O slideshow foi denunciado.
Seu SlideShare está sendo baixado. ×

Neck dissection-slides-060920

Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Anúncio
Próximos SlideShares
Neck dissection
Neck dissection
Carregando em…3
×

Confira estes a seguir

1 de 61 Anúncio
Anúncio

Mais Conteúdo rRelacionado

Diapositivos para si (20)

Semelhante a Neck dissection-slides-060920 (20)

Anúncio

Neck dissection-slides-060920

  1. 1. Neck DissectionNeck Dissection Jeffrey Buyten, MDJeffrey Buyten, MD Susan McCammon, MDSusan McCammon, MD Francis B. Quinn, MDFrancis B. Quinn, MD University of Texas Medical BranchUniversity of Texas Medical Branch Department of OtolaryngologyDepartment of Otolaryngology Grand Rounds PresentationGrand Rounds Presentation September 2006September 2006
  2. 2. OutlineOutline  HistoryHistory  AnatomyAnatomy – Nodal levelsNodal levels – Common nodal drainage patternsCommon nodal drainage patterns  StagingStaging  ClassificationClassification  Sentinel Lymph NodeSentinel Lymph Node
  3. 3. HistoryHistory  Metastatic cervical lymph nodesMetastatic cervical lymph nodes – Early 19Early 19thth CenturyCentury  incurable diseaseincurable disease – 2020thth CenturyCentury  improved treatment ofimproved treatment of neck diseaseneck disease – 2121stst CenturyCentury  second worst prognosticsecond worst prognostic indicator for head and neck SCCAindicator for head and neck SCCA
  4. 4. 1919thth CenturyCentury  18801880  Kocher advocates wide marginKocher advocates wide margin lymphadenectomylymphadenectomy  18811881  Kocher and Packard recommendKocher and Packard recommend dissection of submandibular triangledissection of submandibular triangle for lingual cancerfor lingual cancer  18851885  Butlin questions RND for oral NButlin questions RND for oral N00 diseasedisease  18881888  Jawdynski describes en blocJawdynski describes en bloc resection with resection of carotid,resection with resection of carotid, IJV, SCM.IJV, SCM. Ferlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
  5. 5. 2020thth CenturyCentury  19011901  Solis-Cohen advocateSolis-Cohen advocate lymphadenectomy for Nlymphadenectomy for N00 laryngeallaryngeal CACA  1905 -19061905 -1906  Crile describes enCrile describes en bloc resection in JAMAbloc resection in JAMA  19261926  Bartlett and CallanderBartlett and Callander advocate preservation of XI, IJV,advocate preservation of XI, IJV, SCM, platysma, stylohyoid,SCM, platysma, stylohyoid, digastricdigastric  19331933  Blair and Brown advocateBlair and Brown advocate removal ofremoval of XI.XI. Ferlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
  6. 6. 2020thth CenturyCentury  19511951  Martin advocates Radical Neck Dissection after anaysis ofMartin advocates Radical Neck Dissection after anaysis of 1450 cases1450 cases – Advocated RND for all cases.Advocated RND for all cases. – Standardized the Radical Neck DissectionStandardized the Radical Neck Dissection  1952 – Suarez describes a functional neck dissection1952 – Suarez describes a functional neck dissection – Preservation of SCM, omohyoid, submandibular gland, IJV, XI.Preservation of SCM, omohyoid, submandibular gland, IJV, XI. – Enables protection of carotid.Enables protection of carotid.  19601960’’s – MD Anderson advocate selective ND of highest risk nodals – MD Anderson advocate selective ND of highest risk nodal basinsbasins  1967 - Bocca and Pignataro describe the1967 - Bocca and Pignataro describe the ““functional neckfunctional neck dissectiondissection””  1975 – Bocca establishes oncologic safety of the FND compared to1975 – Bocca establishes oncologic safety of the FND compared to the RNDthe RND Ferlito, A et al. Neck Dissection: past, present and future? J. Laryngol Otol. 2005 (1) 1-6.
