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

Introduction Neck dissection (ND) technique preferences are not well reported. Objective The 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. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In 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. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context.

Comparing human and mouse salivary glands: A practice guide for salivary researchers

“…In humans, the SMG is located in level 1B of the neck (Markey et al, 2017, Hemmat et al, 2017), inferior to the mandible, superior to the hyoid, and posterior to the anterior belly of the digastric muscle (Fig. 1A), while in mice it is located in the ventral cervical subcutaneous region (Fig.…”

“…In humans, the SMG is located in level 1B of the neck (Hemmat, Wang, & Ryan, ; Markey, Morrel, Wang, & Ryan, ), inferior to the mandible, superior to the hyoid, and posterior to the anterior belly of the digastric muscle (Figure a), while in mice, it is located in the ventral cervical subcutaneous region (Figure b; Treuting & Dintzis, ). The SMG is approximately half the size of the PG in humans, but it is the largest of the three major gland types in mice (Dobrosielski‐Vergona, ; Treuting & Dintzis, ).…”

Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review

“…39 It is evident, then, that removal of the perivascular nodes is essential in performing a level IB neck dissection; however, it is a matter of current debate whether the SMG needs to be resected, as most surgeons routinely do, for this to occur. 3,15,21,26,28 Because the lymphatic compartment of level IB is located between the superficial and deep layers of cervical fascia, it is technically possible to remove all lymphatic structures while preserving the SMG. This was demonstrated by Dhiwakar et al, who showed that removal of all level IB nodes without sacrificing the SMG is not only possible but feasible, suggesting that the practice of routinely removing the gland is unnecessary.…”

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

“…Prior survey studies assessing practice patterns regarding malnutrition screening demonstrate response rates ranging from 5.7% 19 to 72%, 16 with recent AHNS surveys reporting response rates of 28%. 22,23 To a certain extent, the low response rate may be explained by fatigue bias, which can occur when surveys are lengthy and/or the participant loses interest toward the end of the survey. 24 This can result in the participant skipping questions or marking responses in a random fashion.…”