5.30.24

Quick Review #138 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #maxillofacial #headandneckcancer #cancer

Supraomohyoid Selective Neck Dissection (SOHND) is a surgical procedure used primarily in the management of certain head and neck cancers. It is designed to remove lymph nodes that are at risk of containing metastatic disease while preserving non-lymphatic structures to minimize morbidity.

Specifics of the SOHND:

1. Purpose:

- SOHND is typically indicated for patients with clinically negative necks (N0) or limited neck disease (small N1) associated with oral cavity cancers.

2. Lymph Nodes Removed:

- The procedure involves the removal of lymph nodes from levels I to III of the neck. These levels include:

- Level I: Submental and submandibular nodes.

- Level II: Upper jugular nodes.

- Level III: Middle jugular nodes.

3. Lymph Nodes Preserved:

- Lymph nodes in levels IV (lower jugular nodes) and V (posterior triangle nodes) are generally preserved unless there is specific clinical or radiological evidence indicating involvement.

4. Muscles Preserved:

- The sternocleidomastoid muscle (SCM) is preserved. This muscle is important for neck movement and maintaining the contour of the neck.

- The omohyoid muscle is also preserved, as the dissection is supraomohyoid (above the omohyoid muscle).

5. Vessels Preserved:

- The internal jugular vein (IJV) is preserved to prevent venous drainage complications from the head and neck.

6. Nerves Preserved:

- The spinal accessory nerve (cranial nerve XI) is preserved to maintain shoulder function.

- The hypoglossal nerve (cranial nerve XII) is preserved to maintain tongue movement.

- The vagus nerve (cranial nerve X) is also preserved.

Key Points:

- Objective: To achieve oncological control by removing at-risk lymph nodes while minimizing the functional and aesthetic impact of the surgery.

- Approach: An incision is made along a skin crease in the neck, typically extending from the midline to behind the ear, providing access to the lymph node levels to be dissected.

- Complications: Potential complications include shoulder dysfunction, due to inadvertent injury to the spinal accessory nerve, and issues related to lymphatic drainage, such as lymphedema.

References:

1. Raisoni. (n.d.). Neck dissection surgery, types, indications, risks complications. Venous System Of The Head And Neck Photograph by Asklepios Medical Atlas.

2. Medina, J. E., & Byers, R. M. (1989). Supraomohyoid neck dissection: Rationale, indications, and surgical technique. Head & Neck Surgery, 11(2), 111-122.

3. Shah, J. P., & Patel, S. G. (2003). Head and Neck Surgery and Oncology (3rd ed.). Mosby. ISBN: 978-0323018190.

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