The Posterior Triangle in Radical Neck Surgery

Skolnik, Emanuel M.; Yee, King F.; Friedman, Michael; Golden, Theodore A.

doi:10.1001/archotol.1976.00780060047002

Cited by 120 publications

(43 citation statements)

References 12 publications

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“…Metastases have been found in level V in 1% or less of the cases [72,75]. Skolnik et al [104] demonstrated no metastatic involvement of the posterior triangle lymphatic system in either the therapeutic or elective neck dissection groups for cancer of the larynx. Recently, Nicolai et al [75] observed that in a series of 402 consecutive patients treated for supraglottic squamous cell carcinoma, level V nodes were never involved.…”

Section: Treatment Of the Clinically Positive Neckmentioning

confidence: 99%

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Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher.The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal ‘skip’ metastases.The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

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Section: Treatment Of the Clinically Positive Neckmentioning

confidence: 99%

“…There is little evidence to support the routine dissection of levels I and V in N1 laryngeal cancer because involvement of the lymph nodes at these levels is virtually nonexistent [74,104,[106][107][108]. On the other hand, the N1 category may include lesions that differ considerably in size and extent.…”

Section: Treatment Of the Clinically Positive Neckmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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“…McGavran et al [1961] and Skolnik et al [1976] stressed the absence of metastases in lymph nodes within the posterior triangle, but these reports deal mainly with primary laryngeal tumors. Schuller et al [1980] had 24% (57 of 242) patients with positive nodes within the posterior triangle and these pa tients had poorer 5-year survival.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrences oc curred in 15% (16 of 109) in those with sac rificed spinal accessory nerve. Skolnik et al [1976] and Carenfelt and Eliasson [1980a] found preservation of the spinal accessory to be a safe method. Jesse et al [1978] found the same in patients where the nerve was not directly invaded by cancer.…”

Section: Discussionmentioning

confidence: 99%

Complications in Neck Dissection

Olofsson¹,

Tytor²

1985

ORL

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Complications following 186 neck dissections in 171 patients are reported. Major surgical complications occurred after 8 neck dissections; minor surgical after 52 and medical complications after 13. Preoperative radiotherapy did not seem to influence the complication rate. 16 of 21 patients with recurrences in the neck had extranodal spread histologically. 76% of the recurrences occurred within a year and proved fatal in nearly all patients. Preservation of the spinal accessory nerve did not increase the recurrence rate.

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“…It is well documented that the lymph nodes of the posterior triangle are involved in a small number of cases in carcinomas of the upper aerodigestive tract (Skolnik et al, 1976a;Candel et al, 1990). It is therefore argued that clearance of levels I to III is adequate for lesions of the oral cavity and oropharynx through a supraomohyoid dissection (Medina and Byers, 1989).…”

Section: The N 'O' Neckmentioning

confidence: 99%

Neck dissection alternatives

Tiwari

1997

IJO & HNS

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The Posterior Triangle in Radical Neck Surgery

Cited by 120 publications

References 12 publications

Surgical Treatment of the Neck in Cancer of the Larynx

Surgical Treatment of the Neck in Cancer of the Larynx

Complications in Neck Dissection

Neck dissection alternatives

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