  7. 7. AnatomyAnatomy  Lymph Node LevelsLymph Node Levels – Sloan Kettering nomenclatureSloan Kettering nomenclature – SubgroupsSubgroups  Common Nodal Drainage PatternsCommon Nodal Drainage Patterns
  8. 8. Level ILevel I  Submental triangleSubmental triangle (Ia)(Ia) – Anterior digastricAnterior digastric – HyoidHyoid – MylohyoidMylohyoid  SubmandibularSubmandibular triangle (Ib)triangle (Ib) – Anterior andAnterior and posterior digastricposterior digastric – Mandible.Mandible.
  9. 9. Marginal Mandibular NerveMarginal Mandibular Nerve  Most commonly injuryMost commonly injury dissection level Ibdissection level Ib  Landmarks:Landmarks: – 1cm anterior and inferior1cm anterior and inferior to angle of mandibleto angle of mandible – Mandibular notchMandibular notch  SubplatysmalSubplatysmal  Deep to fascia of theDeep to fascia of the submandibular glandsubmandibular gland  Superficial to facial veinSuperficial to facial vein
  10. 10. Marginal Mandibular NerveMarginal Mandibular Nerve
  11. 11. Hypoglossal nerveHypoglossal nerve  Lies deep to the IJV,Lies deep to the IJV, ICA, CN IX, X, and XIICA, CN IX, X, and XI  Curves 90 degreesCurves 90 degrees and passes betweenand passes between the IJV and ICAthe IJV and ICA  Ranine veinsRanine veins  Lateral to hyoglossusLateral to hyoglossus  Deep to mylohyoidDeep to mylohyoid
  12. 12. Level ILevel I  IaIa – ChinChin – Lower lipLower lip – Anterior floor of mouthAnterior floor of mouth – Mandibular incisorsMandibular incisors – Tip of tongueTip of tongue  IbIb – Oral CavityOral Cavity – Floor of mouthFloor of mouth – Oral tongueOral tongue – Nasal cavity (anterior)Nasal cavity (anterior) – FaceFace
  13. 13. Level IILevel II  Upper Jugular NodesUpper Jugular Nodes  AnteriorAnterior  Lateral borderLateral border of sternohyoid, posteriorof sternohyoid, posterior digastric and stylohyoiddigastric and stylohyoid  PosteriorPosterior  PosteriorPosterior border of SCMborder of SCM  Skull baseSkull base  Hyoid bone (clinicalHyoid bone (clinical landmark)landmark)  Carotid bifurcationCarotid bifurcation (surgical landmark)(surgical landmark)  Level IIa anterior to XILevel IIa anterior to XI  Level IIb posterior to XILevel IIb posterior to XI – Submuscular recessSubmuscular recess – Oropharynx > oral cavityOropharynx > oral cavity and laryngeal metsand laryngeal mets
  14. 14. Spinal Accessory NerveSpinal Accessory Nerve  CN XI – Relationship with the IJVCN XI – Relationship with the IJV
  15. 15. Level IILevel II  Oral CavityOral Cavity  Nasal CavityNasal Cavity  NasopharynxNasopharynx  OropharynxOropharynx  LarynxLarynx  HypopharynxHypopharynx  ParotidParotid
  16. 16. Level IIILevel III  Middle jugular nodesMiddle jugular nodes – AnteriorAnterior  Lateral border ofLateral border of sternohyoidsternohyoid – PosteriorPosterior  Posterior borderPosterior border of SCMof SCM – Inferior border of level IIInferior border of level II – Cricoid cartilage lowerCricoid cartilage lower border (clinical landmark)border (clinical landmark) – Omohyoid muscle (surgicalOmohyoid muscle (surgical landmark)landmark)  Junction with IJVJunction with IJV
  17. 17. Level IIILevel III  Oral cavityOral cavity  NasopharynxNasopharynx  OropharynxOropharynx  HypopharynxHypopharynx  LarynxLarynx
