ABSTRACT
BACKGROUND AIMS: To describe unilateral and bilateral modified radical neck dissections with access to the thyroid gland and all neck lymph node levels through a single supraclavicular transverse incision. Methods: Ten patients with thyroid or lip carcinomas were submitted to unilateral or bilateral neck dissection through a transverse supraclavicular neck incision. All anterior and lateral neck lymph nodes associated with surrounding fibrofatty tissue were dissected and removed, preserving both sternocleidomastoid muscles and internal jugular veins. Patients with thyroid carcinoma were also submitted to a total thyroidectomy during the same procedure. Results: This surgery was feasible in all patients, preserving oncological principles with no adverse event. Conclusions: A single supraclavicular transverse incision allows adequate access to all levels of the neck lymph nodes, minimises the risk of tissue breakdown and scar disorder, with good cosmetic results. This incision is indicated for radical lymphadenectomy and may be combined with other neck surgeries.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Squamous Cell/surgery , Lip Neoplasms/surgery , Lymph Node Excision/methods , Neck Dissection/methods , Thyroid Neoplasms/surgery , Adenocarcinoma/pathology , Carcinoma, Squamous Cell/pathology , Humans , Lip Neoplasms/pathology , Lymphatic Metastasis , Neck/surgery , Surgical Wound , Thyroid Neoplasms/pathology , Thyroidectomy , Treatment OutcomeABSTRACT
El cáncer de orofaringe es de difícil diagnóstico porque los síntomas iniciales son confusos; usualmente son evidentes cuando el paciente presenta un tumor localmente avanzado. Para un adecuado tratamiento es indispensable conocer el estado basal de los relevos ganglionares, más cuando el manejo estándar es la extracción quirúrgica, que en el último quinquenio ha sido la resección transoral asistida por robot. El compromiso microscópico ganglionar depende del nivel de infiltración del tumor y puede ser hasta del 40%. El mapeo linfático de ganglios centinelas se realiza con linfogammagrafía, cuyo rendimiento mejora cuando las imágenes se adquieren con SPECT/CT. Recientemente, realizamos el estudio mencionado en una paciente con un tumor de la base de la lengua, y se verificó la presencia de un ganglio centinela al nivel IIA ipsilateral a la lesión. Se encontró como beneficio la precisión anatómica derivada del SPECT/CT que fue usado para la fusión de imágenes.
The diagnosis of oropharyngeal cancer is difficult because the initial symptoms are unusual, is evident some times when the patient has a large tumor. To realize appropriate treatment is essential to know if existing nodal infiltration, more even when the standard management is surgical resection, in the last decade is robot-assisted transoral surgery. The microscopic positive lymph node depends on the level of infiltration of the tumor and may be up to 40%. The lymphatic mapping of sentinel nodes is make by lymphoscintigraphy, its accuracy improves when the images are obtained with SPECT/CT. Recently, we did this study in a patient with a tumor at the base of tongue, confirming the presence of a sentinel node of IIA level. The main advantage was the anatomical accuracy when we make fusion of images with SPECT/CT.
