Classification and Terminology of Neck Dissections

Abstract

With the proliferation of operations designed to treat cervical metastatic nodal disease, it has become ever apparent for the need to more clearly and precisely communicate the location of the metastatic cervical nodes and the specific surgery performed. To this end, this paper reviews the variety of operations and the resultant confusing terminology that has emerged over the past five decades. It is suggested that a simplified technology be used that specifically describes the nodal levels dissected, the relevant nonlymphatic structures removed, and those structures that are preserved. It is also suggested that the new imaging-based nodal classification be used to standardize the definition of the nodal levels. It is hoped that this approach will eliminate many of the often confusing and nondescriptive terms and there by facilitate better inter-physician and inter-institutional communication.

Pathways for cervical metastasis in malignant neoplasms of the head and neck region

“…This level is outlined by the hyoid bone superiorly, sternal notch inferiorly, and common carotid arteries laterally. A nodal level VII was proposed by Suen and Goepfert (1987) and Ferlito et al (2000) to include the superior mediastinal lymph nodes, which are the extensions of the paratracheal nodes in level VI below the sternum to the level of the innominate artery. Level VII becomes important when the paratracheal nodes are under consideration for possible metastatic involvement, particularly in the management of thyroid carcinoma (Robbins et al,2008).…”

Rationale for Selective Neck Dissection in Tumors of the Upper Aerodigestive Tract

“…From the point of view of data collection terms such as ''anterior'', ''supraomohyoid '' and ''extended supraomohyoid '' are not very useful. One solution is to simply classify neck dissections according to what is removed and what is preserved (27,28); Table I summarizes the different types of neck dissections and shows the lymph node levels removed and the structures preserved (29).…”

A new device for the identification of lymph nodes removed during different types of neck dissection

“…The removal of a certain number of lymphatic levels during neck dissection may well be therapeutic in intent, but it is also mandatory for correct tumour staging [6]. Te decisions concerning the prognosis, postoperative adjuvant therapy at the individual level and the audit at the departmental level are impossible without proper TNM staging [7].…”