  18. 18. Level IVLevel IV  Lower jugular nodesLower jugular nodes – AnteriorAnterior  Lateral borderLateral border of sternohyoidof sternohyoid – PosteriorPosterior  PosteriorPosterior border of SCMborder of SCM – Cricoid cartilage lowerCricoid cartilage lower border (clinicalborder (clinical landmark)landmark) – Omohyoid muscleOmohyoid muscle (surgical landmark)(surgical landmark)  Junction with IJVJunction with IJV – ClavicleClavicle
  19. 19. Phrenic NervePhrenic Nerve  Sole nerve supplySole nerve supply to the diaphragmto the diaphragm  C3-5C3-5  Anterior surface ofAnterior surface of anterior scaleneanterior scalene  Under prevertebralUnder prevertebral fasciafascia  Posterolateral toPosterolateral to carotid sheathcarotid sheath
  20. 20. Thoracic ductThoracic duct  Conveys lymph from theConveys lymph from the entire body back to the bloodentire body back to the blood – Exceptions:Exceptions:  Right side of head and neck,Right side of head and neck, RUE, right lung right heartRUE, right lung right heart and portion of the liverand portion of the liver – Begins at the cisterna chyliBegins at the cisterna chyli – Enters posterior mediastinumEnters posterior mediastinum between the azygous veinbetween the azygous vein and thoracic aortaand thoracic aorta – Courses to the left into theCourses to the left into the neck anterior to the vertebralneck anterior to the vertebral artery and veinartery and vein – Enters the junction of the leftEnters the junction of the left subclavian and the IJVsubclavian and the IJV
  21. 21. Thoracic DuctThoracic Duct
  22. 22. Level IVLevel IV  HypopharynxHypopharynx  LarynxLarynx  ThyroidThyroid  Cervical esophagusCervical esophagus
  23. 23. Level VLevel V  Posterior triangle of neckPosterior triangle of neck – Posterior border of SCMPosterior border of SCM – ClavicleClavicle – Anterior border ofAnterior border of trapeziustrapezius – VaVa Spinal accessorySpinal accessory nodesnodes – VbVb  Transverse cervicalTransverse cervical artery nodesartery nodes  Radiologic landmarkRadiologic landmark – Inferior border of CricoidInferior border of Cricoid – Supraclavicular nodesSupraclavicular nodes
  24. 24. Spinal Accessory NerveSpinal Accessory Nerve  Penetrates deep surface ofPenetrates deep surface of the SCMthe SCM  Exits posterior surface ofExits posterior surface of SCM deep to ErbSCM deep to Erb’’s points point  Traverses the posteriorTraverses the posterior triangle on the levatortriangle on the levator scapulaescapulae  Enters the trapezius aboutEnters the trapezius about 5 cm above the clavicle5 cm above the clavicle
  25. 25. Level VLevel V  NasopharynxNasopharynx  OropharynxOropharynx  Posterior neck and scalpPosterior neck and scalp
  26. 26. Level VILevel VI  Anterior compartmentAnterior compartment – HyoidHyoid – Suprasternal notchSuprasternal notch – Medial border of carotidMedial border of carotid sheathsheath – Perithyroidal lymph nodesPerithyroidal lymph nodes – Paratracheal lymph nodesParatracheal lymph nodes – Precricoid (Delphian)Precricoid (Delphian) lymph nodelymph node
  27. 27. Level VILevel VI  ThyroidThyroid  Larynx (glottic and subglottic)Larynx (glottic and subglottic)  Pyriform sinus apexPyriform sinus apex  Cervical esophagusCervical esophagus
  28. 28. Level VLevel V  NasopharynxNasopharynx  OropharynxOropharynx  Posterior neck and scalpPosterior neck and scalp
