Staging
N3 N2 N1
Metastases > 6 cm
Single ipsilateral lymph node, < 3 cm
N2a: Single ipsilateral lymph node 3 to 6 cm N2b: Multiple ipsilateral lymph nodes < 6 cm N2c: Bilateral or contralateral nodes < 6cm
TypeⅢ: preserving the spinal accessory nerve, the IJV, and the SCM. The lymph nodes removed include levels Ⅰthrough Ⅴ. The submandibular gland may or may not be removed .
Sloan Kettering nomenclature(1991)
Ia Ib
IIa IIb
Submental Submandibular
Upper jugular (Anterior to XI) Upper jugular (Posterior to XI)
III
IVa IVb Va Vb VI VII



Removal of lymph nodes contained in level I, II, and III. The posterior limit is marked by the cutaneous branches of the cervical plexus and the posterior border of the sternocleidomastoid muscle. The inferior limit is the superior belly of the omohyoid muscle where it crosses the internal jugular vein.
Extended ND




Removal of one or more additional lymph node groups and/or nonlymphatic structures not encompassed by radical neck dissection. Examples of such lymph node groups include the parapharyngeal, superior mediastinal, and paratracheal lymph nodes. Examples of nonlymphatic structures include the carotid artery, hypoglossal nerve, vagus nerve, and paraspinal muscles.
4.Procedure of Selective ND
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Neck Dissection
张杰
Contents
1
Lymph Nodes Levels and Staging
2
3 4
Drainage
Classfication of ND
Procedure of Selective ND
Nanjing Army General Hospital
1.Lymph Nodes Levels
Subglotti c VI, IV IV, VI VI, IV, V, Mediastinal
Cervical esophagus
Thyroid
3.Neck dissection Classification
Neck Dissection
(ND)
Radical Neck Dissection (RND)
Middle jugular
Lower jugular (Clavicular) Lower jugular (Sternal) Posterior triangle (XI) Posterior triangle (Transverse cervical) Central compartment Super
Modified Radical
Selective
Nanjing Army General Hospital
Modified ND
TypeⅠ: preserving the spinal acessory nerve. The en bloc removal of the lymph-node-bearing tissue is from levels I through VI. The IJV and the SCM are resectecd.
2.Nodal Drainage
Nasopharynx Retropharyngeal, II, III, V
Oropharynx
Larygopharynx Larynx
IIb > IIa, III, IV, V
II, III,Retropharyngeal
Supraglot tic IIa > IIb, III, IV
Removal of additional lymph node groups or non lymphatic structures Gold standard operation
Extended
Radical
Preservation of nonlymphatic structures
Preservation of lymph node groups
Selective ND
Four subtype: Supraomohyoid ND (A) Lateral ND (B) Posterolateral ND (C) Anterior ND(D)
Nanjing Army General Hospital
(A) Supraomohyoid neck dissection
(D) Anterior compartment neck dissection



The lymph nodes include the pretracheal, the paratracheal, the perithyroidal, and the pre cricoid (Delphian) (level VI). The superior limit is the hyoid bone; the inferior limit is the suprasternal notch; the lateral limits are the common carotid arteries. It is most frequently indicated in the treatment of thyroid caner.
TypeⅡ: preserving the spinal accessory nerve and the IJV. The lymph-node-bearing tissues of one side of the neck are removed en bloc from levels I through VI. The SCM is resected.
(B) Lateral neck dissection


Removal of the lymph nodes from level II to IV . The posterior limit is marked by the splenius muscle superiorly and the cutaneous branches of the cervical plexus inferiorly.
(C) Posterolateral neck dissection


Removal of the suboccipital lymph nodes, retroauricular lymph nodes and levels II– V. This procedure is mostly used to remove nodal disease from cutaneous melanoma of the posterior scalp and neck
Functional Neck Dissection (FND)
Nanjing Army General Hospital
RND
Radical Neck Dissection
Level I-VI
IJV
SMG
RND
XI
SCM
Nanjing Army General Hospital
Classification