Neck Dissection

The neck dissection is a surgical procedure for control of neck lymph node metastasis from tumours (most commonly Squamous cell carcinoma and Merkel cell carcinoma) of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease. The metastases may originate from tumours of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp.

Lymph nodes in a particular region are numerous and generally referred to in groups. It is impossible to dissect through all the soft tissue to remove individual lymph nodes. As such the neck dissection is the en-bloc resection of all soft tissue in the region including all the lymph nodes and structures passing through them. In the case of a neck dissection, this entails the resection of everything within the superficial layer of deep cervical fascia (also known as the investing layer of cervical fascia). Where deemed excessively morbid, the structures within are conserved. These include the carotid and in some instances the three structures - IJV, SCM and Accessory Nerve.