  29. 29. SubgroupsSubgroups  IaIa SubmentalSubmental  IbIb SubmandibularSubmandibular  IIaIIa Upper jugular (Anterior to XI)Upper jugular (Anterior to XI)  IIbIIb Upper jugular (Posterior to XI)Upper jugular (Posterior to XI)  IIIIII Middle jugularMiddle jugular  IVaIVa Lower jugular (Clavicular)Lower jugular (Clavicular)  IVbIVb Lower jugular (Sternal)Lower jugular (Sternal)  VaVa Posterior triangle (XI)Posterior triangle (XI)  VbVb Posterior triangle (TransversePosterior triangle (Transverse cervical)cervical)  VIVI Central compartmentCentral compartment
  30. 30. Face and Scalp Anterior Facial, Ib Lateral Parotid Posterior Occipital, V Eyelids Medial Ib Lateral Parotid, II Chin Ia, Ib, II External Ear Anterior Parotid, II Posterior Post auricular, II, V Middle Ear Parotid, II Floor of mouth Anterior Ia, Ib, IIa > IIb Lower incisors Ia, Ib, IIa > IIb Lateral Ib, IIa > IIb, III Teeth except incisors Ib, IIa > IIb, III Nasal Cavity Anterior Ib Posterior Retropharyngeal, II, V Common Nodal Drainage PatternsCommon Nodal Drainage Patterns
  31. 31. Nasal Cavity Posterior Retropharyngeal, II, V Nasopharynx Retropharyngeal, II, III, V Oropharynx IIb > IIa, III, IV, V Larynx Supraglottic IIa > IIb, III, IV Subglottic VI, IV Cervical esophagus IV, VI Thyroid VI, IV, V, Mediastinal Tongue Tip Ia, Ib, IIa > IIb, III, IV Lateral Ib, IIa > IIb, III, IV Common Nodal Drainage PatternsCommon Nodal Drainage Patterns
  32. 32. StagingStaging  Nx: Regional lymph nodes cannot beNx: Regional lymph nodes cannot be assessed.assessed.  N0: No regional lymph node metastases.N0: No regional lymph node metastases.  N1: Single ipsilateral lymph node,N1: Single ipsilateral lymph node, << 3 cm3 cm
  33. 33. StagingStaging  N2a: Single ipsilateral lymph node 3 toN2a: Single ipsilateral lymph node 3 to 6 cm6 cm  N2b: Multiple ipsilateral lymph nodesN2b: Multiple ipsilateral lymph nodes << 6 cm6 cm  N2c: Bilateral or contralateral nodesN2c: Bilateral or contralateral nodes << 6cm6cm  N3: Metastases > 6 cmN3: Metastases > 6 cm
  34. 34. StagingStaging  Nasopharyngeal CarcinomaNasopharyngeal Carcinoma – N1 – Unilateral < 6cmN1 – Unilateral < 6cm – N2 – Bilateral < 6 cmN2 – Bilateral < 6 cm – N3a > 6 cmN3a > 6 cm – N3b – Extension toN3b – Extension to supraclavicular fossasupraclavicular fossa  ThyroidThyroid – N1 – Regional node metsN1 – Regional node mets  N1a - IpsilateralN1a - Ipsilateral  N1b - Bilateral, midline,N1b - Bilateral, midline, contralateral cervical orcontralateral cervical or mediastinal LNmediastinal LN
  35. 35. ClassificationClassification  RadicalRadical – Gold standard operationGold standard operation  Modified radicalModified radical – Preservation of non lymphatic structuresPreservation of non lymphatic structures  SelectiveSelective – Preservation of lymph node groupsPreservation of lymph node groups  ExtendedExtended – Removal of additional lymph nodeRemoval of additional lymph node groups or non lymphatic structuresgroups or non lymphatic structures
  36. 36. Radical Neck DissectionRadical Neck Dissection  RemovesRemoves – Nodal groups I-VNodal groups I-V – SCM, IJV, XISCM, IJV, XI – Submandibular gland,Submandibular gland, tail of parotidtail of parotid  PreservesPreserves – Posterior auricularPosterior auricular – SuboccipitalSuboccipital – RetropharyngealRetropharyngeal – PeriparotidPeriparotid – PerifacialPerifacial – Paratracheal nodesParatracheal nodes
