 Spinal accessory chain, 28 dissection, 101 Recurrent laryngeal nerve Spinal accessory maneuver, 86, 120 Parotid nodes, 26 surgery, 103 Spinal accessory nerve Pharyngocutaneous fistula, 131, 134 surgical anatomy, 54 cervical plexus Phrenic nerve, 123 anastomosis, 94 at surgery, 92 division, 82, 113 complications, 135 complications, 136 surgical anatomy, 36 dissection, 84 identification, 125, 136 Retropharyngeal nodes, 28 entrance into sternocleidomastoid surgery, 94, 125 Right lymphatic duct, 28 muscle, 74 surgical anatomy, 44 chylous leak, 130 posterior triangle, 90, 136 Platysma muscle surgery, 98 quality of life, 135 innervation, 36 relations to internal jugular vein, surgical anatomy, 35 84, 118, 136 Plexus S shoulder innervation, 116 brachial Scalene muscles surgery, 116 surgery, 92 surgical anatomy, 42 identification, 77 surgical anatomy, 44 Schobinger surgical anatomy, 43 cervical, 39 skin incision, 69 surgical preservation, 135 surgery, 90, 94, 123 Selective neck dissection, 9, 10 Splenius capitis muscle surgical anatomy, 123 conceptual approach, 55, 58 surgical anatomy, 41 160 FUNCTIONAL AND SELECTIVE NECK DISSECTION

Sternocleidomastoid artery Surgery sympathetic trunk, 94 surgery, 86 anterior jugular vein, 100 tail of parotid gland, 83 surgical anatomy, 52 area VI, 101 thoracic duct, 98 Sternocleidomastoid muscle brachial plexus, 92 thyroid veins, 98 dissection, 70, 89, 112 carotid sheath, 94 transverse cervical artery, 92, 120 fascial incision, 72 central compartment, 101 upper limit, 82 innervation, 41 cervical plexus, 90, 94 vagus nerve, 96 surgical anatomy, 41, 49 anastomosis with XI nerve, Surgical anatomy, 35 surgical management, 75 77 Surgical technique, 63 vascularization, 74 closure of the wound, 105 Sympathetic cervical ganglion Sternohyoid muscle deep layer of cervical fascia, 92 inferior surgical anatomy, 39 dissection of omohyoid muscle, 92 surgical anatomy, 54 Sternothyroid muscle dissection of sternocleidomastoid middle surgical anatomy, 39 muscle, 70 surgical anatomy, 54 Strap muscles draping, 63 superior dissection, 100 external jugular vein, 82, 90 surgical anatomy, 54 innervation, 39 division, 70 Sympathetic trunk surgical anatomy, 37 facial artery, 79–80 complications, 137 Stress ulcer, 138 facial vein, 98, 101 surgery, 94, 125 Stylohyoid muscle hypoglossal nerve, 80, 83 surgical anatomy, 54 surgery, 115 incision Syndrome surgical anatomy, 45 over the sternocleidomastoid shoulder, 135 Stylomandibular ligament muscle, 72 section, 82 skin, 67 T surgical anatomy, 48 instruments, 64 Thoracic duct Sua´rez, Osvaldo, 9, 16, 58, 86, 120 internal jugular vein, 74 ligation, 130 anecdotes, xv knife dissection, 72 surgery, 98 Sublingual artery Kocher’s vein, 101 surgical repair, 99, 130, 133 surgical anatomy, 47 Level VI, 101 Thyrohyoid muscle Submandibular duct limits, 70 surgical anatomy, 39 surgery, 80 lingual nerve, 79 Thyroid veins Submandibular fossa lingual vein, 98 surgery, 98 surgical approach, 77 lingual veins, 83 Thyrolinguofacial trunk Submandibular ganglion marginal nerve, 77 surgical anatomy, 49 surgical anatomy, 48 Mayo stand, 63 Topographic anatomy, 33 Submandibular gland mylohyoid muscle, 78 Transverse cervical artery preservation, 113 occipital artery, 86 surgery, 120 removal, 77 parathyroid glands, 104 Transverse cervical lymphatic chain, surgical anatomy, 47 patient’s position, 63 28 Submandibular nodes, 26 phrenic nerve, 92, 94 Transverse cervical nerve Submandibular triangle, 33 posterior auricular vein, 82 surgical anatomy, 40 surgical anatomy, 45 posterior triangle, 86, 90 Transverse cervical vessels Submental and submandibular nodes protection of skin flaps, 70 surgery, 120 removal, 77 recurrent laryngeal nerve, 103 Transverse process of the atlas Submental nodes, 26 retromandibular vein, 82 surgical landmark, 77 Submental triangle, 33 right lymphatic duct, 98 Trunk Superficial cervical fascia, 24 skin flaps, 69 brachiocephalic Superficial lymphatics, 26 spinal accessory maneuver, 86, 120 surgical anatomy, 50 Superficial temporal artery spinal accessory nerve, 84 sympathetic surgical anatomy, 52 entrance into surgery, 94 Superior laryngeal artery sternocleidomastoid surgical anatomy, 52 muscle, 74 V Superior thyroid artery identification, 77 Vagus nerve surgery, 100 sternocleidomastoid artery, 86 complications, 137 surgical anatomy, 52 sternocleidomastoid muscle, 89 relations to thoracic duct, 137 Superior thyroid veins vascularization, 74 surgery, 96 surgical anatomy, 49 strap muscles surgical anatomy, 50, 53 Supraclavicular fossa dissection, 100 surgical management, 137 blunt dissection, 90 stylomandibular ligament, 82 Vascular blowout, 134 Supraclavicular nerve submandibular duct, 80 carotid artery, 134 surgical anatomy, 40 submandibular fossa, 77 internal jugular vein, 134 Supraomohyoid neck dissection, 56 superior thyroid artery, 100 management, 134 INDEX 161

Vascular complications, 133 lower fold, 127 surgery, 83, 116 Vein surgery, 74 surgical management, 136 anterior jugular, 36 surgical anatomy, 49 superior thyroid division, 100 upper fold, 127 surgical anatomy, 49 ligation, 77 Kocher’s thyroid external jugular, 36 surgery, 101 surgery, 98 division, 70, 110, 113 lingual ligation, 90 surgery, 98 surgery, 82 surgical anatomy, 47, 49 W surgical anatomy, 110 middle thyroid Wash the field, 107 facial surgical anatomy, 49 Wharton’s duct division, 113 posterior auricular, 36 surgery, 80 surgery, 98, 101 surgery, 82 Wound dehiscence, 132 surgical anatomy, 48, posterior facial, 36 49 retromandibular, 36 internal jugular division, 113 danger points, 98, 126 surgery, 82 Y initial folds, 126 Veins Y knife dissection, 126 lingual skin incision, 69