THE NECESSITY OF STERNOCLEIDOMASTOID MUSC LE RESECTION DURING RADICALNECK DISSECTIONS

Surgical therapy of cervical lymph node metastasis is based on their a ccessibility for en bloc resections. First described by Crile in 1906 as a radical neck dissection, this original approach has since undergo ne various modifications. This has produced an ongoing controversy wit h regard to the indications of the individual techniques. In a retrosp ective study, the data of 438 patients with head and neck malignancies managed at the ENT Department of Hamburg University between 1988 and 1994 were analyzed after surgical treatment of cervical lymph nodes. R esults showed that 337 patients (76.9%) required unilateral or bilater al selective neck dissections. In 101 patients (23.1%) in whom a radic al neck dissection was performed, the sternocleidomastoid muscle was r esected completely. Analysis of these cases showed that intraoperative macroscopic invasion occurred in 12 patients (11.9%) and was confirme d histologically. The vast majority of cases (n=89; 88.1%) had an inta ct muscle resected without tumor involvement. Further analysis showed no difference between radically or functionally neck-dissected stage I II or IV patients with oral cavity, oropharyngeal, hypopharyngeal and laryngeal carcinomas. On the basis of these findings, resection of the sternocleidomastoid muscle is not mandatory in patients undergoing pr imary surgery without previous (cervical) radiation and when the muscl e is found to be macroscopically intact.