  37. 37.  RemovesRemoves – Nodal groups I-VNodal groups I-V  PreservesPreserves – SCM, IJV, XI (anySCM, IJV, XI (any combination)combination)  Notate according toNotate according to which structures arewhich structures are preservedpreserved Modified Radical Neck DissectionModified Radical Neck Dissection
  38. 38. Selective Neck DissectionSelective Neck Dissection  Remove high risk lymph node groupsRemove high risk lymph node groups based on tumor site.based on tumor site.  SupraomohyoidSupraomohyoid – Levels I-IIILevels I-III  LateralLateral – Levels II-IVLevels II-IV
  39. 39. Selective Neck DissectionSelective Neck Dissection  PosterolateralPosterolateral – Levels II-VLevels II-V – Postauricular nodesPostauricular nodes – Suboccipital nodesSuboccipital nodes
  40. 40. Selective Neck DissectionSelective Neck Dissection  AnteriorAnterior – Level VILevel VI – RLN injuryRLN injury – HyperparathyroidismHyperparathyroidism
  41. 41. Extended Neck DissectionExtended Neck Dissection  Removal of any structures that areRemoval of any structures that are routinely preserved in a neckroutinely preserved in a neck dissection.dissection.  Notated by naming the structure(s)Notated by naming the structure(s) removed.removed.
  42. 42. Sentinel Lymph NodeSentinel Lymph Node  OverviewOverview  NN00 NeckNeck  TechniquesTechniques  ResultsResults
  43. 43. Sentinel Lymph Node HistorySentinel Lymph Node History  1955  First echelon node  1960  “Sentinel node”  1977  Demonstrated in penile cancer  1992  Morton reintroduced concept in N0 melanoma  Currently widely used in melanoma and breast cancer therapy.
  44. 44. Sentinel lymph node conceptSentinel lymph node concept  Tumor spreads via lymphatics to aTumor spreads via lymphatics to a primary node.primary node.  Examination of primary echelonExamination of primary echelon nodes for tumor direct the need fornodes for tumor direct the need for surgical management of the nodalsurgical management of the nodal basins.basins.
  45. 45. Sentinel lymph node conceptSentinel lymph node concept  Difficulties of lymphatic mapping in headDifficulties of lymphatic mapping in head and neck (Oand neck (O’’Brien).Brien). 1.1. It is difficult to visualize lymphatic channelsIt is difficult to visualize lymphatic channels using lymphoscintigraphy because ofusing lymphoscintigraphy because of proximity to the injection site.proximity to the injection site. 2.2. The radiotracer travels fast in the lymphaticThe radiotracer travels fast in the lymphatic vessels.vessels. 3.3. If more than one node is visible, it can beIf more than one node is visible, it can be difficult to distinguish first echelon nodes fromdifficult to distinguish first echelon nodes from second-echelon nodes.second-echelon nodes. 4.4. The SLN may be small and not easilyThe SLN may be small and not easily accessible (eg, in the parotid gland).accessible (eg, in the parotid gland).
  46. 46. NN00 NeckNeck  Occult neck diseaseOccult neck disease – Head and neck cancerHead and neck cancer  30%30% – Oral cavity CAOral cavity CA  20% to 45%20% to 45%  Factors that indicate > 20% chanceFactors that indicate > 20% chance of subclinical metastasesof subclinical metastases – Tumor thickness > 4mmTumor thickness > 4mm – Size > 2 cmSize > 2 cm – Anatomic locationAnatomic location
