Sorry hit the wrong button and sent before I was finished. Danny boy, in answer to your question,
There are basically three forms of neck dissection.

Selective Neck Dissection:
These neck dissections (another type of modified neck dissection) are procedures that preserve the sternocleidomastoid muscle, the spinal accessory nerve and the jugular vein and also remove less extensive amounts of lymph nodes and surrounding tissue. The anatomy of the neck is such that individual groups of lymph nodes have been defined (we call these levels although they are not defined by the depth of the lymph node group). There five levels described in the lateral neck and all five levels are removed in radical and modified radical neck dissections. Selective neck dissections remove 2-4 levels of lymph nodes. The type of selective neck dissection (and levels removed) will vary depending on the primary cancer site and the lymph nodes at greatest risk of developing metastases.

2. Modified Radical Neck Dissection:
This term describes a variety of neck dissections that basically refer to anything that is less than a radical neck dissection. For instance, many times a lymph node metastasis may be present, but all of the lymph nodes at risk can be removed without sacrificing the spinal accessory nerve. This is probably the most common modification of neck dissection. Other situations may present themselves when the sternocleidomastoid muscle, jugular vein or even all three structures (muscle, vein and nerve) can be safely preserved.

3. Radical Neck Dissection
This operation has been used for almost 100 years and describes the removal of lateral neck nodes and tissues. Tissue is removed from an area that approaches the midline of the neck in front to the trapezius muscle at the side of the neck. Included in this tissue, which extends from the collarbone (clavicle) inferiorly to the jawbone (mandible) superiorly are dozens of lymph nodes. In addition to lymph nodes, this operation removes the submandibular gland (a salivary gland in the upper neck), the sternocleidomastoid muscle, the jugular vein and the spinal accessory nerve (to the trapezius muscle).

There it is in a nutshell so to speak. Danny, you had Free Form Flap surgery and a MRND is my guess.

Oh and one more thing Dan,

How about those Friggin BEARS!!!!!!!!!!!!!!

Robert

Mica, I had tonsil cancer as well. Initially had a tonsilectomy, then rad/chemo, then modified radical neck dissection. Had a similar week to the one you are having in that I questioned whether the surgery was necessary. Especially given what the doctor said as a possible side effect being loss of use of the right arm. He said that even as a surgeon he would have the surgery and learn to operate left handed. I thought about it for a week and even thought about only removing 4 of the 5 lymph nodes (composed of about 35 lymph glands). What made me decide to have the surgery was imagining how I would feel if I had a recurrance and hadn't had the surgery. I would always wonder if it was due to not having the lymph nodes removed. I wanted to everything I could do to beat the disease and not ever look back and say "If only I had ..." This way, if I have a recurrance, I can always tell myself that I did everything I could do to kill this disease. Consider how you would feel if you don't have the surgery and something happens.

As far as the post op situation, the surgery was no big deal at all. The tonsilectomy was much worse, the rad was the worst, the neck disection and chemo was about the same. I am having some post surgical issues with range of motion of neck and shoulder, am in physical theropy, also, but a small price to pay for the clear conscience of having done all I could do to make sure no recurrance happened. And to get that report of clear pathology report and clear CT scans at first post treatment scan. I would always recommend the surgery, but you have to make that decision. Good luck and I will pray for guidance for you.

Mica,

My primary tumor was at the base of my tongue with metastatis to at least one lymph node on the right side. Since I never had surgery, we'll never know pathologically for sure if there was other node involvement. The reason I'm chiming in here is that when I was originally diagnosed, they called my primary unknown and the ENT wanted to do surgery right away. Had I followed that path, I would have had a radical neck dissection along with post-op radiation. After obtaining a second opinion and finding my primary tumor along the way, my entire treatment plan changed. My advice to you would be get a second opinion if you're not comfortable with your current doctor's treatment plan. Remember surgeons want to cut, radiation oncologiest want to radiate and medical oncologists want to chemo you. I feel I was lucky when I encountered the surgeon at MDACC that didn't want to cut on me. Best of luck and let us know what you decide....and why.

-Brett

Mica. The main body of the web site has a description of the different kinds of neck dissections in it. http://www.oralcancerfoundation.org/facts/neck_dissections.htm To find things like this, use the site map or the search engine in the main web site. The search engine in the message board only searches posts.

