Histopathologic Study of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma

Routine removal of the carotid sheath as part of neck dissection is unnecessary if grossly uninvolved as seen intra-operatively

“…In a study of 29 patients with oral cavity squamous cell carcinoma (32 selective neck dissections), which examined the CS histologically for metastatic infiltration and the presence of normal lymphatic tissue, 11 of 29 patients had metastatic neck nodes and none had extracapsular spread of disease. 18 Light microscopy of the CS specimens showed no evidence of tumour deposits. Normal lymphoid aggregates were found in 2 of the 32 CS specimens.…”

“…Further immunohistochemical evaluation revealed an abundance of lymphatic vessels in the CS with no evidence of microscopic intra luminal metastatic emboli. 18 The authors suggested that in the absence of extracapsular spread, there is no need to perform a tedious dissection of the CS. They also postulated that preserving the CS protects the neurovascular bundle, reduces operating time, and eliminates the chance of injury to the major vessels and vagus nerve and carotid body stimulation.…”

“…They also postulated that preserving the CS protects the neurovascular bundle, reduces operating time, and eliminates the chance of injury to the major vessels and vagus nerve and carotid body stimulation. 18 The present authors deliberately did not undertake immunohistochemistry because it is expensive, does not change the management plan and is not the standard of care in the assessment of nodal metastases in the management of HNSCC. KHAFIF-HEFETZ et al studied the anatomic and pathologic structure of CS in 34 patients (40 neck dissections) undergoing neck dissection for HNSCC.…”

“…Uninvolved lymphoid aggregates, composed almost exclusively of B cells, were found at the carotid bifurcation level in only three patients. 19 Both these studies 18,19 had a small sample size and the authors aimed to address this issue with a larger sample. The authors studied 129 CS specimens harvested from 80 consecutive neck dissections in 70 patients.…”