  47. 47. SensitivitySensitivity % (range)% (range) SpecificitySpecificity % (range)% (range) PalpationPalpation 35 (30-40)35 (30-40) 35 (27-42)35 (27-42) CTCT 45 (17-86)45 (17-86) 11 (3-21)11 (3-21) USUS 46 (42-50)46 (42-50) 21 (11-33)21 (11-33) MRIMRI 42 (20-70)42 (20-70) 14 (5-26)14 (5-26) US FNACUS FNAC 42 (27-50)42 (27-50) 00 Accuracy of diagnostic methods in detecting occultAccuracy of diagnostic methods in detecting occult cervical metastases.cervical metastases. A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role ofA new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomographysentinel node biopsy and positron emission tomography
  48. 48. NN00 Neck TreatmentNeck Treatment  T1/T2 N0 oral SCCAT1/T2 N0 oral SCCA – Better 10-year survival in pts who hadBetter 10-year survival in pts who had elective neck dissection.elective neck dissection.  T1/T2 N0 tongue SCCAT1/T2 N0 tongue SCCA – 5-year actuarial benefit for elective neck5-year actuarial benefit for elective neck managementmanagement
  49. 49. Sentinel Lymph Node Biopsy andSentinel Lymph Node Biopsy and NN00 Oral Cavity SCCAOral Cavity SCCA  Multiple small case series display theMultiple small case series display the feasibility of SLNB in oral SCCAfeasibility of SLNB in oral SCCA  Majority of lesions T1/T2Majority of lesions T1/T2  No standardized techniquesNo standardized techniques  All series compareAll series compare – Pre op lymphoscintigraphyPre op lymphoscintigraphy – Intra-op localizationIntra-op localization – Post op pathologyPost op pathology
  50. 50. Pre op TechniquePre op Technique  TechnetiumTechnetium – Day before surgeryDay before surgery – Submucosal injectionsSubmucosal injections – 10-30 MBq Tc 99m per10-30 MBq Tc 99m per quadrantquadrant – +/- local anesthesia+/- local anesthesia – Avoid spillageAvoid spillage – Rinse mouthRinse mouth  Dosage does not correlateDosage does not correlate with ability to identifywith ability to identify nodesnodes
  51. 51. Pre op TechniquePre op Technique  LymphoscintigraphyLymphoscintigraphy – DynamicDynamic  45 -60 minutes45 -60 minutes  Necessary to clearly identifyNecessary to clearly identify sentinel nodessentinel nodes  SLNs seen within 15 minutesSLNs seen within 15 minutes – StaticStatic  Confirms dynamic imagesConfirms dynamic images  AP / Lateral / ObliqueAP / Lateral / Oblique  Delayed images for nonDelayed images for non revealing dynamic studiesrevealing dynamic studies – Cobalt pencilCobalt pencil  Labels anatomical pointsLabels anatomical points – Left / right mandibleLeft / right mandible – ChinChin – Cricoid cartilageCricoid cartilage – Sternal notchSternal notch
  52. 52. Oral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection HistopathologyOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection Histopathology
  53. 53. Oral Cancer: Correlation of Sentinel LympOral Cancer: Correlation of Sentinel Lymp
  54. 54. Pre op TechniquePre op Technique  Blue DyeBlue Dye – Submucosal injectionSubmucosal injection – 2.5% Patent Blue dye2.5% Patent Blue dye – No more than 20 minNo more than 20 min pre incisionpre incision Oral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection HistopathologyOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection Histopathology
  55. 55. Operative TechniqueOperative Technique  Limited incision guided byLimited incision guided by lymphoscintigraphy and gammalymphoscintigraphy and gamma probeprobe  Frozen section analysisFrozen section analysis
  56. 56. Operative TechniqueOperative Technique  Gamma probeGamma probe – Examine operativeExamine operative bed for increasedbed for increased signalsignal – Tumor extirpationTumor extirpation – Lead shieldLead shield – Removal of highRemoval of high signal nodessignal nodes – Examine removedExamine removed node and comparenode and compare to operative bedto operative bed