Thank you everyone who contributed a response to my concerns. You have given me a lot of information to take with me tomorrow when I have the surgery conversation with my DR.
Mica

Mica -- I know I"m a little late in replying. My husband had mod rad neck dissection Oct 8th and is doing just fine. As the dissection was on the left side and original tumor site is on right, he had double-trouble with eating. He is healing slowly though and other than some issues with remembering to exercise his shoulder to keep stiffness out, he's doing fine. Is also in the middle of continued radiation as the dissection found cancer in nasopharynx. My advice to you, if you haven't already decided with your doctor is, if you have questions or concerns, seek a second opinion. We have done that and always find that we're more comfortable, even if the 2nd or 3rd opinion is the same at least we feel like we're getting the best option. My husband certainly didn't want the dissection but we felt it was a good "preemptive" strike against cancer reoccuring on the other side. Luckily, the biopsies done while getting the dissection did find the cancer in the nasopharynx and in 2 of the lymphnodes that were removed. So, it was a good decision although one never wants to have to make. Please post when you can to let everyone know how you're doing. Millie

I have only just found this site and am quite the newbie, but I am having angst over a radical neck dissection scheduled for the 5th.

I have poorly differentiated squamous cell carcinomo (PDSCC) with an unknown primary. I have a lymph node that is 3cm in size that was biopsied and came back positive for the PDSCC. I have had my tonsils removed and tongue and throat biopsies, but they came back negative, hence the lack of a primary source.

I am an HMO member and the "tumor board" had me meet with a surgical oncologists who informed me that a radical neck dissection is in order. Since then, he has had to opt out of the surgery and I am to meet with an ENT surgeon in the morning (who removed the tonsils and did the biopsies).

I understand the reasoning behind removing the lymph nodes, but there had been discussion that they may be able to save the nerve that would involve my ability to use my right arm. However, they plan to remove the muscle tissue. They also plan to follow up with radiation. I don't understand why they can save some areas of the neck and not the muscle. The only answer I have received is it is their protocal to insure they get all of the cancer even if it isn't present in the muscle. I am tempted to insist they do a modified neck dissection and remove only what they know to be cancerous. They can take all of the lymph nodes on the right side of my neck, but leave the nerves. veins, and muscle tissue alone and follow up with radiation. But, I wonder if they will adhere to my wishes and if I am making a huge mistake.

Thanks for listening.

John Paul,

I'm a newbie here, too, but my radical neck dissection was 2 years ago, so I can relate to what you're going through. It's great to ask a lot of questions at this point, and it may turn out that a less-than-radical dissection is in order. I'll keep a good thought for you as you go to see the ENT tomorrow.

As I said, I had the radical dissection. The loss of the spinal accessory nerve meant that I lost strength in my right arm. In time, I lost strtength in my left arm and started to experience a lot of pain in both shoulders. I let 9 months go by (silly me) then insisted on some sort of solution. A referral to physical therapy started a painful rehabilitation, but within a month I had a lot less pain and a whole lot more mobility. I continuted the exercises on my own, and today I have almost full (95%) use of my arms/shoulders and rarely notice pain. (I had to invest a lot of pain to get the gain, but it was worth it!)

Ask your questions. Make the best choice for you. But know that there is a bright light down the road.

Ken

John Paul, welcome to the site. Sorry you had to find us, but hopefully we can help. As an update to my previous post on this thread from September 21, the strength in my right shoulder is slowly returning. I stopped physical therapy due to expired insurance coverage for therapy of this type. I am begining to have some nerve pain in my shoulder and neck, but I welcome it as I think it is the nerves trying to reconnect. This may be a little wishful thinking, but with my strength coming back, a positive outlook may help the situation.

As I mentioned in my previous post, I would always recommend the radical neck dissection, if for no other reason than to insure I had done all that I could to make sure no recurrance happened. But that is a decision you will have to make. My doctor spent an extra hour in the surgery to remove all necessary tissues to insure clean margins as well as the lymph nodes after chemo/rad. He avoided the nerves as much as possible and I think he was especially careful as I had explained my concerns of loosing my right arm usage. So I think that expressing your concerns is a good thing and will motivate the doctor to take extra care during surgery. Not that the doctor would have been careless, but an extra level of concern may help the outcome. Good luck with making your decision. Will pray for guidance and a good outcome for you.

Hi John Paul,

Welcome to OCF. Sorry you have had to find us but glad you are here.. Angst is a good way to describe what I went through before surgery, also.

I agree with Ken, don't hesitate to ask Your ENT and discuss it with him. Earlier in this thread, Robert gives a good listing of the different types of neck dissections. The more knowledge you have when talking to your Dr. the better. Am sending positive thoughts your way.

Peace
Jack
..........
Dx 1/15/97 SCC rt. tonsil met to rt lymph node Stg IV,
Srgry 1/23/97 tonsillectomy & mod radical neck dissection,
Radiation 35 trtmnts both sides