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NeckDissection張杰ContentsLymphNodesLevelsandStaging1Drainage2ClassficationofND3ProcedureofSelectiveND4SloanKetteringnomenclature(1991)Ia SubmentalIb SubmandibularIIa Upperjugular(AnteriortoXI)IIb Upperjugular(PosteriortoXI)III MiddlejugularIVa Lowerjugular(Clavicular)IVb Lowerjugular(Sternal)Va Posteriortriangle(XI)Vb Posteriortriangle(Transversecervical)VI CentralcompartmentVII

Super1.LymphNodesLevelsN2N3N1Singleipsilaterallymphnode,<3cmN2a:Singleipsilaterallymphnode3to6cmN2b:Multipleipsilaterallymphnodes<6cmN2c:Bilateralorcontralateralnodes<6cmMetastases>6cmStagingNasopharynx

Retropharyngeal,II,III,VOropharynx

IIb>IIa,III,IV,VLarygopharynxII,III,RetropharyngealLarynxSupraglotticIIa>IIb,III,IV

SubglotticVI,IVCervicalesophagus

IV,VIThyroid

VI,IV,V,Mediastinal2.NodalDrainage3.NeckdissectionClassificationRadicalNeckDissection(RND)

NeckDissection(ND)FunctionalNeckDissection(FND)

RNDSMGLevel

I-VIIJVXISCMRNDRadicalNeckDissectionClassificationRemovalofadditionallymphnodegroupsornonlymphaticstructuresGoldstandardoperationPreservationofnon-lymphaticstructuresPreservationoflymphnodegroupsExtendedRadicalModifiedRadicalSelectiveModifiedNDTypeⅠ:preservingthespinalacessorynerve.Theenblocremovalofthelymph-node-bearingtissueisfromlevelsIthroughVI.TheIJVandtheSCMareresectecd.TypeⅡ:preservingthespinalaccessorynerveandtheIJV.Thelymph-node-bearingtissuesofonesideoftheneckareremovedenblocfromlevelsIthroughVI.TheSCMisresected.TypeⅢ:preservingthespinalaccessorynerve,theIJV,andtheSCM.ThelymphnodesremovedincludelevelsⅠthroughⅤ.Thesubmandibularglandmayormaynotberemoved.SelectiveNDFoursubtype:SupraomohyoidND(A)LateralND(B)PosterolateralND(C)AnteriorND(D)RemovaloflymphnodescontainedinlevelI,II,andIII.Theposteriorlimitismarkedbythecutaneousbranchesofthecervicalplexusandtheposterior

borderofthesternocleidomastoidmuscle.Theinferiorlimitisthesuperiorbellyoftheomohyoidmusclewhereitcrossestheinternaljugularvein.(A)SupraomohyoidneckdissectionRemovalofthelymphnodesfromlevelIItoIV.Theposteriorlimitismarkedbythespleniusmusclesuperiorlyandthecutaneousbranchesofthecervicalplexusinferiorly.(B)Lateralneckdissection

Removalofthesuboccipitallymphnodes,retroauricularlymphnodesandlevelsII–V.Thisprocedureismostlyusedtoremovenodaldiseasefromcutaneousmelanomaoftheposteriorscalpandneck(C)PosterolateralneckdissectionThelymphnodesincludethepretracheal,theparatracheal,theperithyroidal,andtheprecricoid(Delphian)(levelVI).Thesuperiorlimitisthehyoidbone;theinferiorlimitisthesuprasternalnotch;thelaterallimitsarethecommoncarotidarteries.Itismostfrequentlyindicatedinthetreatmentofthyroidcaner.(D)AnteriorcompartmentneckdissectionExtendedND

Removalofoneormoreadditionallymphnodegroupsand/ornonlymphaticstructuresnotencompassedbyradicalneckdissection.Examplesofsuchlymphnodegroupsincludetheparapharyngeal,superiormediastinal,andparatracheallymph

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