Consistent Level IIa Node as a Surgical Landmark for Identification of Spinal Accessory Nerve
Published: February 1, 2019 | DOI: https://doi.org/10.7860/JCDR/2019/40144.12620
Vidita Powle, Vishal Yadav, Sushma Mehta, Abhishek Ghosh
1. Fellow, Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Center, Bangalore, Karnataka, India.
2. Assistant Consultant, Department of Head and Neck Surgical Oncology, Rajiv Gandhi Cancer Institute, Delhi, India.
3. Fellow, Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Center, Bangalore, Karnataka, India.
4. Senior Resident, Department of Head and Neck Surgical Oncology, Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India.
Correspondence
Abhishek Ghosh,
Old Loco Colony, Shivpurwa Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India.
E-mail: 13abhishekghosh@gmail.com
Introduction: Treatment of Oral SCC requires a composite resection of the lesion and elective/therapeutic neck dissection, whenever a surgical option is being considered as a form of treatment. During neck dissection, one of the critical structures to be preserved is the Spinal Accessory Nerve (SAN). In our experience of operating on N+ necks for selective neck dissections, we found the presence of a constant lymph-node at the level of hyoid bone/digastric muscle tendon lateral to the internal jugular vein (level IIa). Direct deeper dissection exactly beneath this node led to the identification of the SAN.
Aim: The aim of the study was to ascertain level IIa lymph node as a landmark for identification of SAN, during neck dissection procedures.
Materials and Methods: In this prospective study, 100 consecutive selective neck dissection procedures done for patients with radiological N+ necks with resectable Oral SCC were included.
Results: In 96% of cases identification SAN was done with the technique used alone.
Conclusion: The purpose of this study was to establish this technique as a standard of care either alone or in adjunct with other established landmarks for identification of SAN,by trainees as has been a long established practice in our department. We even have a separate nomenclature for it, the ‘Trainee Node.’
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