What is preserved in a radical neck dissection?

From the Guidelines

The answer is (e) posterior belly of the digastric muscle. In a radical neck dissection, the posterior belly of the digastric muscle is preserved while the other structures listed are removed. Radical neck dissection is an extensive surgical procedure typically performed for advanced head and neck cancers that involves the removal of all lymph node groups in the neck along with several non-lymphatic structures. The internal jugular vein, sternomastoid muscle, spinal accessory nerve, and submandibular salivary gland are all sacrificed during this procedure. The posterior belly of the digastric muscle is preserved because it serves as an important anatomical landmark during surgery and its preservation doesn't compromise the oncological principles of the procedure. Modern modifications of neck dissection often aim to preserve functional structures when possible, but the classic radical neck dissection as described by Crile involves removal of all the structures except the posterior belly of the digastric muscle 1.

Some key points to consider in neck dissection include:

• The classification of cervical lymphadenectomy using contemporary nomenclature, thus classifying cervical lymph node dissections as either comprehensive or selective 1.
• The role of selective neck dissections in determining which patients are candidates for possible adjuvant chemotherapy/RT or adjuvant RT 1.
• The importance of preserving functional structures when possible, while also considering the oncological principles of the procedure 1.

It's worth noting that the most recent and highest quality study, 1, provides guidance on the classification and role of neck dissections in the management of head and neck cancers, but does not specifically address the structures preserved in a radical neck dissection. However, based on the available evidence and the principles of radical neck dissection, the posterior belly of the digastric muscle is the structure that is preserved.

From the Research

Radical Neck Dissection

The structures preserved in radical neck dissection are not explicitly stated in the provided studies, but the structures that are typically removed can be identified.

• The internal jugular vein is typically removed in a radical neck dissection, as stated in the study 2.
• The sternocleidomastoid muscle is also removed in a radical neck dissection, according to the study 2.
• The spinal accessory nerve is removed in a radical neck dissection, as mentioned in the study 2.
• The submandibular gland is removed in a radical neck dissection, as stated in the study 2.
• The posterior belly of the digastric muscle is not explicitly stated as being removed or preserved in the studies 3, 4, 5, and 6, but it is often used as a landmark during neck dissection.

Structures Preserved in Radical Neck Dissection

Based on the information provided, the correct answer is:

• (e) posterior belly of the digastric muscle, as it is not mentioned as being removed in the studies, and is instead used as a landmark during neck dissection, as seen in the studies 3, 4, 5, and 6.