Functional and Selective Neck Dissection (IIa) Following Squamous Cell Carcinoma of the Plate

Background: Neck dissection has been an adjunct surgical procedure in the management of malignancies affecting the head and neck region. Radical neck dissection was the original surgical procedure for the treatment of regional neck metastases. The aim of this paper is to report the management of a female patient with regional neck metastases from squamous cell carcinoma affecting the hard palate.Methods: A case report of a 60-year-old patient with squamous cell carcinoma of the palate who later manifested with an enlarged unilateral cervical lymph node ten weeks after surgery on the primary site. A functional and selective neck dissection in which the accessory nerve; internal jugular vein and sternocleidomastoid muscle were preserved and only the lymph node at the IIa level was removed was carried out under local anaesthesia.Results: The malignant ulcer on the palate was excised and the neck was dissected to remove the clinically enlarged lymph node. These procedures were uneventful and patient was referred for post- operative radiotherapy for possible residual tumours.Conclusion: There is need to reduce the morbidity and mortality associated with the radical neck dissection and this has led to the use of various levels of selective neck dissections as in the case presented

Applications of ultrasonography in the diagnosis of soft tissue swellings of the cervicofacial region

Purpose: To determine the accuracy; sensitivity; specificity and prediction values of ultrasound as a means of diagnosis of cervico-facial soft tissue swellings. Materials and methods: We carried out ultrasonographic evaluation of 76 consecutive cases of cervico-facial soft tissue swellings that presented at the Obafemi Awolowo University Teaching Hospital Complex; Ile-Ife; Nigeria from August 2002 to November 2003. The patients' demographics and relevant clinical information were obtained. Ultrasonographic evaluation was done using the B-mode transcutaneous ultrasonic imaging device with a transducer frequency of 5MHz. All the lesions were subjected to histopathological examination. Results: There were 43(56.6) males and 33(43.4) females whose ages ranged from 2 weeks to 70 years (mean + SD; 22 + 19.7 years). Histologically; tumours constituted the highest percentage of swellings (35.5); followed by cysts (26.3). Males were more predominant in all classes of swellings except benign tumours. The accuracy of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for both adenocarcinoma and hemangioma. It was also 100for majority of the cysts and HIV associated salivary gland swellings. The sensitivity of ultrasound in the diagnosis of pleomorphic adenoma was 80and 100for adenocarcinoma; hemangioma; all the cysts and HIV associated swellings. Ultrasound was also 100specific in the diagnosis of monomorphic adenoma and hemangioma. Conclusion: Ultrasound is a useful diagnostic tool for cervicofacial soft tissue swellings. The accuracy of diagnosis is enhanced by the characteristics of the probe and the experience of the sonologist