The Value Of More Tissue Preserved Functional Neck Dissection

Neck dissection is very important in the treatment of oral cavity mucosal squamous cell carcinoma. Traditional radical neck dissection, which applied in 1950, improve apparently the prognosis of oral cavity mucosal squamous cell carcinoma, but it will result in severe complain and functional disability, such as circulating obstacle after dissection of intra cervical vein and the shoulder syndrome after resection of accessory nerve and neck deformity after dissection of sternocledomastoid muscle, because of dissection of a large mount of functional structures of neck. General functional neck dissection, which popularized in 1960 according to the anatomy research of the human lymphatic system and used in the patients without clinical palpable cervical lymph nodes or with palpable but mobile cervical nodes which diameter not bigger than 3 centimeter, reduce the complication because of preserving intra cervical vein> accessory nerve and sternocledomastoid muscle, but it also conduce to deficiency of skin sensation and other complication. This study is to evaluate the value of more Tissue Preserved functional neck dissection in oral cavity mucosal squamous cell carcinoma, for example, if more Tissue Preserved functional neck dissection can improve survival quality but not increase the recurrence of cervical lymph node.Methods:52 cases of oral cavity mucosal squamous cell carcinoma((T1~3N0~1Mo)), which treated in the head and neck department of zhejiang cancer hospital from October 1999 to October 2002, were treated by primary cancer removed and more tissue preserved functional neck dissection(26 cases) which preserved sternmastoid muscle, internal jugular vein, spinal accessory nerve, supraclavicular nerve, external jugular vein, greater auricular nerve, omohyoid muscle and transversus colli nerve or general functional neck dissection(26 cases) which preserved sternmastoid muscle, internal jugular vein and spinal accessory nerve.Criteria of selection and group for patient: patient without clinical palpable cervical lymph nodes or with palpable but mobile cervical nodes which diameter not bigger than 3 centimeter was selected in this study. The type of neck dissection was determined by surgeon who pick out blindly one card which marked advancingly with "more function" or "general" and stored in a box before operation.The time of neck dissection was recorded under operation. All patients were re-examed by color Doppler scan 3 months postoperatively to be identified the trace or blood flow of external jugular vein. And. the skin sensation of pain and cold in bilateral ears, neck and subclavical area was assessed by using sterile needle in all patients 3 months after surgery. All patients were followed-up every three months from surgery, neck lymph node recurrence was confirmed according to pathologic examination.All materials of this study, including the lymph node recurrence rate, the sensation of skin and the time of neck, the mean operation time of neck dissection, etc, were analyzed by statistics analysis.Results:Among 52 cases, cancer cells were found in the cervical lymph nodes of 20 cases by pathological examination and the total cervical metastases rate is 38.46% (20/52). 8 cases were found in the more tissue preserved functional neck dissection group and 12 cases were found in the general functional neck dissection group, the cervical metastases rates were 30.77% (8/26) and 46.15%(12/26) respectively, no statistical difference was found between thetwo groups (p>0.05). AH cases were followed up at least 15 months in operation, 3 cases recurrences were found (3/52), and 1 in the more tissue preserved functional neck dissection group, 2 in the general functional neck dissection group, the recurrent rate is 3.85% (1/26) versus 7.69% (2/26) respectively, however, there is no statistical significance between the both groups (p>0.05).16 patients in the more Tissue Preserved functional neck dissection group conserved part pain sensation in the operated area, no cases had pain sensation...