It developed as a minimally invasive option compared to Radical Neck Dissection first described in 1906.
Surgeons in the mid-20th century questioned removing non-lymphatic structures not directly affected by tumors.
The Modified Radical Neck Dissection (MRND) removes lymph nodes I to V while preserving non-lymphatic structures where feasible.
Types of MRND are as follows:
Type I: It preserves spinal accessory nerve
Type II: It preserves spinal accessory nerve and internal jugular vein
Type III: It preserves spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle
It balances oncologic safety with reduced morbidity and shoulder function preservation.
The neck connects the head to the torso and termed cervical in Latin means “of the neck.”
The neck supports the head’s weight and offers flexibility for movement. The thyroid cartilage creates a prominence called the laryngeal prominence thus known as the “Adam’s apple.”
The hyoid bone is felt between the Adam’s apple and chin, while the cricoid cartilage is below the thyroid cartilage.
The quadrangular area on the neck is bounded above by the mandible’s lower border and mastoid process.
Neck muscles include suprahyoid, infrahyoid, and anterior vertebral muscles.
Indications
MRND is indicated when maintaining the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle is feasible without oncologic compromise.
Selective neck dissection or MRND is suitable for N0 or N1 patients; MRND is reasonable for N2 if non-lymphatic structures are preserved.
MRND is contraindicated if preserving neck non-lymphatic structures hampers complete cervical cancer resection.
Head and Neck Squamous Cell Carcinoma
Thyroid Cancer
Salivary Gland Tumors
Cutaneous Malignancies
Contraindications
Gross invasion of non-lymphatic structures
Distant metastasis
Inoperable primary tumor
Previous neck surgery or radiation
Poor baseline shoulder function
Outcomes
MRND is a safe oncological choice enhancing functional and cosmetic outcomes for patients.
MRND shows no significant survival difference without invasion in studies. MRND minimizes disability by preserving non-lymphatic structures in surgery.
Preoperative evaluation includes history and physical examination, and imaging of patient.
Administer general anesthesia with endotracheal intubation. Head turned opposite to surgical side and slight extension.
Informed Consent:
Explain the procedure’s risks and potential complications clearly to the patient.
Patient Positioning:
Patients should be positioned in supine positions. Patients should turn their head to the opposite side of the neck being operated on.
Slight extension of the neck to expose the surgical field better.
Figure. Modified Radical Neck Dissection
Technique
Step 1:
Incision made to enhance neck exposure during surgery. Bilateral neck dissections require a continuous incision from mastoid tip to tip.
Dissecting the plane between fascia and platysma allows en bloc access to lymphatic structures within fascia.
Flap elevation moves posteriorly beneath adipose tissue to the trapezius muscle’s edge.
The submental triangle contents are elevated from the mandible’s inferior border and opposite digastric muscle while preserving fascia.
Retraction of the mylohyoid muscle exposes the submandibular duct and lingual nerve for ligation and division.
Contents from level I are moved caudally for better visualization of the superior internal jugular vein using retraction techniques.
Electrocauterization or blunt dissection can elevate fascia from SCM to isolate the SAN effectively.
The nerve is about 1 cm above the greater auricular nerve behind the SCM.
Atraumatic dissection with a hemostat or finger helps create a safe dissection plane while preserving fibrous tissue around metastases.
The posterior triangle contents are lifted en bloc while protecting the phrenic nerve and brachial plexus beneath the fascia.
The SAN must be freed from soft tissues in the posterior triangle and retracted with a vessel loop or nerve hook.
Lymph node-bearing fibroadipose tissues in this area are rotated under the SAN like sublevel VA dissection.
During SCM resection, transection occurs below the mastoid tip and above the clavicle, with levels II, III, and IV contents elevated post-omohyoid division.
For metastatic nodal involvement or tumor thrombosis, the vein is ligated and divided after vagus nerve preservation.
Preserving the superficial fascial layer above the carotid artery is preferred unless essential exposure occurs.
Neck dissection is oriented for lymph node evaluation, followed by suction drains placement and layered closure.
