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Medicine LibreTexts

6.3.9: 9. Neck Dissection or Irradiation with Parotid Cancer

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    • 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