Modified Radical Neck Dissection for Cervical Metastasis

Summary

Here, we present a protocol for radical neck dissection integrating oncologic resection, cranial nerve preservation, and functional reconstruction in cervical metastasis.

Abstract

Radical neck dissection (RND) has stood as the cornerstone surgical procedure for managing controlled cervical metastatic disease for over a century. This comprehensive intervention involves the en bloc resection of the tissue contents within the major cervical triangles, bounded by the deep muscular layer and the investing cervical fascia. The anatomical boundaries extend from the inferior border of the mandible superiorly to the clavicle inferiorly, and from the midline anteriorly to the anterior border of the trapezius muscle posteriorly. A standard RND specimen systematically incorporates the sternocleidomastoid muscle (SCM), the internal jugular vein (IJV), the spinal accessory nerve (CN XI), and the lymphatic tissue encompassing levels I through V. However, evolving surgical practice often favors a modified Radical neck dissection (MRND) approach, which preserves non-lymphatic structures such as the IJV and CN XI when not overtly involved by disease, to minimize functional morbidity without compromising oncologic efficacy. This video article delineates a meticulous, step-by-step protocol for performing a radical or modified radical neck dissection, emphasizing critical technical nuances for achieving complete oncologic resection, preserving vital neurovascular structures-including the marginal mandibular nerve, vagus nerve, and phrenic nerve-and undertaking functional reconstruction. Key advantages of our protocol, demonstrated through a representative case, include a high rate of successful nodal clearance, a minimal postoperative complication profile (e.g., <5% rate of chyle leak or major hematoma), and excellent functional outcomes in shoulder abduction and facial symmetry due to precise nerve preservation techniques. This procedural demonstration serves as a valuable educational resource for surgeons mastering this complex and widely performed operation in head and neck oncology.

Introduction

Radical neck dissection (RND) has remained the definitive surgical procedure for managing cervical metastatic disease throughout the past century¹. This comprehensive intervention entails the en bloc resection of all tissue compartments bounded superficially by the cervical fascia and deeply by the deep muscular layer². Its anatomical boundaries extend from the inferior border of the mandible superiorly to the clavicle inferiorly, and from the midline anteriorly to the anterior border of the trapezius muscle posteriorly. The resection specifically encompasses the cervical lymphatic network (levels I-V) along with associa....

Protocol

The protocol presented here has been approved and conducted as per the guidelines of the West China Hospital of Stomatology. The patients in this study underwent routine surgical procedures with no investigational interventions performed. All patients provided signed informed consent for surgery and use of the data for this study.

1. Preoperative preparation

1. Position the patient supine with the head turned to the healthy side and slightly extended.
2. Following the induction of general anesthesia with intravenous agents, a lubricated endotracheal tube was inserted through the nostril and advanced into the....

Results

After the surgery, the entire removed cervical tissue is shown in Figure 2. Figure 3 shows the important anatomical areas that can be directly observed after the cleaning and thorough hemostasis have been completed. Thirty complete lymph nodes were isolated from the cervical tissues, as shown in Figure 4. The postoperative pathological examination has confirmed the diagnosis, and the treatment process has been completed according to.......

Discussion

This open neck dissection protocol provides a systematic approach to two fundamental challenges in managing cervical metastasis: achieving oncologically radical resection while preserving neural function, and eliminating dead space through fascial flap reconstruction. Balancing oncological safety with functional outcomes remains critical for long-term patient prognosis¹.

Meticulous dissection of neural structures (spinal accessory, vagus, and phrenic nerves) using bipol.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3-0 antibaterial vicryl absorbable suture	Johnson (Suzhou) Medical Devices Co., Ltd.	VCP1772D	For tissue suturing
DSRobot 4K-Station	Digital Vision	-	Surgery video recording
High-Frequency Electrosurgical Unit	Guangdong Baisheng Medical Equipment Co., Ltd.	OBS-350A	Precise tissue cutting and coagulation
Ultrasonic cutting and hemostasis system	Tianjin Ruiqi Surgical Instrument Company	CSUS6000	For cutting and hemostasis