It developed as a minimally invasive option compared to Radical Neck Dissection first described in 1906.
Surgeons in the mid-20th century questioned removing non-lymphatic structures not directly affected by tumors.
The Modified Radical Neck Dissection (MRND) removes lymph nodes I to V while preserving non-lymphatic structures where feasible.
Types of MRND are as follows:
Type I: It preserves spinal accessory nerve
Type II: It preserves spinal accessory nerve and internal jugular vein
Type III: It preserves spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle
It balances oncologic safety with reduced morbidity and shoulder function preservation.
The neck connects the head to the torso and termed cervical in Latin means “of the neck.”
The neck supports the head’s weight and offers flexibility for movement. The thyroid cartilage creates a prominence called the laryngeal prominence thus known as the “Adam’s apple.”
The hyoid bone is felt between the Adam’s apple and chin, while the cricoid cartilage is below the thyroid cartilage.
The quadrangular area on the neck is bounded above by the mandible’s lower border and mastoid process.
Neck muscles include suprahyoid, infrahyoid, and anterior vertebral muscles.
MRND is indicated when maintaining the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle is feasible without oncologic compromise.
Selective neck dissection or MRND is suitable for N0 or N1 patients; MRND is reasonable for N2 if non-lymphatic structures are preserved.
MRND is contraindicated if preserving neck non-lymphatic structures hampers complete cervical cancer resection.
Head and Neck Squamous Cell Carcinoma
Thyroid Cancer
Salivary Gland Tumors
Cutaneous Malignancies
Gross invasion of non-lymphatic structures
Distant metastasis
Inoperable primary tumor
Previous neck surgery or radiation
Poor baseline shoulder function
MRND is a safe oncological choice enhancing functional and cosmetic outcomes for patients.
MRND shows no significant survival difference without invasion in studies. MRND minimizes disability by preserving non-lymphatic structures in surgery.
Preoperative evaluation includes history and physical examination, and imaging of patient.
Administer general anesthesia with endotracheal intubation. Head turned opposite to surgical side and slight extension.
Informed Consent:
Explain the procedure’s risks and potential complications clearly to the patient.
Patient Positioning:
Patients should be positioned in supine positions. Patients should turn their head to the opposite side of the neck being operated on.
Slight extension of the neck to expose the surgical field better.
Figure. Modified Radical Neck Dissection
Step 1:
Incision made to enhance neck exposure during surgery. Bilateral neck dissections require a continuous incision from mastoid tip to tip.
Dissecting the plane between fascia and platysma allows en bloc access to lymphatic structures within fascia.
Flap elevation moves posteriorly beneath adipose tissue to the trapezius muscle’s edge.
The submental triangle contents are elevated from the mandible’s inferior border and opposite digastric muscle while preserving fascia.
Retraction of the mylohyoid muscle exposes the submandibular duct and lingual nerve for ligation and division.
Contents from level I are moved caudally for better visualization of the superior internal jugular vein using retraction techniques.
Electrocauterization or blunt dissection can elevate fascia from SCM to isolate the SAN effectively.
The nerve is about 1 cm above the greater auricular nerve behind the SCM.
Atraumatic dissection with a hemostat or finger helps create a safe dissection plane while preserving fibrous tissue around metastases.
The posterior triangle contents are lifted en bloc while protecting the phrenic nerve and brachial plexus beneath the fascia.
The SAN must be freed from soft tissues in the posterior triangle and retracted with a vessel loop or nerve hook.
Lymph node-bearing fibroadipose tissues in this area are rotated under the SAN like sublevel VA dissection.
During SCM resection, transection occurs below the mastoid tip and above the clavicle, with levels II, III, and IV contents elevated post-omohyoid division.
For metastatic nodal involvement or tumor thrombosis, the vein is ligated and divided after vagus nerve preservation.
Preserving the superficial fascial layer above the carotid artery is preferred unless essential exposure occurs.
Neck dissection is oriented for lymph node evaluation, followed by suction drains placement and layered closure.
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