6.3.9: 9. Neck Dissection or Irradiation with Parotid Cancer
- Page ID
- 18315
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\)
- When neck dissection is indicated and a surgeon lacks the expertise, refer to another centre for neck dissection
- Clinically/radiologically apparent cervical metastases: Modified radical neck dissection (Levels 1-5)
- Clinically/radiologically N0 neck
- Elective treatment of the neck (Levels 2/3/4) for parotid cancer is controversial
- Elective neck dissection and elective radiotherapy are equally effective
- Known risk factors for occult neck disease are
- Tumour size >4cm
- High-grade histology
- Extraparotid tumour extension
- Always sample nodes in Level 2a at the time of parotidectomy, or perform Level 2 selective neck dissection, to avoid having to redissect Level 2
- If positive on frozen section, proceed to modified neck dissection
- If frozen section not available, then histological examination guides subsequent treatment planning
- When performing elective neck dissection (Levels 2/3/4) for skin cancer metastases to the parotid, always include the nodes overlying the sternomastoid along the external jugular vein