Radical neck dissection (RND) is a surgical procedure used to control the spread of squamous cell carcinoma (SCC), a type of cancer, from the tissues of the head and neck to the lymph nodes in the neck. The surgery, created in 1906, removes lymph nodes into which cancer cells may have migrated. Since the lymph nodes circulate lymph throughout the body, the mortality rate is doubled if the lymph nodes become cancerous. RND is therefore extremely important in preventing the spread of cancer.
Radical neck dissection is the most thorough of the possible neck dissection procedures to control the spread of cancer. It is performed only on the affected side of the neck. All of the lymph nodes on that side of the neck are removed, from the mandible, or jaw, to the clavicle. In addition, RND involves the removal of the spinal accessory nerve that controls neck muscles, the internal jugular vein, and the sternocleidomastoid muscle responsible for head rotation.
While radical neck dissection has a long history of success, and is a well-designed surgery, it has been refined in recent decades. Newer procedures preserve some structures that are removed in radical neck dissection. In modified radical neck dissection (MRND), one or more non-lymphatic structures, such as the jugular or accessory nerve, is preserved. In selective neck dissection (SND), one or more lymph node groups are preserved. Extended neck dissection, on the other hand, involves the removal of additional structures that are retained in a radical neck dissection.
In order to determine whether a patient can benefit from a radical neck dissection, a physician can conduct a number of tests. In most cases, the patient is already aware of a mass or lesion in the neck. The first line of detection is palpation, which is simple to perform, but not always accurate.
Imaging techniques including computed tomography (CT) scanning, magnetic resonance imaging (MRI), and ultrasound can provide more reliable evidence of cancer in the lymph nodes. Finally, the most accurate, but also the most invasive, means of detecting cancer in the lymph nodes is biopsy and histologic examination. Histologic examination is also routinely performed after a neck dissection.
While radical neck dissection can be essential in preserving or prolonging the life of a cancer patient, not all patients with cancer in the lymph nodes of the neck are good candidates for the surgery. For patients with cardiopulmonary disease, especially those undergoing carotid artery management, the surgery may present too great a risk. In addition, if imaging techniques reveal that cancer has spread beyond the areas targeted by RND, the surgery is unlikely to benefit the patient, and the risks outweigh any advantages.