  57. 57. ComplicationsComplications  Reported complication rates < 1%Reported complication rates < 1% – Cutaneous malignancy casesCutaneous malignancy cases  Injury of VII, XI due to limitedInjury of VII, XI due to limited exposureexposure
  58. 58. ResultsResults  Sentinel nodes found in > 90% ofSentinel nodes found in > 90% of cases.cases. – Experience mattersExperience matters – Surgeons with less than 10 casesSurgeons with less than 10 cases  56% success in SLNB56% success in SLNB  Lymphoscintigraphy revealedLymphoscintigraphy revealed unexpected bilateral or contralateralunexpected bilateral or contralateral disease in about 14% of ptsdisease in about 14% of pts  About 2-3 SLN per patientAbout 2-3 SLN per patient
  59. 59. ResultsResults  Up to 46% of SLN harbor metastasesUp to 46% of SLN harbor metastases – Fine section frozen analysisFine section frozen analysis  Increases sensitivity to about 95%Increases sensitivity to about 95% – Immunohistochemical stainingImmunohistochemical staining  False negative ratesFalse negative rates – 10%10% – Grossly involved nodes less likely to take upGrossly involved nodes less likely to take up tracertracer  Better sensitivity for T1/T2 lesionsBetter sensitivity for T1/T2 lesions – Most false negative results associated withMost false negative results associated with larger T3 lesionslarger T3 lesions
  60. 60. BibliographyBibliography 1.1. Lymphatic Mapping and Sentinel Lymphadenectomy for 106Lymphatic Mapping and Sentinel Lymphadenectomy for 106 Head and Neck Lesions: Contrasts Between Oral Cavity andHead and Neck Lesions: Contrasts Between Oral Cavity and Cutaneous Malignancy Laryngoscope, 116(Suppl. 109):1–15,Cutaneous Malignancy Laryngoscope, 116(Suppl. 109):1–15, 20062006 2.2. Oral Cancer: Correlation of Sentinel Lymph Node Biopsy andOral Cancer: Correlation of Sentinel Lymph Node Biopsy and Selective Neck Dissection HistopathologySelective Neck Dissection Histopathology 3.3. The value of frozen section analysis of the sentinel lymph nodeThe value of frozen section analysis of the sentinel lymph node in clinically N0 squamous cell carcinoma of the oralin clinically N0 squamous cell carcinoma of the oral cavity and oropharynx LAURENT TSCHOPP, MD, MICHELcavity and oropharynx LAURENT TSCHOPP, MD, MICHEL NUYENS, MD, EDOUARD STAUFFER, MD, THOMAS KRAUSE, MD,NUYENS, MD, EDOUARD STAUFFER, MD, THOMAS KRAUSE, MD, and PETER ZBÄREN, MD, Bern, Switzerland Otolaryngol Headand PETER ZBÄREN, MD, Bern, Switzerland Otolaryngol Head Neck Surg 2005;132:99-102.Neck Surg 2005;132:99-102. 4.4. A new approach to pre-treatment assessment of the N0 neck inA new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsyoral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography N.C. Hydea,*, E.and positron emission tomography N.C. Hydea,*, E. Prvulovichb, L. Newmanc, W.A. Waddingtonb, D. Visvikisb, P.Prvulovichb, L. Newmanc, W.A. Waddingtonb, D. Visvikisb, P. Ellb Oral Oncology 39 (2003) 350–360Ellb Oral Oncology 39 (2003) 350–360 5.5. The Accuracy of Head and Neck Carcinoma Sentinel LymphThe Accuracy of Head and Neck Carcinoma Sentinel Lymph Node Biopsy in the Clinically N0 Neck Taimur Shoaib1 CANCERNode Biopsy in the Clinically N0 Neck Taimur Shoaib1 CANCER June 1, 2001 / Volume 91 / Number 11June 1, 2001 / Volume 91 / Number 11

Notas do Editor

  • 230 pts 63 pts

×