Neck Dissection

Question 1

DDX for central neck mass

Answer 1

Thyroglossal cyst
Thyroid mass (isthmus)
Parathyroid gland
Skin lesion
Lipoma

Question 2

DDx of anterior triangle

Answer 2

Cervical lymph node
Carotid body tumor
Carotid body aneurysm
Branchial cyst

Question 3

DDX of posterior triangle

Answer 3

Cervical LN
Cystic hygroma
Neurogenic tumor
Pharyngeal pouch
Cervical rib

Question 4

Boundaries of anterior triangle

Answer 4

Midline
Anterior border of SCM
Inferior border of mandible

Question 5

Boundaries of posterior triangle

Answer 5

Posterior border of SCM
Anterior border of trapezius
Clavicle

Question 6

What is a branchial cyst?

Answer 6

Congenital epithelial cysts, due to failure of obliteration of branchial cleft during embyronic development

Question 7

What is cystic hygroma?

Answer 7

Cystic lymphatic lesion that are benign lymphatic malformations that can arise anywhere

Question 8

Drainage of level 1 (submental + submandibular) lymph nodes

Answer 8

Lower lip
Oral cavity
Salivary gland
Anterior tongue
Anterior nasal cavity

Question 9

Drainage of Level 2 LN (upper jugular)

Answer 9

Oral cavity
Nasal cavity
Pharynx (naso/oro/hypo)
Larynx
Parotid Gland

Question 10

Drainage of Level 3 LN( middle jugular group)

Answer 10

Oral cavity
Pharynx (naso/oro/hypo)
Larynx

Question 11

Drainage of the Level 4

Answer 11

Hypopharynx
Cervical Oesophagus
Larynx

Question 12

Drainage of Level 5 LN (posterior triangle)

Answer 12

Nasopharyx
Oropharynx
Thyroid gland

Question 13

Drainage of Level 6

Answer 13

Thyroid gland
Glottic/subglottic larynx
Pyriform sinus
Cervical oesophagus

Question 14

Boundaries of Level 1a

Answer 14

Both sides of anterior belly of digastric
Hyoid

Question 15

Boundaries of Level Ib

Answer 15

Anterior belly of digastric
Posterior belly of digastric
Mandible (superior)

Question 16

Boundaries of Level II

Answer 16

Superior: skull base
Inferior: hyoid bone (horizontal plane along inferior border)
Anterior: stylohyoid
Posterior: posterior border of SCM
Division of a/b: vertical plane of spinal accessory nerve

Question 17

Boundaries of the Level III

Answer 17

Superior: hyoid horizontal plane
Inferior: inferior border of cricoid cartilage
Anterior: sternohyoid
Posterior: Posterior border of SCM

Question 18

Boundaries of Level 4 (lower jugular)

Answer 18

Superior: plane of lower border of cricoid cartilage
Inferior: clavicle
Anterior: sternohyoid
Posterior: posterior body of SCM

Question 19

What separates 5a and 5b?

Answer 19

Horizontal plane from inferior arch of cricoid cartilage

Question 20

What lymph nodes due level 6 contain?

Answer 20

Pre-tracheal
Para-tracheal
Pre-cricoid
Peri-thyroidal

Question 21

What is the boundaries of level 6?

Answer 21

Superior: hyoid
Inferior: suprasternal notch
Lateral: common carotid artery

Question 22

Define radical neck dissection

Answer 22

Removal of all lymphatic tissue in levels 1-5 along with spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle

Question 23

Define extended radical neck dissection

Answer 23

Removal of additional lymph node groups in addition to radical neck dissection (level 1-5)

Question 24

Define modified radical neck dissection

Answer 24

Removal of lymphatic tissue in levels 1-5 while preserving any or all of the three non-lymphatic structures (spinal accessory nerve, internal jugular vein, sternocleidomastoid muscle)

Question 25

Modified Radical Neck Dissection 1) Type 1 2) Type 2 3) Type 3 Preservation of which non-lymphatic structures

Answer 25

1) spinal accessory nerve (SAN) 2) SAN and internal jugular vein (IJV) 3) SAN, IJV and sternocleidomastoid

Question 26

Central neck dissection

Answer 26

Level 6

Question 27

Anterior neck dissection

Answer 27

Level 6

Question 28

Lateral neck dissection

Answer 28

Level 2,3,4

Question 29

Posterolateral neck dissection

Answer 29

Level 2,3,4,5

Question 30

Define selective neck dissection

Answer 30

Dissection of lymphatic tissue in less than level 1-5 with preservation of SAN, IJV, and SCM

Question 31

Indications for modified radical neck dissection

Answer 31

* N0 in Upper aerodigestive tract SCC, esp hypopharyx or larynx * N1 neck with mobile nodes \<3cm * Well differentiated thyroid cancer with lymph nodes in posterior triangle

Question 32

Indications for supra-omohyoid neck dissection

Answer 32

* Oral cavity cancer with N0

Question 33

Indications for bilateral supra-omohyoid neck dissection

Answer 33

* Anterior tongue cancer

Question 34

Supraomohyoid neck dissection

Answer 34

Level 1, 2, 3

Question 35

Indications for supraomohyoid dissection + parotidectomy

Answer 35

Melanoma of cheek SCC of cheek

Question 36

Indications for lateral neck dissection

Answer 36

N0 neck in * CA oropharynx * CA hypopharynx * CA larynx * CA supraglottis

Question 37

Indications of posterolateral neck dissection

Answer 37

* Melanoma * Skin SCC * Soft tissue sarcoma of neck and scalp

Question 38

Indications for anterior neck dissection

Answer 38

* Thyroid cancer * Parathyroid cancer * Sub-glottic cancer * Cervical oesophageal cancer * Laryngeal cancer with subglottic extension

Question 39

Complications of modified radical neck dissection

Answer 39

* Hematoma * Infection * Skin flap necrosis * Chyle fistula * Marginal mandibular nerve injury * Carotid artery rupture * Shoulder syndrome (if SAN preserved) * Cosmetic neck deformity (if loss of SCM) * Facial edema (if IJV ligated) * Apnea (carotid body denervation if bilateral dissection) * Jugular vein thrombosis or blowout if subsequent radiotherapy